Relationship Between Depression and Psychosocial Functioning after Traumatic Brain Injury

Depression is a frequently reported consequence of TBI that presents many psychosocial challenges for individuals post-injury. A number of research studies have documented that major depression following TBI can range from 13% at one year to as high as 61% at eight years, a finding that suggests that the number of individuals who become depressed after TBI increases over time. Major Depression after TBI may be time-limited, or extend over a prolonged period of time. Currently, there are few predictors of who will become depressed after TBI, and few studies which examine the natural course of onset and/or recovery from depression and its impact on psychological functioning following TBI. 

This Study involves 188 individuals with TBI living in the community who were less than five years post onset of their TBIs. These individuals were enrolled in a study which assessed mood and psychosocial functioning at two time points: at initial interview between one and four years post injury and at repeat interview approximately 12 months later. The primary goal of this study was to evaluate the stability of mood over time and examine the impact of mood on psychosocial functioning, quality of life and extent of community integration. Using psychiatric criteria to determine the presence or absence of a major depression, the participants were divided into one of four groups: (1) those with no depression at either interview; (2) those whose depression had resolved at second interview; (3) those who had become depressed at second interview and (4) those who remained depressed at both initial and follow up. The groups were similar in terms of age, gender, education, level of income, and racial backgrounds. Participants had a full range of TBI severity with most experiencing a moderate to severe injury. The Structured Clinical Interview for Depression (SCID) and self-report measures of depression, quality of life ( QOL), overall health, pain, needs, role changes, and brain injury symptoms were used to assess impact of mood on psychosocial functioning.

Results

The four groups were different in terms of psychosocial functioning. The group of participants that reported no depression at either assessment reported fewer depressive symptoms and higher psychological functioning than all other groups. The group of individuals that remained depressed at both assessments reported the poorest psychosocial functioning with a further decline in their overall quality of life at second assessment. The group whose depression resolved at second assessment was initially similar to those in the group who developed depression at second assessment, however, at second assessment, the psychosocial functioning of the resolved-depression group improved but got worse for those in the late-onset depression group. Having a diagnosis of depression prior to a TBI did not predict who would experience depression or the pattern of resolution of depression after TBI

Who May Be Affected By These Findings

 Individuals with TBI, family members, caregivers, health professionals, community providers, and researchers.

Caveats

There were several limitations in the study which should be considered. The information used for analysis was that reported by the individuals being studied; this information was not verified by another observer (for example, a family member or professional). The research design limited the study to a one year follow up of individuals. Although this time period is adequate to assess an episode of depression, the patterns of depression after TBI identified in the study may well continue to shift over time for individuals. The study did not track interventions that participants may have or have not received between the first and second assessments, e.g., use of medications for mood, therapy, other rehabilitation efforts, etc. Such interventions might have affected the psychosocial outcomes found in the study.

Bottom Line

Findings highlight differing patterns of depression after TBI and the psychosocial impacts of depression for individuals after TBI. The study points to the importance of ongoing assessment of mood and psychosocial function during the initial five years post TBI since depression may emerge, resolve or remain chronic during this time period. Timely interventions for depression may help limit the duration of the depression and thus enhance quality of life for individuals post TBI.