Prevalence and determinants of depression and its association with quality of life in Traumatic Brain Injury (TBI) patients

Open access


Introduction: Traumatic brain injury (TBI) is a major cause of disability. Assessment and treatment of TBI typically focus on physical and cognitive impairments, yet psychological impairments represent significant causes of disability. Depression may be the most common and disabling psychiatric condition in individuals with TBI.

Objective: This cross-sectional study was design to investigate prevalence and risk factors of depression in Traumatic brain injury (TBI).

Material and method: The Group studied consists of 204 patients of mild and moderate TBI between 14-days to one-year post injury. Demographic characteristics of the participants were assessed on a self-designed semi structured performa. Interviews focused on assessment of severity of TBI, depression and quality of life (Qol) using GCS, PHQ-9 and WHOBREF-QOL respectively.

Results: Total 204 patients were included. 42.15% participants were found to have depression. None of the demographic variables were associated with depression except female sex, severity and time since injury. Moderate TBI patient (55.80%) had significantly higher occurrence of depression than the mild cases (44.2%). Patients with lesser duration (time since injury) of TBI had high incidence (50.2%) of depression compare to longer duration of TBI. Depressed patients also had poor Qol than those without depression in all domains except physical health domain. Neuroanatomical localization was also correlated with depression. Cerebral contusions were the most common (44.24%) lesions associated with depression.

Conclusion: Depression is commonly associated, yet under diagnosed clinical entities in head injury and have tremendous impact in overall outcome measures. Every patient of head injury warrants psychiatric evaluation and concomitant treatment if required to ensure the attainment of not only neuroanatomical intact but overall productive and qualitative life vindicating the holistic and multidisciplinary treatment approach.

1. Blazer DR, Kessler RC, McGonagle KA, Swartz MS. The prevalence and distribution of major depression in a national comorbidity sample: The National Comorbidity Survey. Am J Psychiatry.1994; 151:979-986.

2. Bowen A, Neumann V, Conner M, Tennant A, Chamberlain MA. Mood disorders following traumatic brain injury: identifying the extent of the problem and the people at risk. Brain Inj. 1998;12:177–190.

3. Bombardier CH, Fann JR, Temkin NR, Esselman PC, Barber J, Dikmen SS. Rates of major depressive disorder and clinical outcomes following traumatic brain injury. JAMA. 2010; 19; 303(19): 1938-45.

4. Definition of mild traumatic brain injury. Developed by the Mild traumatic brain injury committee of the Head injury. Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine. J Head Trauma Rehabil 1993;8(3): 86-87.

5. Deb S, Lyons I, Koutzoukis C, Ali I, McCarthy G. Rate of psychiatric illness 1 year after traumatic brain injury. Am J Psychiatry. 1999;156:374–378.

6. Dikmen SS, Bombardier CH, Machamer J, Fann JR, Temkin NR. Natural history of depression in traumatic brain injury. Arch Phys Med Rehabil.2004; 85:1457-1464.

7. Fedoroff JP, Starkstein SE, Forrester AW, Geisler FH, Jorge RE, Arndt SV, Robinson, RG. Depression in patients with acute traumatic brain injury. Am J Psychiatry. 1992; 149,918-923.

8. Graham Teasdale, Bryan Jennett. Assessment of coma and impaired consciousness: A Practical Scale. The Lancet, 304, 7872,81-84.

9. Holsinger T, Steffens DC, Phillips C, et al. Head injury in early adulthood and the lifetime risk of depression. Arch Gen Psychiatry. 2002;59:17–22.

10. jorge RE, Robinson RG, Arndt SV, Starkstein SE, Forrester AW, Geisler F. Depression following traumatic brain injury: a 1 year longitudinal study. J Affect Disord. 1993;27:233–243

11. Jorge RE, Robinson RG, Moser D, Tateno A, Crespo-Facorro B, Arndt S. Major depression following traumatic brain injury. Arch Gen Psychiatry. 2004;61:42–50.

12. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6): 617-627.

13. Koponen S, Taiminen T, Portin R, et al. Axis I and II psychiatric disorders after traumatic brain injury: a 30-year follow-up study. Am J Psychiatry. 2002;159:1315–1321.

14. Kreutzer JS, Seel RT, Gourley E. The prevalence and symptom rates of depression after traumatic brain injury: a comprehensive examination. Brain Inj. 2001;15:563–576.

15. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16 : 606-13.

16. Kochhar PH, Rajadhyaksha SS, Suvarna VR. Translation and validation of brief patients health questionnaire against DSM IV as a tool to diagnose major depressive disorder in Indian patients. J Postgrad Med 2007; 53 : 102-7.

17. Rao V, Munro CA. Rosenberg P, Ward J, Bertrand M, Degoankar M, Horska A, Pham D, Yousem DM, Barker. Neuroanatomical correlates of depression in post traumatic brain injury: preliminary results of a pilot study. J Neuropsychiatry ClinNeurosci. 2010 ;22(2):231-5.

18. Rapoport MJ, McCullagh S, Shammi P, Feinsteinb A. Cognitive impairment associated with major depression following mild and moderate traumatic brain injury. J Neuropsychiatry ClinNeurosci. 2005;17:61–65.

19. Rosenthal M, Christensen BK, Ross TP. Depression following traumatic brain injury. Arch Phys Med Rehabil. 1998;79(1):90-103.

20. Saxena S, Chandramani K, Bhargava R. WHOQOL Hindi: a questionnaire for assessing quality of life in health care setting in India. Natl Med. J. India 1998; 11: 160–166.

21. Seel RT, Kreutzer JS, Rosenthal M, Hammond FM, Corrigan JD, Black K. Depression after traumatic brain injury: a national institute on disability and rehabilitation research model systems multicenter investigation. Arch Phys Med Rehabil. 2003; 84:177–184.

22. Skevington SM, Lotfy M, O'Connell KA. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res. 2004;13:299-310.

23. Steadman Pare D, Colaytonio A, Ratcliff G, Chase S, Vernich L. Factors associated with perceived quality of life many years after TBI. J Head Trauma Rehabil.2001; 16:330-342.

24. Trevena L, Cameron I. Traumatic brain injury-long term care of patients patients in general practice. Aust Fam Physician.2011;40(12):956-61.

25. Varney NR, Martzke JS, Roberst RJ. Major depression in patients with closed head injury. Neuropsychology.1987; 1:7-9.

Romanian Neurosurgery

The Journal of Romanian Society of Neurosurgery

Journal Information


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 205 205 12
PDF Downloads 67 67 7