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Abstract
Objective: This study utilized the Traumatic Brain Injury Model Systems (TBIMS) National Database to examine the prevalence of depression and suicidal behaviour in a large cohort of patients who sustained moderate-to-severe TBI.
Method: Participants presented to a TBIMS acute care hospital within 72 hours of injury and received acute care and comprehensive rehabilitation in a TBIMS designated brain injury inpatient rehabilitation programme. Depression and suicidal ideation were measured with the Patient Health Questionnaire (PHQ-9). Self-reported suicide attempts during the past year were recorded at each follow-up examination, at 1, 2, 3, 10, 15 and 20 years post-injury.
Results: Throughout the 20 years of follow-up, rates of depression ranged from 24.8–28.1%, suicidal ideation ranged from 7.0–10.1% and suicide attempts (past year) ranged from 0.8–1.7%. Participants who endorsed depression and/or suicidal behaviour at year 1 demonstrated consistently elevated rates of depression and suicidal behaviour 5 years after TBI.
Conclusion: Compared to the general population, individuals with TBI are at greater risk for depression and suicidal behaviour many years after TBI. The significant psychiatric symptoms evidenced by individuals with TBI highlight the need for routine screening and mental health treatment in this population.
Declarations of interest
The contents of this manuscript were developed under a grant from the Department of Health and Human Services, National Institute on Disability, Independent Living and Rehabilitation Research grant numbers H133A120085, H133A120026, H133A120028, H133A120035, H133A120037 and H133A120031. However, those contents do not necessarily represent the policy of the Department of Education and you should not assume endorsement by the Federal Government. Lauren B. Fisher, PhD received a fellowship grant from Harvard Medical School to support the current work. Flora Hammond, MD, has received personal fees from Avanir for participation on the PRISM II Steering Committee and stock ownership [Stock ownership in health care companies include: ABBVIE INC SHS ($34 247 market value), ELI LILLY & CO ($14 535), GLAXOSMITHKLINE PLC ADR ($23 794), Exchange Traded Funds ($84 545) and Mutual Funds ($47 095)]. Joseph Giacino, PhD, is a member of the Advisory Board of the TBIMS National Data and Statistical Center. Dr. Zafonte and Dr. Iverson acknowledge additional support from the INTRuST Post-traumatic Stress Disorder and Traumatic Brain Injury Clinical Consortium funded by the Department of Defense Psychological Health/Traumatic Brain Injury Research Programme (X81XWH-07-CC-CSDoD). Grant Iverson, PhD, has been reimbursed by the government, professional scientific bodies and commercial organizations for discussing or presenting research relating to MTBI and sport-related concussion at meetings, scientific conferences and symposiums. He has a clinical practice in forensic neuropsychology involving individuals who have sustained mild TBIs. He has received honorariums for serving on research panels that provide scientific peer review of programmes. He is a co-investigator, collaborator or consultant on grants relating to mild TBI funded by several organizations. For the remaining authors, no conflicts were declared.