Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients after Mild Traumatic Brain Injury: A TRACK-TBI Study

Murray B. Stein, Sonia Jain, Joseph T. Giacino, Harvey Levin, Sureyya Dikmen, Lindsay D. Nelson, Mary J. Vassar, David O. Okonkwo, Ramon Diaz-Arrastia, Claudia S. Robertson, Pratik Mukherjee, Michael McCrea, Christine L. Mac Donald, John K. Yue, Esther Yuh, Xiaoying Sun, Laura Campbell-Sills, Nancy Temkin, Geoffrey T. Manley, Opeolu AdeoyeNeeraj Badjatia, Kim Boase, Yelena Bodien, M. Ross Bullock, Randall Chesnut, John D. Corrigan, Karen Crawford, Ann Christine Duhaime, Richard Ellenbogen, V. Ramana Feeser, Adam Ferguson, Brandon Foreman, Raquel Gardner, Etienne Gaudette, Luis Gonzalez, Shankar Gopinath, Rao Gullapalli, J. Claude Hemphill, Gillian A Hotz, Frederick Korley, Joel Kramer, Natalie Kreitzer, Chris Lindsell, Joan Machamer, Christopher Madden, Alastair Martin, Thomas McAllister, Randall Merchant, Florence Noel, Eva Palacios, Daniel Perl, Ava Puccio, Miri Rabinowitz, Jonathan Rosand, Angelle Sander, Gabriela Satris, David Schnyer, Seth Seabury, Mark Sherer, Sabrina Taylor, Arthur Toga, Alex Valadka, Paul Vespa, Kevin Wang, Ross Zafonte

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Importance: Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. Objective: To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). Design, Setting, and Participants: Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 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 were included in this study. Main Outcomes and Measures: Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. Results: Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups 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). Risk factors for probable PTSD at 6 months after mTBI included 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). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. Conclusions and Relevance: After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention..

Original languageEnglish (US)
Pages (from-to)249-258
Number of pages10
JournalJAMA Psychiatry
Volume76
Issue number3
DOIs
StatePublished - Mar 1 2019
Externally publishedYes

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Brain Concussion
Post-Traumatic Stress Disorders
Major Depressive Disorder
Depression
Wounds and Injuries
Odds Ratio
Orthopedics
Checklist
Psychiatry
Mental Health
Logistic Models
Traumatic Brain Injury
Education
Weights and Measures
Propensity Score
Glasgow Coma Scale
Trauma Centers
Health
Violence
Longitudinal Studies

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients after Mild Traumatic Brain Injury : A TRACK-TBI Study. / Stein, Murray B.; Jain, Sonia; Giacino, Joseph T.; Levin, Harvey; Dikmen, Sureyya; Nelson, Lindsay D.; Vassar, Mary J.; Okonkwo, David O.; Diaz-Arrastia, Ramon; Robertson, Claudia S.; Mukherjee, Pratik; McCrea, Michael; Mac Donald, Christine L.; Yue, John K.; Yuh, Esther; Sun, Xiaoying; Campbell-Sills, Laura; Temkin, Nancy; Manley, Geoffrey T.; Adeoye, Opeolu; Badjatia, Neeraj; Boase, Kim; Bodien, Yelena; Bullock, M. Ross; Chesnut, Randall; Corrigan, John D.; Crawford, Karen; Duhaime, Ann Christine; Ellenbogen, Richard; Feeser, V. Ramana; Ferguson, Adam; Foreman, Brandon; Gardner, Raquel; Gaudette, Etienne; Gonzalez, Luis; Gopinath, Shankar; Gullapalli, Rao; Hemphill, J. Claude; Hotz, Gillian A; Korley, Frederick; Kramer, Joel; Kreitzer, Natalie; Lindsell, Chris; Machamer, Joan; Madden, Christopher; Martin, Alastair; McAllister, Thomas; Merchant, Randall; Noel, Florence; Palacios, Eva; Perl, Daniel; Puccio, Ava; Rabinowitz, Miri; Rosand, Jonathan; Sander, Angelle; Satris, Gabriela; Schnyer, David; Seabury, Seth; Sherer, Mark; Taylor, Sabrina; Toga, Arthur; Valadka, Alex; Vespa, Paul; Wang, Kevin; Zafonte, Ross.

In: JAMA Psychiatry, Vol. 76, No. 3, 01.03.2019, p. 249-258.

Research output: Contribution to journalArticle

Stein, MB, Jain, S, Giacino, JT, Levin, H, Dikmen, S, Nelson, LD, Vassar, MJ, Okonkwo, DO, Diaz-Arrastia, R, Robertson, CS, Mukherjee, P, McCrea, M, Mac Donald, CL, Yue, JK, Yuh, E, Sun, X, Campbell-Sills, L, Temkin, N, Manley, GT, Adeoye, O, Badjatia, N, Boase, K, Bodien, Y, Bullock, MR, Chesnut, R, Corrigan, JD, Crawford, K, Duhaime, AC, Ellenbogen, R, Feeser, VR, Ferguson, A, Foreman, B, Gardner, R, Gaudette, E, Gonzalez, L, Gopinath, S, Gullapalli, R, Hemphill, JC, Hotz, GA, Korley, F, Kramer, J, Kreitzer, N, Lindsell, C, Machamer, J, Madden, C, Martin, A, McAllister, T, Merchant, R, Noel, F, Palacios, E, Perl, D, Puccio, A, Rabinowitz, M, Rosand, J, Sander, A, Satris, G, Schnyer, D, Seabury, S, Sherer, M, Taylor, S, Toga, A, Valadka, A, Vespa, P, Wang, K & Zafonte, R 2019, 'Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients after Mild Traumatic Brain Injury: A TRACK-TBI Study', JAMA Psychiatry, vol. 76, no. 3, pp. 249-258. https://doi.org/10.1001/jamapsychiatry.2018.4288
Stein, Murray B. ; Jain, Sonia ; Giacino, Joseph T. ; Levin, Harvey ; Dikmen, Sureyya ; Nelson, Lindsay D. ; Vassar, Mary J. ; Okonkwo, David O. ; Diaz-Arrastia, Ramon ; Robertson, Claudia S. ; Mukherjee, Pratik ; McCrea, Michael ; Mac Donald, Christine L. ; Yue, John K. ; Yuh, Esther ; Sun, Xiaoying ; Campbell-Sills, Laura ; Temkin, Nancy ; Manley, Geoffrey T. ; Adeoye, Opeolu ; Badjatia, Neeraj ; Boase, Kim ; Bodien, Yelena ; Bullock, M. Ross ; Chesnut, Randall ; Corrigan, John D. ; Crawford, Karen ; Duhaime, Ann Christine ; Ellenbogen, Richard ; Feeser, V. Ramana ; Ferguson, Adam ; Foreman, Brandon ; Gardner, Raquel ; Gaudette, Etienne ; Gonzalez, Luis ; Gopinath, Shankar ; Gullapalli, Rao ; Hemphill, J. Claude ; Hotz, Gillian A ; Korley, Frederick ; Kramer, Joel ; Kreitzer, Natalie ; Lindsell, Chris ; Machamer, Joan ; Madden, Christopher ; Martin, Alastair ; McAllister, Thomas ; Merchant, Randall ; Noel, Florence ; Palacios, Eva ; Perl, Daniel ; Puccio, Ava ; Rabinowitz, Miri ; Rosand, Jonathan ; Sander, Angelle ; Satris, Gabriela ; Schnyer, David ; Seabury, Seth ; Sherer, Mark ; Taylor, Sabrina ; Toga, Arthur ; Valadka, Alex ; Vespa, Paul ; Wang, Kevin ; Zafonte, Ross. / Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients after Mild Traumatic Brain Injury : A TRACK-TBI Study. In: JAMA Psychiatry. 2019 ; Vol. 76, No. 3. pp. 249-258.
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title = "Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients after Mild Traumatic Brain Injury: A TRACK-TBI Study",
abstract = "Importance: Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. Objective: To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). Design, Setting, and Participants: Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 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 were included in this study. Main Outcomes and Measures: Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. Results: Participants were 1155 patients (752 men [65.1{\%}]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4{\%}]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups 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). Risk factors for probable PTSD at 6 months after mTBI included 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). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. Conclusions and Relevance: After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention..",
author = "Stein, {Murray B.} and Sonia Jain and Giacino, {Joseph T.} and Harvey Levin and Sureyya Dikmen and Nelson, {Lindsay D.} and Vassar, {Mary J.} and Okonkwo, {David O.} and Ramon Diaz-Arrastia and Robertson, {Claudia S.} and Pratik Mukherjee and Michael McCrea and {Mac Donald}, {Christine L.} and Yue, {John K.} and Esther Yuh and Xiaoying Sun and Laura Campbell-Sills and Nancy Temkin and Manley, {Geoffrey T.} and Opeolu Adeoye and Neeraj Badjatia and Kim Boase and Yelena Bodien and Bullock, {M. Ross} and Randall Chesnut and Corrigan, {John D.} and Karen Crawford and Duhaime, {Ann Christine} and Richard Ellenbogen and Feeser, {V. Ramana} and Adam Ferguson and Brandon Foreman and Raquel Gardner and Etienne Gaudette and Luis Gonzalez and Shankar Gopinath and Rao Gullapalli and Hemphill, {J. Claude} and Hotz, {Gillian A} and Frederick Korley and Joel Kramer and Natalie Kreitzer and Chris Lindsell and Joan Machamer and Christopher Madden and Alastair Martin and Thomas McAllister and Randall Merchant and Florence Noel and Eva Palacios and Daniel Perl and Ava Puccio and Miri Rabinowitz and Jonathan Rosand and Angelle Sander and Gabriela Satris and David Schnyer and Seth Seabury and Mark Sherer and Sabrina Taylor and Arthur Toga and Alex Valadka and Paul Vespa and Kevin Wang and Ross Zafonte",
year = "2019",
month = "3",
day = "1",
doi = "10.1001/jamapsychiatry.2018.4288",
language = "English (US)",
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pages = "249--258",
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TY - JOUR

T1 - Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients after Mild Traumatic Brain Injury

T2 - A TRACK-TBI Study

AU - Stein, Murray B.

AU - Jain, Sonia

AU - Giacino, Joseph T.

AU - Levin, Harvey

AU - Dikmen, Sureyya

AU - Nelson, Lindsay D.

AU - Vassar, Mary J.

AU - Okonkwo, David O.

AU - Diaz-Arrastia, Ramon

AU - Robertson, Claudia S.

AU - Mukherjee, Pratik

AU - McCrea, Michael

AU - Mac Donald, Christine L.

AU - Yue, John K.

AU - Yuh, Esther

AU - Sun, Xiaoying

AU - Campbell-Sills, Laura

AU - Temkin, Nancy

AU - Manley, Geoffrey T.

AU - Adeoye, Opeolu

AU - Badjatia, Neeraj

AU - Boase, Kim

AU - Bodien, Yelena

AU - Bullock, M. Ross

AU - Chesnut, Randall

AU - Corrigan, John D.

AU - Crawford, Karen

AU - Duhaime, Ann Christine

AU - Ellenbogen, Richard

AU - Feeser, V. Ramana

AU - Ferguson, Adam

AU - Foreman, Brandon

AU - Gardner, Raquel

AU - Gaudette, Etienne

AU - Gonzalez, Luis

AU - Gopinath, Shankar

AU - Gullapalli, Rao

AU - Hemphill, J. Claude

AU - Hotz, Gillian A

AU - Korley, Frederick

AU - Kramer, Joel

AU - Kreitzer, Natalie

AU - Lindsell, Chris

AU - Machamer, Joan

AU - Madden, Christopher

AU - Martin, Alastair

AU - McAllister, Thomas

AU - Merchant, Randall

AU - Noel, Florence

AU - Palacios, Eva

AU - Perl, Daniel

AU - Puccio, Ava

AU - Rabinowitz, Miri

AU - Rosand, Jonathan

AU - Sander, Angelle

AU - Satris, Gabriela

AU - Schnyer, David

AU - Seabury, Seth

AU - Sherer, Mark

AU - Taylor, Sabrina

AU - Toga, Arthur

AU - Valadka, Alex

AU - Vespa, Paul

AU - Wang, Kevin

AU - Zafonte, Ross

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Importance: Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. Objective: To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). Design, Setting, and Participants: Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 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 were included in this study. Main Outcomes and Measures: Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. Results: Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups 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). Risk factors for probable PTSD at 6 months after mTBI included 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). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. Conclusions and Relevance: After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention..

AB - Importance: Traumatic brain injury (TBI) has been associated with adverse mental health outcomes, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), but little is known about factors that modify risk for these psychiatric sequelae, particularly in the civilian sector. Objective: To ascertain prevalence of and risk factors for PTSD and MDD among patients evaluated in the emergency department for mild TBI (mTBI). Design, Setting, and Participants: Prospective longitudinal cohort study (February 2014 to May 2018). Posttraumatic stress disorder and MDD symptoms were assessed using the PTSD Checklist for DSM-5 and the Patient Health Questionnaire-9 Item. Risk factors evaluated included preinjury and injury characteristics. Propensity score weights-adjusted multivariable logistic regression models were performed to assess associations with PTSD and MDD. A total of 1155 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 were included in this study. Main Outcomes and Measures: Probable PTSD (PTSD Checklist for DSM-5 score, ≥33) and MDD (Patient Health Questionnaire-9 Item score, ≥15) at 3, 6, and 12 months postinjury. Results: Participants were 1155 patients (752 men [65.1%]; mean [SD] age, 40.5 [17.2] years) with mTBI and 230 patients (155 men [67.4%]; mean [SD] age, 40.4 [15.6] years) with nonhead orthopedic trauma injuries. Weights-adjusted prevalence of PTSD and/or MDD in the mTBI vs orthopedic trauma comparison groups 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). Risk factors for probable PTSD at 6 months after mTBI included 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). Risk factors for probable MDD after mTBI were similar with the exception that cause of injury was not associated with increased risk. Conclusions and Relevance: After mTBI, some individuals, on the basis of education, race/ethnicity, history of mental health problems, and cause of injury were at substantially increased risk of PTSD and/or MDD. These findings should influence recognition of at-risk individuals and inform efforts at surveillance, follow-up, and intervention..

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U2 - 10.1001/jamapsychiatry.2018.4288

DO - 10.1001/jamapsychiatry.2018.4288

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JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-622X

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