Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury
Authors: Murray B. Stein, Sonia Jain, Joseph T. Giacino, Harvey Levin, Sureyya Dikmen, Lindsay D. Nelson, Mary J. Vassar, David O. Okonkwo, Ramon Diaz-Arrastia, Claudia S. Robertson, Pratik Mukherjee, Michael McCrea, Christine L. Mac Donald, John K. Yue, Esther Yuh, Xiaoying Sun, Laura Campbell-Sills, Nancy Temkin, Geoffrey T. Manley, Opeolu Adeoye, Neeraj Badjatia, Kim Boase, Yelena Bodien, M. Ross Bullock, Randall Chesnut, John D. Corrigan, Karen Crawford, Ramon Diaz-Arrastia, Sureyya Dikmen, Ann-Christine Duhaime, Richard Ellenbogen, V. Ramana Feeser, Adam Ferguson, Brandon Foreman, Raquel Gardner, Etienne Gaudette, Joseph T. Giacino, Luis Gonzalez, Shankar Gopinath, Rao Gullapalli, J Claude Hemphill, Gillian Hotz, Sonia Jain, Frederick Korley, Joel Kramer, Natalie Kreitzer, Harvey Levin, Chris Lindsell, Joan Machamer, Christopher Madden, Alastair Martin, Thomas McAllister, Michael McCrea, Randall Merchant, Pratik Mukherjee, Lindsay D. Nelson, Florence Noel, David O. Okonkwo, Eva Palacios, Daniel Perl, Ava Puccio, Miri Rabinowitz, Claudia S. Robertson, Jonathan Rosand, Angelle Sander, Gabriela Satris, David Schnyer, Seth Seabury, Mark Sherer, Murray B. Stein, Sabrina Taylor, Arthur Toga, Nancy Temkin, Alex Valadka, Mary J. Vassar, Paul Vespa, Kevin Wang, John K. Yue, Esther Yuh, Ross Zafonte
Journal: JAMA Psychiatry (2019)

<h3>Importance</h3> Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. <h3>Objective</h3> To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). <h3>Design, Setting, and Participants</h3> Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for<i>DSM-5</i>and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers were included in this study. <h3>Main Outcomes and Measures</h3> Probable PTSD (PTSD Checklist for<i>DSM-5</i>score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. <h3>Results</h3> Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (<i>P</i> &lt; .001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (<i>P</i> = .03). Risk factors for probable PTSD at 6 months after mTBI included less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. <h3>Conclusions and Relevance</h3> After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention.