Mild TBI May Fuel or Exacerbate Mental Health Problems

Megan Brooks

February 08, 2019

About one in five people who suffer a mild traumatic brain injury (mTBI) will develop posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) within 3 to 6 months, new research suggests.

Risk factors for PTSD or MDD after mTBI include being black, lower education, and a history of mental illness; for PTSD, an additional risk factor is injury resulting from violence.

This study shows that injury to the brain is associated with new onset or exacerbation of preexisting mental health problems in a "substantial minority" of patients, write Murray Stein, MD, of the University of California San Diego, and the TRACK-TBI study team. "These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention," they suggest.

The study was published online January 30 in JAMA Psychiatry.

The researchers studied 1155 adults (65% men, mean age 40.5) seen in the emergency department for mTBI (Glasgow Coma Scale scores, 13–15) and 230 adults (67% men, mean age 40.4) with nonhead orthopedic trauma injuries.

The main outcomes were probable PTSD (PTSD Checklist for DSM-5 score at least 33) and MDD (Patient Health Questionnaire-9 Item score at least 15) assessed at 3, 6, and 12 months after injury.

At 3 and 6 months following injury, adults with mTBI were more likely than orthopedic trauma patients to report symptoms of PTSD and/or MDD.

Table. Weights-adjusted prevalence of PTSD and/or MDD at 3 and 6 months post-injury

 

mTBI

Orthopedic trauma

P value

3 months

20.0%

8.7%

P < .001

6 months

21.1%

12.1%

P =  .03

 

Risk factors for probable PTSD 6 months after mTBI included lower education (adjusted odds ratio [aOR], 0.89; 95% confidence interval [CI], 0.82 - 0.97 per year), being black (aOR, 5.11; 95% CI, 2.89 - 9.05), self-reported psychiatric history (aOR, 3.57; 95% CI, 2.09 - 6.09), and injury resulting from assault or other violence (aOR, 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.

"The emergence and long-term course of PTSD after TBI is variable, and our findings show that PTSD and MDD, although common, occur in only a minority of patients post-mTBI but especially those with prior mental health problems," the investigators point out.

"Consequently, we may want to consider watchful waiting (ie, active vigilance with planned follow-up) of patients with prior mental health problems and intervene when it is apparent that symptoms are persisting or worsening," they add.

A limitation of the study is the focus on only two mental health disorders (PTSD and MDD) after mTBI. Further research is needed to see if other mental health conditions may arise following mTBI, the investigators suggest.

The study was supported by the National Institutes of Health and US Department of Defense. Abbott Laboratories provided funding for add-in TRACK-TBI clinical studies. One Mind provided funding for TRACK-TBI patients' stipends and support to clinical sites. Stein has been a consultant for Actelion, Aptinyx, Bionomics, Dart Neuroscience, Healthcare Management Technologies, Janssen, Neurocrine Biosciences, Oxeia Biopharmaceuticals, Pfizer, and Resilience Therapeutics in the past 3 years; owns founders shares and stock options in Resilience Therapeutics; and has stock options in Oxeia Biopharmaceuticals.

JAMA Psychiatry. Published online January 30, 2019. Abstract

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