Hostname: page-component-669899f699-7tmb6 Total loading time: 0 Render date: 2025-04-24T21:19:24.974Z Has data issue: false hasContentIssue false
  • English
  • Français

The nature, frequency and course of psychiatric disorders in the first year after traumatic brain injury: a prospective study

Published online by Cambridge University Press:  11 April 2011

K. R. Gould ,
J. L. Ponsford ,
L. Johnston  and
M. Schönberger
K. R. Gould
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, VIC, Australia School of Psychology and Psychiatry, Monash University, Clayton, VIC, Australia
J. L. Ponsford*
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, VIC, Australia School of Psychology and Psychiatry, Monash University, Clayton, VIC, Australia
L. Johnston
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, VIC, Australia
M. Schönberger
Affiliation:
Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, VIC, Australia School of Psychology and Psychiatry, Monash University, Clayton, VIC, Australia Department of Rehabilitation Psychology, Institute of Psychology, University of Freiburg, Germany
*
*Address for correspondence: Professor J. L. Ponsford, School of Psychology and Psychiatry, Monash University, Clayton, VIC 3800, Australia. (Email: jennie.ponsford@med.monash.edu.au)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Psychiatric disorders are common following traumatic brain injury (TBI). However, few studies have examined the course of disorder development and the influence of pre-injury psychiatric history. The present study aimed to examine the frequency of, and association between, psychiatric disorders occurring pre- and post-injury, and to examine the post-injury course of disorders.

Method

Participants were 102 adults (75.5% male) with predominantly moderate-severe TBI. Participants were initially assessed for pre-injury and current disorders, and reassessed at 3, 6 and 12 months post-injury using the Structured Clinical Interview for DSM-IV Disorders (SCID).

Results

Over half of the participants had a pre-injury psychiatric disorder; predominantly substance use, mood, and anxiety disorders. In the first year post-injury, 60.8% of participants had a psychiatric disorder, commonly anxiety and mood disorders. Post-injury disorders were associated with the presence of a pre-injury history (p<0.01), with 74.5% of participants with a pre-injury psychiatric history experiencing a post-injury disorder, which commonly presented at initial assessment or in the first 6 months. However, 45.8% of participants without a pre-injury history developed a novel post-injury disorder, which was less likely to emerge at the initial assessment and generally developed later in the year.

Conclusions

Despite evidence that most post-injury psychiatric disorders represent the continuation of pre-existing disorders, a significant number of participants developed novel psychiatric disorders. This study demonstrates that the timing of onset may differ according to pre-injury history. There seem to be different trajectories for anxiety and depressive disorders. This research has important implications for identifying the time individuals are most at risk of psychiatric disorders post-injury.

Keywords

Anxiety disordersdepressive disorderspsychiatric disorderssubstance use disorderstraumatic brain injury
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 10 , October 2011 , pp. 2099 - 2109
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

ABS (2009). National Survey of Mental Health and Wellbeing 2007. Basic CURF, CD-ROM. Findings based on use of Australian Bureau of Statistics (ABS) CURF data, November Re-Issue.Google Scholar
Anson, K, Ponsford, J (2006). Coping and emotional adjustment following traumatic brain injury. Journal of Head Trauma Rehabilitation 21, 248–259.CrossRefGoogle ScholarPubMed
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn, text revision. American Psychiatric Association: Washington, DC.Google Scholar
Ashman, TA, Spielman, LA, Hibbard, MR, Silver, JM, Chandna, T, Gordon, WA (2004). Psychiatric challenges in the first 6 years after traumatic brain injury: cross-sequential analyses of Axis I disorders. Archives of Physical Medicine and Rehabilitation 85, 36–42.CrossRefGoogle ScholarPubMed
Bombardier, CH, Fann, JR, Temkin, NR, Esselman, PC, Barber, J, Dikmen, SS (2010). Rates of major depressive disorder and clinical outcomes following traumatic brain injury. Journal of the American Medical Association 303, 1938–1945.CrossRefGoogle ScholarPubMed
Bombardier, CH, Temkin, NR, Machamer, J, Dikmen, SS (2003). The natural history of drinking and alcohol-related problems after traumatic brain injury. Archives of Physical Medicine and Rehabilitation 84, 185–191.CrossRefGoogle ScholarPubMed
Deb, S, Lyons, I, Koutzoukis, C, Ali, I, McCarthy, G (1999). Rate of psychiatric illness 1 year after traumatic brain injury. American Journal of Psychiatry 156, 374–378.CrossRefGoogle ScholarPubMed
Fann, JR, Bombardier, CH, Dikmen, S, Esselman, P, Warms, CA, Pelzer, E, Rau, H, Temkin, N (2005). Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury. Journal of Head Trauma Rehabilitation 20, 501–511.CrossRefGoogle ScholarPubMed
Fann, JR, Burington, B, Leonetti, A, Jaffe, KM, Katon, W, Thompson, RS (2004). Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. Archives of General Psychiatry 61, 53–61.CrossRefGoogle Scholar
Fann, JR, Katon, WJ, Uomoto, JM, Esselman, PC (1995). Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. American Journal of Psychiatry 152, 1493–1499.Google ScholarPubMed
Fedoroff, JP, Starkstein, SE, Forrester, AW, Geisler, FH, Jorge, RE, Arndt, SV, Robinson, RG (1992). Depression in patients with acute traumatic brain injury. American Journal of Psychiatry 149, 918–923.Google ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-Patient Edition (SCID-I/NP). Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Fujii, D, Ahmed, I (2002). Characteristics of psychotic disorder due to traumatic brain injury: an analysis of case studies in the literature. Journal of Neuropsychiatry and Clinical Neurosciences 14, 130–140.CrossRefGoogle ScholarPubMed
Godfrey, HP, Partridge, FM, Knight, RG, Bishara, S (1993). Course of insight disorder and emotional dysfunction following closed head injury: a controlled cross-sectional follow-up study. Journal of Clinical and Experimental Neuropsychology 15, 503–515.CrossRefGoogle ScholarPubMed
Haro, JM, Arbabzadeh-Bouchez, S, Brugha, TS, Girolamo, GD, Guyer, ME, Jin, R, Lepine, JP, Mazzi, F, Reneses, B, Vilagut, G, Sampson, NA, Kessler, RC (2006). Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health Surveys. International Journal of Methods in Psychiatric Research 15, 167–180.CrossRefGoogle ScholarPubMed
Härter, M, Baumeister, H, Reuter, K, Jacobi, F, Höfler, M, Bengel, J, Wittchen, HU (2007). Increased 12-month prevalence rates of mental disorders in patients with chronic somatic diseases. Psychotherapy and Psychosomatics 76, 354–360.CrossRefGoogle ScholarPubMed
Hibbard, MR, Uysal, S, Kepler, K, Bogdany, J, Silver, J (1998). Axis I psychopathology in individuals with traumatic brain injury. Journal of Head Trauma Rehabilitation 13, 24–39.CrossRefGoogle ScholarPubMed
Hoofien, D, Gilboa, A, Vakil, E, Donovick, PJ (2001). Traumatic brain injury (TBI) 10–20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning. Brain Injury 15, 189–209.Google Scholar
Jablensky, A, McGrath, J, Herrman, H, Castle, D, Gureje, O, Evans, M, Carr, V, Morgan, V, Korten, A, Harvey, C (2000). Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders. Australian and New Zealand Journal of Psychiatry 34, 221–236.CrossRefGoogle Scholar
Jorge, RE, Robinson, RG, Arndt, SV, Forrester, AW, Geisler, F, Starkstein, SE (1993 a). Comparison between acute- and delayed-onset depression following traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences 5, 43–49.Google ScholarPubMed
Jorge, RE, Robinson, RG, Moser, D, Tateno, A, Crespo-Facorro, B, Arndt, SV (2004). Major depression following traumatic brain injury. Archives of General Psychiatry 61, 42–50.CrossRefGoogle ScholarPubMed
Jorge, RE, Robinson, RG, Starkstein, SE, Arndt, SV (1993 b). Depression and anxiety following traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences 5, 369–374.Google ScholarPubMed
Jorge, RE, Robinson, RG, Starkstein, SE, Arndt, SV, Forrester, AW, Geisler, FH (1993 c). Secondary mania following traumatic brain injury. American Journal of Psychiatry 150, 916–921.Google ScholarPubMed
Jorge, RE, Starkstein, SE, Arndt, S, Moser, D, Crespo-Facorro, B (2005). Alcohol misuse and mood disorders following traumatic brain injury. Archives of General Psychiatry 62, 742–749.CrossRefGoogle ScholarPubMed
Kashluba, S, Hanks, RA, Casey, JE, Millis, SR (2008). Neuropsychologic and functional outcome after complicated mild traumatic brain injury. Archives of Physical Medicine and Rehabilitation 89, 904–911.CrossRefGoogle ScholarPubMed
Kim, E, Lauterbach, EC, Reeve, A, Arciniegas, DB, Coburn, KL, Mendez, MF, Rummans, TA, Coffey, EC (2007). Neuropsychiatric complications of traumatic brain injury: a critical review of the literature (a report by the ANPA Committee on Research). Journal of Neuropsychiatry and Clinical Neurosciences 19, 106–127.CrossRefGoogle ScholarPubMed
Koponen, S, Taiminen, T, Portin, R, Himanen, L, Isoniemi, H, Heinonen, H, Hinkka, S, Tenovuo, O (2002). Axis I and II psychiatric disorders after traumatic brain injury: a 30-year follow-up study. American Journal of Psychiatry 159, 1315–1321.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JBW (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.CrossRefGoogle ScholarPubMed
Lewis, A (1942). Discussion on differential diagnosis and treatment of post-contusional states. Proceedings of the Royal Society of Medicine 35, 607–614.Google Scholar
Lishman, WA (1988). Physiogenesis and psychogenesis in the ‘post-concussional syndrome’. British Journal of Psychiatry 153, 460–469.CrossRefGoogle ScholarPubMed
Moldover, JE, Goldberg, KB, Prout, MF (2004). Depression after traumatic brain injury: a review of evidence for clinical heterogeneity. Neuropsychology Review 14, 143–154.CrossRefGoogle ScholarPubMed
Nelson, HE (1982). National Adult Reading Test. NFER-Nelson: Windsor, UK.Google Scholar
O'Donnell, ML, Creamer, MP, Pattison, PP, Atkin, CF (2004). Psychiatric morbidity following injury. American Journal of Psychiatry 161, 507–514.CrossRefGoogle ScholarPubMed
Ponsford, J, Sloan, S, Snow, P (1995). Traumatic Brain Injury: Rehabilitation for Everyday Adaptive Living. Lawrence Erlbaum Associates: Hove, UK.Google Scholar
Ponsford, J, Whelan-Goodinson, R, Bahar-Fuchs, A (2007). Alcohol and drug use following traumatic brain injury: a prospective study. Brain Injury 21, 1385–1392.CrossRefGoogle ScholarPubMed
Rutherford, WH, Merrett, JD, McDonald, JR (1977). Sequelae of concussion caused by minor head injuries. Lancet 309, 1–4.CrossRefGoogle Scholar
Saha, S, Chant, D, Welham, J, McGrath, J (2005). A systematic review of the prevalence of schizophrenia. PLoS Medicine 2, e141.CrossRefGoogle ScholarPubMed
Sbordone, RJ, Liter, JC, Pettler-Jennings, P (1995). Recovery of function following severe traumatic brain injury: a retrospective 10-year follow-up. Brain Injury 9, 285–299.CrossRefGoogle ScholarPubMed
Spitzer, RL (1983). Psychiatric diagnosis: are clinicians still necessary? Comprehensive Psychiatry 24, 399–411.CrossRefGoogle ScholarPubMed
van Reekum, R, Bolago, I, Finlayson, MAJ, Garner, S, Links, PS (1996). Psychiatric disorders after traumatic brain injury. Brain Injury 10, 319–328.CrossRefGoogle ScholarPubMed
Wade, TD, Bergin, JL, Tiggemann, M, Bulik, CM, Fairburn, CG (2006). Prevalence and long-term course of lifetime eating disorders in an adult Australian twin cohort. Australian and New Zealand Journal of Psychiatry 40, 121–128.CrossRefGoogle Scholar
Watt, KJ, O'Carroll, RE (1999). Evaluating methods for estimating premorbid intellectual ability in closed head injury. Journal of Neurology, Neurosurgery, and Psychiatry 66, 474–479.CrossRefGoogle ScholarPubMed
Wells, JE, Browne, MAO, Scott, KM, McGee, MA, Baxter, J, Kokaua, J; New Zealand Mental Health Survey Research Team (2006). Prevalence, interference with life and severity of 12 month DSM-IV disorders in Te Rau Hinengaro: the New Zealand Mental Health Survey. Australian and New Zealand Journal of Psychiatry 40, 845–854.CrossRefGoogle ScholarPubMed
Whelan-Goodinson, R, Ponsford, J, Johnston, L, Grant, F (2009). Psychiatric disorders following traumatic brain injury: their nature and frequency. Journal of Head Trauma Rehabilitation 24, 324–332.CrossRefGoogle ScholarPubMed
Williams, DH, Levin, HS, Eisenberg, HM (1990). Mild head injury classification. Neurosurgery 27, 422–428.CrossRefGoogle ScholarPubMed
Williams, WH, Evans, JJ, Needham, P, Wilson, BA (2002). Neurological, cognitive and attributional predictors of posttraumatic stress symptoms after traumatic brain injury. Journal of Traumatic Stress 15, 397–400.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Gould Supplementary Material

Gould Supplementary Appendix

Download Gould Supplementary Material(PDF)
PDF 522.4 KB