Friday, February 1, 2019

Prior Mental Health Problems May Increase Risk of PTSD, MDD Following mTBI

Certain patients who experience mild traumatic brain injury (mTBI) may be at especially increased risk for developing posttraumatic stress disorder (PTSD) or major depressive disorder (MDD) following injury, according to a study published this week in JAMA Psychiatry.

“We observed that having an antecedent mental health problem prior to TBI [traumatic brain injury] was an exceptionally strong risk factor for having PTSD or MDD postinjury,” wrote author Murray B. Stein, M.D., M.P.H., of the University of California, San Diego and colleagues. “[T]his finding underscores the importance of clinicians being aware of the mental health history of their patients with mTBI, as this information is central to expectations regarding both short-term and long-term outcome.”

For this large, multisite study, Stein and colleagues included some 1,200 civilian patients whose head injury occurred within 24 hours of emergency department admission, who received a CT scan, and who scored 13 to 15 on the Glascow Coma Scale. About 20% of these patients reported having a psychiatric history (patients with what the authors referred to as “major debilitating mental disorders—for example, schizophrenia, bipolar disorder”—were excluded from the trial). Patients took the PTSD Checklist for DSM-5 (PCL-5) and the Patient Health Questionnaire-9 (PHQ-9) at the start of the trial and again at two weeks and three, six, and 12 months postinjury. The researchers also included a comparison group of 230 patients who experienced orthopedic trauma, but not head injury; six months of follow-up data on this group was included in the analysis.

Nearly 1 in 5 participants with mTBI had probable PTSD (19%) six months postinjury, compared with 8% of those with orthopedic injuries. Major risk factors for PTSD at six months after an mTBI included being black, having an mTBI caused by assault or violence, or history of psychiatric disorder—each of which was associated with a four to five times greater risk of PTSD.

About 9% of those with mTBI had probable MDD six months postinjury, compared with 3% of those with orthopedic injuries. Major risk factors for MDD at six months after an mTBI included being black and having a history of psychiatric disorder—each of which was associated with a three to four times greater risk of moderately severe to severe depression.

Stein and colleagues noted that they were uncertain how to characterize the finding that black patients were at increased risk for PTSD and MDD following a mTBI, but wrote that it did not appear to be due to the cause of injury or socioeconomic status, such as education, employment status, or health insurance status. They called for further study of this finding.

“Some individuals, on the basis of antecedent mental health status and—in the case of PTSD—context of injury (i.e., assault or other violence), are at substantially increased risk of mental health problems following mTBI,” Stein and colleagues concluded. “These findings should influence recognition of at-risk individuals following mTBI and inform efforts at surveillance and intervention.”

For related information, see the Psychiatric News article “Sertraline May Help Prevent Depression Following Traumatic Brain Injury.”

(Image: iStock/MJFelt)


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