Risk of Posttraumatic Stress Disorder and Major Depression after Mild Traumatic Brain Injury

Post by Stephanie Williams

What's the science?

Psychological factors may influence the rate of recovery following concussion. Evidence from soldiers who endure concussive traumatic brain injuries (TBI) shows that many have posttraumatic stress disorder (PTSD) and major depression (MDD) symptoms that do not improve over time. It is unclear which factors play important roles in determining increased risk for PTSD and MDD after TBI. This week in JAMA Psychiatry, Stein and colleagues investigated risk factors associated with mTBI for developing PTSD and MDD.

How did they do it?                          

The authors analyzed data from 1155 patients who had been admitted to level 1 trauma centers in the United States for traumatic brain injuries, and 230 patients who had been admitted for non-head orthopedic injuries. Brain injury patients were included in the study for if they received a Glasgow Coma Scale score of 13 to 15, and met other criteria that indicated they had a mild TBI (mTBI). Data was collected from patients at several points in time, beginning with their admission (“baseline”), and including follow ups at 2 weeks, 3, 6 and 12 months after being diagnosed. The authors measured several demographic variables related to PTSD symptoms, depressive symptoms, and mental disorder history in their analysis. They analyzed these data (using logistic regression models adjusted with propensity rates) to determine which factors put individuals at risk for developing PTSD and MDD.

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What did they find?

The authors identified several significant risk factors for PTSD at 6 months post-injury, including lower levels of education, a history of mental health disorders, being black, and experiencing an injury resulting from assault or violence. Risk factors for MDD were similar: lower levels of education, being black and a history of mental health disorders. The authors note that their finding that black individuals were at increased risk for developing mental health disorders following mTBI could be confounded by unmeasured covariates. One novel finding in this study was that the cause of TBI (e.g. violence) was associated with risk for PTSD but not for MDD. Overall, the authors observed that PTSD and MDD were present only in a minority of patients who had mTBI. The rates of PTSD and MDD at the 6-month follow up were 9 and 19%, respectively. They also found that individuals who experienced non-head orthopedic injuries experienced less PTSD and MDD.

What's the impact?

The findings from this study can inform better treatment strategies for individuals with mTBI. In particular, the authors’ finding that the contextual nature of the injury (i.e whether the injury had a violent cause) determines subsequent pathology suggests that individuals who receive similar injuries in different ways could benefit from different treatment plans. Using the risk factors the authors have identified, healthcare providers could decide to use extra surveillance and specialized intervention plans for individuals who may be at risk for developing PTSD or MDD post-injury.

Stein et al. Risk of Postraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury. JAMA Psychiatry (2019). Access the original scientific publication here.