Prior Psychiatric Disorder and Post-Traumatic Stress, Depressive and Anxiety Disorder after Traumatic Brain Injury...

The most consistent risk factor for developing psychiatric problems post-traumatic brain injury (TBI) is a preexisting psychiatric disorder, but many studies have reported that psychiatric disorders can occur de novo following "mild" TBI. The objective of this secondary analysis of a prospective cohort study of patients (n = 1,947) with acute TBI and presenting Glasgow Coma Scale (GCS) score between 13 and 15 was to describe the association of pre-injury psychiatric history with prevalence and risk factors for probable posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and nonspecific anxiety disorder (ANX) following TBI at long-term follow-up. Rates of probable PTSD, MDD, or ANX were analyzed from years 1 to 7 post-injury. Multivariable regression models were built to predict meeting cutoffs for PTSD, MDD, and ANX at 1 year, 2-4 years, and 5-7 years post-injury. Predictors were psychiatric history, migraine history, TBI history, initial head CT scan, loss of consciousness, post-traumatic amnesia, GCS, insurance type, highest level of care, cause of injury, years of education, age, sex, and race/ethnicity. Participants with history of pre-injury psychiatric disorder met clinical cutoffs for PTSD, MDD, and ANX at approximately double the rate of participants without history of psychiatric disorder at year 1 (16-28% vs. 5-13%), between years 2 and 4 (15-35% vs. 6-18%), and between years 5 and 7 (10-28% vs. 5-12%). Multivariable modeling confirmed several classical risk factors for post-TBI psychiatric sequelae at any time during follow-up, such as psychiatric history, prior TBI, female sex, and Black race. Assault, mechanism of injury, and Medicaid, self-pay, or other insurance (reference: private insurance) were also associated with PTSD, MDD, and ANX at various timepoints. Probable PTSD, MDD, and ANX were more common in participants with pre-injury psychiatric history, but significant psychiatric symptoms are identifiable for years post-injury, even among those with de novo psychiatric disorders.