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Prevalence of Depression and Anxiety Disorders Following Mild Traumatic Brain Injury: A Retrospective Cohort Study

29 Pages Posted: 24 Oct 2019

See all articles by Richard Delmonico

Richard Delmonico

Kaiser Permanente - Kaiser Foundation Rehabilitation Center

Brian R. Theodore

Kaiser Permanente - Kaiser Foundation Rehabilitation Center

M. Elizabeth Sandel

University of California, Davis - School of Medicine

Mary Anne Armstrong

Kaiser Permanente - Division of Research

Michelle Camicia

Kaiser Permanente - Kaiser Foundation Rehabilitation Center

More...

Abstract

Background: The annual incidence of traumatic brain injuries (TBI) in the US is at least 1.6 million, and worldwide estimates are approximately 9.5 million. Of these individuals, approximately 80-90% are considered mild TBIs (mTBI) and are associated with elevated risks of developing post-injury affective disorders. To determine the prevalence and relative risk of post-injury affective disorders over 4 years following mTBI among adult members of a large health maintenance organization.

Methods: A longitudinal matched cohort study of mTBI cases and matched controls from an integrated healthcare delivery system in northern California. mTBI group included 9,428 adult health plan members diagnosed with mTBI from 2000-2007 and enrolled in the year prior to injury, during which no TBI was ascertained. The control group included 18,856 individuals randomly selected and matched for age, sex, race/ethnicity, medical comorbidities and reference date (2: 1 matching). Study outcomes were diagnoses of affective disorders (anxiety, depression or adjustment disorder with mixed features) in the 4 years following the reference date.

Findings: The prevalence for affective disorders was most prominent during the first 12 months and was 43% following mTBI and 29% in the control group. Four-year aggregate adjusted odds ratio for developing an affective disorder following mTBI was .2 (95% CI: 1.1, 1.2; p < .001) and 1.5 (95% CI: 1.5, 1.6; p < .001) for patients with and without prior affective disorders, respectively. Interpetation: mTBI was associated with a significantly increased risk of developing subsequent affective disorders, especially during the first 12 months following injury. The findings in this study underscore the importance of screening for and addressing affective disorders at the earlier stages following the injury, in order to avoid persisting conditions that may pose a barrier to full recovery.

Funding Statement: This study was funded by the Kaiser Permanente Community Benefits Grant.

Declaration of Interests: None of the coauthors have any conflicts of interest. M. Elizabeth Sandel's disclosure: M. Elizabeth Sandel, MD, is a medical director for Paradigm. Paradigm, a care and case management company based in Walnut Creek, California, that leads the workers' compensation industry in solving complex health care challenges and improving lives.

Ethics Approval Statement: The study was approved by the KPNC Institutional Review Board with waiver of consent.

Suggested Citation

Delmonico, Richard and Theodore, Brian R. and Sandel, M. Elizabeth and Armstrong, Mary Anne and Camicia, Michelle, Prevalence of Depression and Anxiety Disorders Following Mild Traumatic Brain Injury: A Retrospective Cohort Study (10/14/2019 23:47:20). Available at SSRN: https://ssrn.com/abstract=3471336 or http://dx.doi.org/10.2139/ssrn.3471336

Richard Delmonico (Contact Author)

Kaiser Permanente - Kaiser Foundation Rehabilitation Center ( email )

Vallejo, CA
United States

Brian R. Theodore

Kaiser Permanente - Kaiser Foundation Rehabilitation Center

Vallejo, CA
United States

M. Elizabeth Sandel

University of California, Davis - School of Medicine

Davis, CA
United States

Mary Anne Armstrong

Kaiser Permanente - Division of Research

2000 Broadway, 3rd Floor
Oakland, CA 94612
United States

Michelle Camicia

Kaiser Permanente - Kaiser Foundation Rehabilitation Center

Vallejo, CA
United States

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