Depressive symptomatology after mild-to-moderate traumatic brain injury: a comparison of three measures

Measurement of posttraumatic brain injury depression is problematic. Disagreement exists about the best screening measure, and symptoms of brain injury often overlap those of depression. In an outpatient sample of 75 persons, we compared aspects of Criterion A of the Diagnostic and Statistical Manual of Mental Disorders--Fourth Revision, Text Revision (2000), with three depression subscales: the Neurobehavioral Functioning (NFI-D), Profile of Moods State (POMS-D), and Center for Epidemiologic Studies (CES-D). Nearly 40% of this outpatient sample had significant levels of depressive symptoms. All measures were internally consistent, reliable, and highly correlated. For persons with mild-to-moderate traumatic brain injury, the CES-D was the best screening instrument because of its ease in administration, sensitivity in detecting probable major depressive disorders, its established categories of severity, and its comprehensiveness. Further effort in the establishment of depression severity categories using the NFI-D is needed.