A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury

• Published in: Psychological medicine 2016-04, Vol.46 (6), p.1331-1341
• Main Authors: Alway, Y., Gould, K. R., Johnston, L., McKenzie, D., Ponsford, J.
• Format: Article
• Language: English
• Subjects: Accidents; Adolescent; Adult; Aged; Anxiety; Anxiety disorders; Anxiety Disorders - epidemiology; Australia; Brain injuries; Brain Injuries, Traumatic - psychology; Brain Injuries, Traumatic - rehabilitation; Comorbidity; Critical period; Diagnostic and Statistical Manual of Mental Disorders; Female; First year; Humans; Injuries; Longitudinal Studies; Male; Medical diagnosis; Mental disorders; Middle Aged; Mood; Mood Disorders - epidemiology; Morbidity; Original Articles; Prospective Studies; Psychiatry; Regression Analysis; Risk Factors; Substance abuse; Substance-Related Disorders - epidemiology; Time Factors; Traumatic brain injury; Young Adult
• ISSN: 0033-2917; 1469-8978
• DOI: 10.1017/S0033291715002986

Psychiatric disorders commonly emerge during the first year following traumatic brain injury (TBI). However, it is not clear whether these disorders soon remit or persist for long periods post-injury. This study aimed to examine, prospectively: (1) the frequency, (2) patterns of co-morbidity, (3) trajectory, and (4) risk factors for psychiatric disorders during the first 5 years following TBI. Participants were 161 individuals (78.3% male) with moderate (31.2%) or severe (68.8%) TBI. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV, administered soon after injury and 3, 6 and 12 months, and 2, 3, 4 and 5 years post-injury. Disorder frequencies and generalized estimating equations were used to identify temporal relationships and risk factors. In the first 5 years post-injury, 75.2% received a psychiatric diagnosis, commonly emerging within the first year (77.7%). Anxiety, mood and substance-use disorders were the most common diagnostic classes, often presenting co-morbidly. Many (56.5%) experienced a novel diagnostic class not present prior to injury. Disorder frequency ranged between 61.8 and 35.6% over time, decreasing by 27% [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.65-0.83] with each year post-injury. Anxiety disorders declined significantly over time (OR 0.73, 95% CI 0.63-0.84), whilst mood and substance-use disorder rates remained stable. The strongest predictors of post-injury disorder were pre-injury disorder (OR 2.44, 95% CI 1.41-4.25) and accident-related limb injury (OR 1.78, 95% CI 1.03-3.07). Findings suggest the first year post-injury is a critical period for the emergence of psychiatric disorders. Disorder frequency declines thereafter, with anxiety disorders showing greater resolution than mood and substance-use disorders.