Stein MB, et al. - In patients assessed in the emergency department for mild traumatic brain injury (mTBI), researchers performed a prospective longitudinal cohort study to determine the prevalence of and risk factors for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD). Outcomes suggest that a substantial minority of patients experience new onset or worsening of preexisting mental health problems after injury to the brain. Patients with mTBI had an increased risk of mental health problems in correlation with the number of preinjury (eg, prior mental health problems) and injury-related (eg, assault or other violent cause of injury in the case of PTSD) characteristics.

Methods

• This longitudinal cohort study was performed from February 2014 to May 2018.
• Researchers used the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item to assess posttraumatic stress disorder and MDD symptoms.
• Preinjury and injury characteristics were evaluated as the risk factors.
• Performing propensity score weights-adjusted multivariable logistic regression models, they assessed associations with PTSD and MDD.
• This study included 1,155 patients with mTBI (Glasgow Coma Scale score, 13-15) and 230 patients with nonhead orthopedic trauma injuries 17 years and older seen in 11 US hospitals with level 1 trauma centers.
• Main outcomes and measures comprised probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months after injury.

Results

• The 1,155 mTBI patients comprised 752 men ([65.1%], mean [SD] age 40.5 [17.2] years) and 230 nonhead orthopedic trauma injury patients comprised 155 men ([67.4%], mean [SD] age 40.4 [15.6] years).
• In the mTBI vs orthopedic trauma comparison groups, weights-adjusted prevalence of PTSD and/or MDD at 3 months was 20.0% (SE, 1.4%) vs 8.7% (SE, 2.2%) (P < .001) and at 6 months was 21.2% (SE, 1.5%) vs 12.1% (SE, 3.2%) (P=.03).
• Less education (adjusted odds ratio, 0.89; 95% CI, 0.82-0.97 per year), being black (adjusted odds ratio, 5.11; 95% CI, 2.89-9.05), self-reported psychiatric history (adjusted odds ratio, 3.57; 95% CI, 2.09-6.09), and injury resulting from assault or other violence (adjusted odds ratio, 3.43; 95% CI, 1.56-7.54) were the risk factors for probable PTSD at 6 months after mTBI .
• For probable MDD after mTBI, risk factors were comparable, except that cause of injury was not linked to increased risk.