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Psychosocial and Functional Predictors of Depression and Anxiety Symptoms in Veterans and Service Members With TBI: A
Angela M Benavides1, Jacob A Finn, Xinyu Tang
1Extended Care & Rehabilitation, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota (Drs Benavides and Finn); Department of Psychiatry, University of Minnesota-Twin Cities, Minneapolis (Dr Finn); Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock (Dr Tang); Polytrauma System of Care, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Dr Ropacki); Center of Innovation for Disability and Rehabilitation Research, James A. Haley Veterans Affairs Medical Center, and Department of Anthropology, University of South Florida, Tampa, Florida (Dr Brown); Defense and Veterans Brain Injury Center, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (Mr Smith and Dr Stevens); Departments of Psychology and Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond (Dr Stevens); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Drs Rabinowitz and Hart); Department of Rehabilitation, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Rabinowitz); Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas (Dr Juengst); and Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, Florida (Dr Johnson-Greene).
Objective:
To identify psychosocial and functional predictors of self-reported depression and anxiety symptoms at year 2 following traumatic brain injury (TBI).
Setting:
Five Department of Veterans Affairs (VA) Polytrauma Rehabilitation Centers (PRCs) within the TBI Model Systems (TBIMS).
Participants:
A total of 319 service members/veterans enrolled in VA TBIMS who were eligible for and completed both 1- and 2-year follow-up evaluations.
Design:
Secondary analysis from multicenter prospective longitudinal study.
Main Measures:
Demographic, injury-related, military, mental health, and substance use variables. Questionnaires included the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Neurobehavioral Symptom Inventory. Rating scales included the Participation Assessment with Recombined Tools-Objective and Disability Rating Scale.
Results:
The final sample was largely male (96%) and predominantly White (65%), with a median age of 27 years. In unadjusted analyses, pre-TBI mental health treatment history and year 1 employment status, community activity, sleep difficulties, and self-reported depression and anxiety symptoms were associated with year 2 PHQ-9 scores; pre-TBI mental health treatment history and year 1 community activity, social contact, problematic substance use, sleep difficulties, and self-reported depression and anxiety symptoms were associated with year 2 GAD-7 scores. In multivariable analyses, only year 1 community activity and depression symptoms uniquely predicted year 2 PHQ-9 scores, and only year 1 employment status, community activity, problematic substance use, and anxiety symptoms uniquely predicted year 2 GAD-7 scores.
Conclusion:
Anxiety and depression commonly occur after TBI and are important treatment targets. Some predictors (eg, participation and substance use) are modifiable and amenable to treatment as well. Early identification of anxiety and depression symptoms is key.
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