Mild traumatic brain injury (mTBI) increases the risk for posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD) in a civilian population, according to an article published in JAMA Psychiatry. Level of education, race/ethnicity, history of mental health problems, and cause of injury also influence risk.
Murray B. Stein, MD, MPH, from the Department of Psychiatry and the Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, and colleagues reviewed data collected between February 2014 and May 2016 to determine the prevalence of and risk factors for PTSD and MDD in patients evaluated for mTBI in the emergency department. The study included 1155 patients with mTBI and 230 comparison patients with nonhead orthopedic trauma injuries who were seen in 11 US hospitals.
The investigators used the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Patient Health Questionnaire-9 item to evaluate patients for the presence of PTSD or MDD at 3, 6, and 12 months after the injury. Probable PTSD was diagnosed in patients with a PTSD Checklist score of ≥33 and probable MDD in patients with a Patient Health Questionnaire-9 item score of ≥15.
At 3 months, the adjusted prevalence of PTSD or MDD in the mTBI group was 20.0% compared with 8.7% in the nonhead injury group (P <.001), and at 6 months those percentages were 21.2% and 12.1%, respectively (P =.03). Factors predicting a significant risk for probable PTSD at 6 months included less education (adjusted odds ratio [aOR], 0.89), being black (aOR, 5.11), prior history of a mental health disorder (aOR, 3.57), and injury as the result of assault or other violence (aOR, 3.43). Risk factors for MDD were similar; however, there was no risk associated with the cause of injury.
The researchers suggested that the finding of increased risk for PTSD, but not MDD, with an injury that occurs as the result of an assault or other form of violence speaks to the importance of the context of the injury for the psychopathology of PTSD. It also suggests that cognitive behavioral interventions may be important early in the healing process.
The researchers also argued that the results of this study may have implications for the identification of at-risk individuals and the subsequent surveillance and treatment of mental disorders after mTBI. They also note that because of study limitations, it was not possible to find a reason for the increased risk for PTSD or MDD after mTBI for black individuals.
Stein MB, Jain S, Giacino JT, et al. Risk of posttraumatic stress disorder and major depression in civilian patients after mild traumatic brain injury. A TRACK-TBI study [published online January 30, 2019]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2018.4288