An examination of the relationships between psychiatric disorders and traumatic brain injury: a prospective study
Other literature type
Gould, Kate Rachel
Uncategorized | 1959.1/475279 | psychosocial outcomes | psychiatric disorders | thesis(doctorate) | monash:63266 | 2010 | anxiety disorder | mental health issues | traumatic brain injury | depressive disorder | restricted access | rehabilitation | ethesis-20101125-225544 | substance use disorder
Psychiatric disorders are commonly associated with traumatic brain injury (TBI). However, pre- and post-injury frequencies of disorders are variable, and their course, associated risk factors and relationship with psychosocial outcome are poorly understood due to methodological inconsistencies. No studies have prospectively examined the full range of Axis I psychiatric disorders using semi-structured clinical interview. Accordingly, the main aims of the current study were to (a) investigate the nature and frequency of pre-injury psychiatric disorders; (b) prospectively examine the nature, frequency and course of Axis 1 psychiatric disorders in the first year post-injury; (c) prospectively examine the contribution of a broad range of demographic, injury-related and concurrent factors to the development of psychiatric disorders in the first year post-injury; (d) prospectively investigate the relationship between psychiatric disorder and post-injury psychosocial functioning; and (e) examine the temporal relationships between anxiety and depressive disorders with psychosocial outcome.
Participants were recruited and assessed during inpatient rehabilitation admission and completed follow-up interviews at three, six and 12 months post-injury. Data from between 102 and 122 participants were utilised in the studies. Participants were predominantly young males with moderate to severe TBI. Psychiatric disorder was determined using the Structured Clinical Interview for DSM-IV Diagnosis (SCID) and measures of coping style, quality of life, neuropsychological functioning, psychosocial outcome, and pain were also utilised.
More than half of participants had a pre-injury psychiatric disorder, predominantly substance use, anxiety and depressive disorders, which was equivalent to demographically adjusted population rates. In the year post-injury, 60.8% of participants had a psychiatric disorder, commonly anxiety and depressive disorders. Almost three-quarters of participants with a pre-injury history also had a post-injury disorder, which commonly presented at initial assessment or in the first six months. However, 45.8% of participants without a pre-injury history developed a novel post-injury disorder, which generally developed later in the year.
Results of regression analyses revealed that post-injury psychiatric disorders were associated with earlier psychiatric disorder or psychiatric treatment. Absence of depression at one year post-injury was also predicted by absence of limb injury, whereas slower psychomotor speed was associated with reduced likelihood of later anxiety. Post-injury psychiatric disorders were associated with unemployment, pain, poor quality of life, and use of non-productive coping skills. Post-injury depressive disorders were not associated with concurrent measures of cognitive functioning, whereas anxiety disorders were associated with impairments on several measures of attention and executive functioning.
At one year post-injury, the majority of participants had a moderate disability, with occupational activities the area most changed due to the injury, followed by interpersonal relationships and independent living. After controlling for relevant background factors (post-traumatic amnesia duration and orthopaedic injury), depression and anxiety diagnosed pre-injury or at the initial assessment were significantly related to one year psychosocial outcome. Earlier substance use disorder was not significantly associated with psychosocial outcome. Poor psychosocial outcome was associated with concurrent pain, non-productive coping style, unemployment, inability to drive, depressive disorder, anxiety disorder and impaired attention and executive functioning. Cross-lagged analyses demonstrated that poor psychosocial outcome preceded depression, whilst earlier depression did not affect later psychosocial outcome. A reciprocal relationship was found between anxiety and psychosocial outcome.
The results of this study highlight the magnitude of the post-injury psychiatric disorder phenomenon which afflicts more than are spared. Even individuals who have received multi-disciplinary, funded, specialist inpatient rehabilitation experience severe and incapacitating distress in the first year after a TBI and this is associated with, and perhaps even caused by, poor psychosocial recovery. This research sheds some light on the factors that may help predict who is most at risk, and when these disorders are likely to emerge, so that clinicians may better instigate early intervention, and reduce the added emotional burden borne by injury survivors.