JAMA logoAn individual suffering from a brain injury suffers massively. To add to it, a recent study conducted by the University Of Washington School Of Medicine, Seattle claims that individuals facing a traumatic brain injury may undergo major depression during the year following hospitalization. Thus, individuals suffering from a brain injury may worsen their health by depression.

The study aimed to analyze the rate of major depressive disorder (MDD), during the first year after traumatic brain injury (TBI) and to scrutinize predictors of MDD. It also determined the MDD-related illness and the effect on the quality of life. The authors investigated 559 hospitalized adults, who were facing complicated mild to severe TBI. They were made to undergo structured telephone interviews, from the 1st – 6th months and then in the 8th, 10th and 12th months. The investigators then, calculated the level of depression and anxiety faced by these adults, with the assistance of Patient Health Questionnaire (PHQ). Further, these calculations were administered at every assessment. Also, the European Quality of Life measure was given at 12 months.

Charles H. Bombardier, Ph.D., of the University Of Washington School Of Medicine, Seattle and his colleagues shared, “Traumatic brain injury (TBI) is a major cause of disability in the United States and a signature injury among wounded soldiers. Assessment and treatment of TBI typically focus on physical and cognitive impairments, yet psychological impairments represent significant causes of disability. Major depressive disorder (MDD) may be the most common and disabling psychiatric condition in individuals with TBI. Poorer cognitive functioning, aggression and anxiety, greater functional disability, poorer recovery, higher rates of suicide attempts, and greater health care costs are thought to be associated with MDD after TBI.”

It then appeared that, individuals with TBI claim to suffer from massive depressive disorder. During the first year after TBI, 297 out of the 559 adults, which formed 53.1 percent, possibly faced MDD at least one time. The rate of MDD was probably 8 times greater than that in common people. But, the authors seem to mention that, the collection of data at each assessment time point was incomplete. Therefore, the conclusions drawn regarding the rate and depression duration may alter.

“Systematic integration of mental health services into standard care of patients with TBI may be needed to improve long-term outcomes after TBI. Within inpatient rehabilitation, integrated clinical pathways can be used to organize early identification, risk assessment, diagnosis, and guideline-driven treatment of MDD. Systematic depression screening and stepped-care treatment protocols should be integrated into routine outpatient care. For those without or beyond routine follow-up, novel case-finding programs may be useful, possibly via scheduled telephone contacts, Internet-based screening or other technology-assisted methods,” the authors explained.

Individuals especially men, who were injured in crashes due to vehicles seemed to sustain complex mild injuries. Apparently, the point prevalence’s of MDD ranged between 31 percent at 1 month and 21 percent at 6 months. The risk of MDD is assumed to be related to various factors like the relation between TBI and MDD at the time of injury. Furthermore, it can possibly be dependent on the history of MDD before injury and an adult’s dependence on alcohol. Age factor too was highlighted, as older adults aged more than 60 years faced a lower risk of MDD than adults aged 18-29 years.

The outcome of the study also revealed that, 60 percent adults were probably more likely to suffer from similar anxiety disorders after TBI. While 7 percent adults without MDD may face the same disorders. It should be noted that, only 44 percent of patients with MDD were provided with antidepressants or counseling. A year after TBI, patients facing MDD reported problems of mobility, usual activities, and pain/discomfort and greater difficulty with role functioning. Reduction in the quality of life was noted by adults with MDD even after adjusting for predictors of MDD.

Approximately, half of the patients who became depressed were identified by 3 months. This made it possible to prevent or treat MDD. Yet, the authors claim that, individuals who have although survived TBI, continue to run a higher risk of MDD throughout the first year. This risk remained irrespective of pre-injury depression history. Therefore, this study may help in not only identifying but also preventing MDD in patients undergoing major brain injury.

The study was published in the May 19 issue of JAMA, a theme issue on mental health.