An estimated 1.4 million U.S. people sustain a TBI each year; of those, 50,000 die and more than 200,000 are hospitalized*. Those who survive face a broad range of problems. Many of those problems are obvious, such as difficulty walking, talking, or moving; other problems are more subtle, such as changes in personality or mood. These subtle problems can have a major impact on recovery and rehabilitation.
To understand more about this complex topic, researchers supported by the NICHD through the National Center for Medical Rehabilitation Research (NCMRR) are studying one of the more hidden problems associated with TBI: depression. Some small-scale research has related depression after TBI with poor outcomes ranging from aggression and anxiety, to higher rates of suicide attempts, to greater health care costs.
But is the association real?
Results from an NICHD-supported study show that rates of depression are significantly higher among those who have experienced TBI than among those who have not experienced TBI or the general population. This study, the first large-scale study of closely and routinely followed TBI patients, showed that the rate of depression among TBI survivors was nearly 8 times that of the general population. In the study, 53.1 percent of the participants reported depressions, compared to 6.7 percent in the general population.
“This research suggests that depression rates among TBI survivors have been underestimated,” said Beth Ansel, Ph.D., director of the NCMRR’s Program in TBI and Stroke Rehabilitation. “If not treated, depression can significantly compromise rehabilitation, recovery and the quality of life for such individuals. These findings indicate that health care providers and individuals with TBI need to be more aware of depressive symptoms and need to take action before the symptoms impact recovery.”
Despite previous theories, which suggest a history of depression is either unrelated or inversely related to depression after TBI, this research found that pre-injury depression and depression at the time of injury predicted higher rates of depression after TBI compared to those with no history of depression. Within the study sample, 11.4 percent were depressed at the time of their injury and experienced depression after TBI. Another 18.4 percent experienced a recurrence of depression after their injury, while 23.3 percent experienced depression for the first time after their injury. Even so, by the end of 12 months after injury, 41 percent of those with no history of depression reported at least one major depressive episode.
The research also seemed to disprove the theory that TBI survivors are too affected within the first 6 months after injury to allow for detection of depressive symptoms. About half of those with depression were identified at 3 months post injury.
The study also examined co-morbidity of anxiety disorders with depression after TBI, as well as risk factors that make depression after TBI more likely. The Bombardier, Fann, et al article, published in the Journal of the American Medical Association, is available at http://jama.ama-assn.org/cgi/content/full/303/19/1938 . A short video about the finding is also available at http://jama.ama-assn.org/cgi/content/full/303/19/1938/DC2 .
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* Centers for Disease Control and Prevention
Originally Posted: June 18, 2010
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