Association of depression and anxiety with the severity of traumatic brain injury in patients from the metropolitan area of Medellín, 2019 - 2021
DOI:
https://doi.org/10.17533/udea.iatreia.172Keywords:
Anxiety, Brain Injuries, Traumatic, Depression, Patient Health QuestionnaireAbstract
Introduction: depression and anxiety are common following traumatic brain injury (TBI). However, the relationship between these disorders and TBI severity remains contradictory. The objective of this study was to evaluate the association between the occurrence of anxious or depressive symptoms and TBI severity in adults with moderate or severe TBI in Medellín, Antioquia.
Methods: Analytical study with a prospective cohort of patients aged 18 years and above with moderate or severe TBI. State and trait anxiety symptoms (measured using the STAI-E and STAI-R, respectively) and depressive symptoms (measured using the PHQ-9) were assessed at baseline and at 6 months, and compared based on TBI severity measured using the Glasgow Coma Scale (GCS). Results: A total of 58 patients were included, with 35 having severe TBI and 23 having moderate TBI. 70.6% of the patients completed the followup. Traffic accidents and falls accounted for 86% of the TBI causes. Patients with severe TBI exhibited more intense depressive symptoms at baseline
(p=0.027) and at six months (p=0.012). No significant differences were found in anxiety symptoms between groups, except for trait anxiety at six months in the severe TBI group (p=0.043).
Conclusions: The intensity of depressive symptoms measured by the PHQ- 9 is directly related to TBI severity assessed by the GCS, while the relationship between anxiety symptoms and TBI severity is less clear.
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(1) Menon DK, Schwab K, Wright DW, Maas AI; Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Position statement: definition of traumatic brain injury. Arch Phys Med Rehabil. 2010 Nov;91(11):1637-40. DOI 10.1016/j.apmr.2010.05.017.
(2) Moreno Lozada SL. Datos para la Vida. Bogotá: Forensis; 2018.
(3) Gould KR, Ponsford JL, Johnston L, Schönberger M. The nature, frequency and course of psychiatric disorders in the first year after traumatic brain injury: a prospective study. Psychol Med. 2011 Oct;41(10):2099-109. DOI 10.1017/S003329171100033X.
(4) Hart T, Benn EK, Bagiella E, Arenth P, Dikmen S, Hesdorffer DC, Et al. Early trajectory of psychiatric symptoms after traumatic brain injury: relationship to patient and injury characteristics. J Neurotrauma. 2014 Apr 1;31(7):610-7. DOI 10.1089/neu.2013.3041.
(5) Hart T, Brenner L, Clark AN, Bogner JA, Novack TA, Chervoneva I, Et al. Major and minor depression after traumatic brain injury. Arch Phys Med Rehabil. 2011 Aug;92(8):1211-9. DOI 10.1016/j.apmr.2011.03.005.
(6) Powell MR, Brown AW, Klunk D, Geske JR, Krishnan K, Green C, Bergquist TF. Injury Severity and Depressive Symptoms in a Post-acute Brain Injury Rehabilitation Sample. J Clin Psychol Med Settings. 2019 Dec;26(4):470-482. DOI 10.1007/s10880-019-09602-w.
(7) 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 May 19;303(19):1938-45. DOI 10.1001/jama.2010.599.
(8) Osborn AJ, Mathias JL, Fairweather-Schmidt AK. Prevalence of anxiety following adult traumatic brain injury: A meta-analysis comparing measures, samples and postinjury intervals. Neuropsychology. 2016 Feb;30(2):247-61. DOI 10.1037/neu0000221.
(9) Colombia. Ministerio de Salud. Boletín de salud mental Depresión, Subdirección de Enfermedades No Transmisibles. Bogotá: El Ministerio; 2017.
(10) Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G. The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol. 2014 Aug;13(8):844-54. DOI 10.1016/S1474-4422(14)70120-6.
(11) Cassiani-Miranda CA, Cuadros-Cruz AK, Torres-Pinzón H, Scoppetta O, Pinzón-Tarrazona JH, Et al. Validity of the Patient Health Questionnaire-9 (PHQ-9) for depression screening in adult primary care users in Bucaramanga, Colombia. Rev Colomb Psiquiatr (Engl Ed). 2021 Jan-Mar;50(1):11-21. DOI 10.1016/j.rcp.2019.09.001.
(12) Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012 Feb 21;184(3):E191-6. DOI 10.1503/cmaj.110829.
(13) Kvaal K, Ulstein I, Nordhus IH, Engedal K. The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients. Int J Geriatr Psychiatry. 2005 Jul;20(7):629-34. DOI 10.1002/gps.1330.
(14) Guillén-Riquelme A, Buela-Casal G. Metaanálisis de comparación de grupos y metaanálisis de generalización de la fiabilidad del cuestionario State-Trait Anxiety Inventory (STAI) [Meta-analysis of group comparison and meta-analysis of reliability generalization of the State-Trait Anxiety Inventory Questionnaire (STAI)]. Rev Esp Salud Publica. 2014 Jan-Feb;88(1):101-12. Spanish. DOI 10.4321/S1135-57272014000100007.
(15) Fritz CO, Morris PE, Richler JJ. Effect size estimates: current use, calculations, and interpretation. J Exp Psychol Gen. 2012 Feb;141(1):2-18. DOI 10.1037/a0024338.
(16) Colombia. Ministerio de Salud. Colciencias. Encuesta Nacional de Salud Mental 2015. Bogotá: El Ministerio; 2015.
(17) Osborn AJ, Mathias JL, Fairweather-Schmidt AK. Depression following adult, non-penetrating traumatic brain injury: a meta-analysis examining methodological variables and sample characteristics. Neurosci Biobehav Rev. 2014 Nov;47:1-15. DOI 10.1016/j.neubiorev.2014.07.007.
(18) Scholten AC, Haagsma JA, Cnossen MC, Olff M, van Beeck EF, Polinder S. Prevalence of and Risk Factors for Anxiety and Depressive Disorders after Traumatic Brain Injury: A Systematic Review. J Neurotrauma. 2016 Nov 15;33(22):1969-94. DOI 10.1089/neu.2015.4252.
(19) Jorge RE, Robinson RG, Starkstein SE, Arndt SV. Depression and anxiety following traumatic brain injury. J Neuropsychiatry Clin Neurosci. 1993 Fall;5(4):369-74. DOI 10.1176/jnp.5.4.369.
(20) Colombia. Ministerio de Salud. Colciencias. Encuesta Nacional de Salud, Bienestar y Envejecimiento, SABE Colombia, 2014-2015. Bogotá: El Ministerio; 2021.
(21) Bodnar CN, Morganti JM, Bachstetter AD. Depression following a traumatic brain injury: uncovering cytokine dysregulation as a pathogenic mechanism. Neural Regen Res. 2018 Oct;13(10):1693-704. DOI 10.4103/1673-5374.238604.
(22) Lewis FD, Horn GJ. Depression following traumatic brain injury: Impact on post-hospital residential rehabilitation outcomes. NeuroRehabilitation. 2017;40(3):401-10. DOI 10.3233/NRE-161427.
(23) Fann JR, Bombardier CH, Temkin N, Esselman P, Warms C, Barber J, Dikmen S. Sertraline for Major Depression During the Year Following Traumatic Brain Injury: A Randomized Controlled Trial. J Head Trauma Rehabil. 2017 Sep/Oct;32(5):332-42. DOI 10.1097/HTR.0000000000000322.
(24) Kumar RG, Gao S, Juengst SB, Wagner AK, Fabio A. The effects of post-traumatic depression on cognition, pain, fatigue, and headache after moderate-to-severe traumatic brain injury: a thematic review. Brain Inj. 2018;32(4):383-394. DOI 10.1080/02699052.2018.1427888.
(25) Sanabria-Mazo J, Riaño-Lara V, Rojas-Gomez J, Carmona M, Méndez-Ulrich J, Feliu-Soler A, et al. Efectos en la salud mental de la población colombiana durante la pandemia del COVID. PSY-COVID-COLOMBIA. 2020. DOI 10.13140/RG.2.2.33334.52805/4.
(26) Cifuentes-Avellaneda A, Rivera-Montero D, Vera-Gil C, Murad-Rivera R, Sánchez S, Castaño L, et al. Ansiedad, depresión y miedo: impulsores de la mala salud mental durante el distanciamiento físico en Colombia. Bogotá: Profamilia; 2020.
(27) Cnossen MC, Scholten AC, Lingsma HF, Synnot A, Haagsma J, Steyerberg PEW, Polinder S. Predictors of Major Depression and Posttraumatic Stress Disorder Following Traumatic Brain Injury: A Systematic Review and Meta-Analysis. J Neuropsychiatry Clin Neurosci. 2017 Summer;29(3):206-224. DOI 10.1176/appi.neuropsych.16090165.
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