Depression Trajectories during the First Year after Traumatic Brain Injury: Journal of Neurotrauma

C. H. Bombardier, T. Hoekstra, S. Dikmen, J. R. Fann

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Major depression is prevalent after traumatic brain injury (TBI) and associated with poor outcomes. Little is known about the course of depression after TBI. Participants were 559 consecutively admitted patients with mild to severe TBI recruited from inpatient units at Harborview Medical Center, a Level I trauma center in Seattle, WA. Participants were assessed with the Patient Health Questionnaire-9 (PHQ-9) depression measure at months 1-6, 8, 10, and 12 post-injury. We used linear latent class growth mixture modeling (LCGMM) of PHQ-9 total scores to identify homogeneous subgroups with distinct longitudinal trajectories. A four-class LCGMM had good fit indices and clinical interpretability. Trajectory groups were: low depression (70.1%), delayed depression (13.2%), depression recovery (10.4%), and persistent depression (6.3%). Multinomial logistic regression analyses were used to distinguish trajectory classes based on baseline demographic, psychiatric history, and clinical variables. Relative to the low depression group, the other three groups were consistently more likely to have a pre-injury history of other mental health disorders or major depressive disorder, a positive toxicology screen for cocaine or amphetamines at the time of injury, and a history of alcohol dependence. They were less likely to be on Medicare versus commercial insurance. Trajectories based on LCGMM are an empirical and clinically meaningful way to characterize distinct courses of depression after TBI. When combined with baseline predictors, this line of research may improve our ability to predict prognosis and target groups who may benefit from treatment or secondary prevention efforts (e.g., proactive telephone counseling).
Original languageEnglish
Pages (from-to)2115-2124
Number of pages10
JournalJournal of Neurotrauma
Volume33
DOIs
Publication statusPublished - 2016

Cite this

@article{3c0ba024758a42f5b5edd7b0b5414a3e,
title = "Depression Trajectories during the First Year after Traumatic Brain Injury: Journal of Neurotrauma",
abstract = "Major depression is prevalent after traumatic brain injury (TBI) and associated with poor outcomes. Little is known about the course of depression after TBI. Participants were 559 consecutively admitted patients with mild to severe TBI recruited from inpatient units at Harborview Medical Center, a Level I trauma center in Seattle, WA. Participants were assessed with the Patient Health Questionnaire-9 (PHQ-9) depression measure at months 1-6, 8, 10, and 12 post-injury. We used linear latent class growth mixture modeling (LCGMM) of PHQ-9 total scores to identify homogeneous subgroups with distinct longitudinal trajectories. A four-class LCGMM had good fit indices and clinical interpretability. Trajectory groups were: low depression (70.1{\%}), delayed depression (13.2{\%}), depression recovery (10.4{\%}), and persistent depression (6.3{\%}). Multinomial logistic regression analyses were used to distinguish trajectory classes based on baseline demographic, psychiatric history, and clinical variables. Relative to the low depression group, the other three groups were consistently more likely to have a pre-injury history of other mental health disorders or major depressive disorder, a positive toxicology screen for cocaine or amphetamines at the time of injury, and a history of alcohol dependence. They were less likely to be on Medicare versus commercial insurance. Trajectories based on LCGMM are an empirical and clinically meaningful way to characterize distinct courses of depression after TBI. When combined with baseline predictors, this line of research may improve our ability to predict prognosis and target groups who may benefit from treatment or secondary prevention efforts (e.g., proactive telephone counseling).",
author = "Bombardier, {C. H.} and T. Hoekstra and S. Dikmen and Fann, {J. R.}",
note = "M1 - 23 ISI Document Delivery No.: ED2JG Times Cited: 0 Cited Reference Count: 71 Bombardier, Charles H. Hoekstra, Trynke Dikmen, Sureyya Fann, Jesse R. National Center for Medical Rehabilitation Research, the National Institute of Child Health and Human Development, and National Institutes of Health [R01HD39415] This work was supported by the National Center for Medical Rehabilitation Research, the National Institute of Child Health and Human Development, and National Institutes of Health grant R01HD39415 to Drs. Bombardier and Fann (co-principal investigators). Pfizer supplied masked sertraline and placebo for the controlled trial. The funding sources had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the article. 0 6 MARY ANN LIEBERT, INC NEW ROCHELLE J NEUROTRAUM",
year = "2016",
doi = "10.1089/neu.2015.4349",
language = "English",
volume = "33",
pages = "2115--2124",
journal = "Journal of Neurotrauma",
issn = "0897-7151",
publisher = "Mary Ann Liebert Inc.",

}

Depression Trajectories during the First Year after Traumatic Brain Injury : Journal of Neurotrauma. / Bombardier, C. H.; Hoekstra, T.; Dikmen, S.; Fann, J. R.

In: Journal of Neurotrauma, Vol. 33, 2016, p. 2115-2124.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Depression Trajectories during the First Year after Traumatic Brain Injury

T2 - Journal of Neurotrauma

AU - Bombardier, C. H.

AU - Hoekstra, T.

AU - Dikmen, S.

AU - Fann, J. R.

N1 - M1 - 23 ISI Document Delivery No.: ED2JG Times Cited: 0 Cited Reference Count: 71 Bombardier, Charles H. Hoekstra, Trynke Dikmen, Sureyya Fann, Jesse R. National Center for Medical Rehabilitation Research, the National Institute of Child Health and Human Development, and National Institutes of Health [R01HD39415] This work was supported by the National Center for Medical Rehabilitation Research, the National Institute of Child Health and Human Development, and National Institutes of Health grant R01HD39415 to Drs. Bombardier and Fann (co-principal investigators). Pfizer supplied masked sertraline and placebo for the controlled trial. The funding sources had no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the article. 0 6 MARY ANN LIEBERT, INC NEW ROCHELLE J NEUROTRAUM

PY - 2016

Y1 - 2016

N2 - Major depression is prevalent after traumatic brain injury (TBI) and associated with poor outcomes. Little is known about the course of depression after TBI. Participants were 559 consecutively admitted patients with mild to severe TBI recruited from inpatient units at Harborview Medical Center, a Level I trauma center in Seattle, WA. Participants were assessed with the Patient Health Questionnaire-9 (PHQ-9) depression measure at months 1-6, 8, 10, and 12 post-injury. We used linear latent class growth mixture modeling (LCGMM) of PHQ-9 total scores to identify homogeneous subgroups with distinct longitudinal trajectories. A four-class LCGMM had good fit indices and clinical interpretability. Trajectory groups were: low depression (70.1%), delayed depression (13.2%), depression recovery (10.4%), and persistent depression (6.3%). Multinomial logistic regression analyses were used to distinguish trajectory classes based on baseline demographic, psychiatric history, and clinical variables. Relative to the low depression group, the other three groups were consistently more likely to have a pre-injury history of other mental health disorders or major depressive disorder, a positive toxicology screen for cocaine or amphetamines at the time of injury, and a history of alcohol dependence. They were less likely to be on Medicare versus commercial insurance. Trajectories based on LCGMM are an empirical and clinically meaningful way to characterize distinct courses of depression after TBI. When combined with baseline predictors, this line of research may improve our ability to predict prognosis and target groups who may benefit from treatment or secondary prevention efforts (e.g., proactive telephone counseling).

AB - Major depression is prevalent after traumatic brain injury (TBI) and associated with poor outcomes. Little is known about the course of depression after TBI. Participants were 559 consecutively admitted patients with mild to severe TBI recruited from inpatient units at Harborview Medical Center, a Level I trauma center in Seattle, WA. Participants were assessed with the Patient Health Questionnaire-9 (PHQ-9) depression measure at months 1-6, 8, 10, and 12 post-injury. We used linear latent class growth mixture modeling (LCGMM) of PHQ-9 total scores to identify homogeneous subgroups with distinct longitudinal trajectories. A four-class LCGMM had good fit indices and clinical interpretability. Trajectory groups were: low depression (70.1%), delayed depression (13.2%), depression recovery (10.4%), and persistent depression (6.3%). Multinomial logistic regression analyses were used to distinguish trajectory classes based on baseline demographic, psychiatric history, and clinical variables. Relative to the low depression group, the other three groups were consistently more likely to have a pre-injury history of other mental health disorders or major depressive disorder, a positive toxicology screen for cocaine or amphetamines at the time of injury, and a history of alcohol dependence. They were less likely to be on Medicare versus commercial insurance. Trajectories based on LCGMM are an empirical and clinically meaningful way to characterize distinct courses of depression after TBI. When combined with baseline predictors, this line of research may improve our ability to predict prognosis and target groups who may benefit from treatment or secondary prevention efforts (e.g., proactive telephone counseling).

U2 - 10.1089/neu.2015.4349

DO - 10.1089/neu.2015.4349

M3 - Article

VL - 33

SP - 2115

EP - 2124

JO - Journal of Neurotrauma

JF - Journal of Neurotrauma

SN - 0897-7151

ER -