Article

OBJECTIVE: To examine patterns of change and factors associated with change in
depression, both major (major depressive disorder [MDD]) and minor, between 1 and
2 years after traumatic brain injury (TBI). DESIGN: Observational prospective
longitudinal study. SETTING: Inpatient rehabilitation centers, with 1- and 2-year
follow-up conducted primarily by telephone. PARTICIPANTS: Persons with TBI
(N=1089) enrolled in the Traumatic Brain Injury Model Systems database, followed
at 1 and 2 years postinjury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE:
Patient Health Questionnaire-9. RESULTS: Among participants not depressed at 1
year, close to three fourths remained so at 2-year follow-up. However, 26%
developed MDD or minor depression between the first and second years postinjury.
Over half of participants with MDD at year 1 also reported MDD the following
year, with another 22% reporting minor depression; thus three fourths of those
with MDD at year 1 experienced clinically significant symptoms at year 2. Almost
one third of those with minor depression at year 1 traversed to MDD at year 2.
Polytomous logistic regression confirmed that worse depression at year 1 was
associated with higher odds of depression a year later. For those without
depression at year 1, symptom worsening over time was related to year 2
problematic substance use and lower FIM motor and cognitive scores. For those
with depression at year 1, worsening was associated with lower cognitive FIM,
poor social support, and preinjury mental health issues including substance
abuse. CONCLUSIONS: Major and minor depression exist on a continuum along which
individuals with TBI may traverse over time. Predictors of change differ
according to symptom onset. Results highlight importance of long-term monitoring
for depression, treating minor as well as major depression, and developing
interventions for comorbid depression and substance abuse.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS