Health & Medicine - Posted by Leila Gray-UW on Monday, June 7, 2010 12:54 - 2 Comments 
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(2 votes, average: 5.00 out of 5) Loading ...Depression, brain injury go hand-in-hand
Proactive mental health care should be considered as an integral part of treatment and rehabilitation following a traumatic brain injury. More than half of brain injury patients develop major depression within a year, but only 44 percent receive antidepressant medications or counseling. (Credit: iStockphoto)
U. WASHINGTON (US)—More than half of adults who suffer a traumatic brain injury develop major depression in the following year, according to a new study, but less than 50 percent of them receive antidepressant medications or counseling.
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The text of this article by Futurity is licensed under a Creative Commons Attribution-No Derivatives License.
“We found a very high prevalence of depression in the months after the head injury,” explains Charles Bombardier, professor of rehabilitative medicine at the University of Washington.
“Yet only 44 percent of the depressed patients received antidepressant medications or counseling.”
This is especially surprising, he says, because patients with brain injury are seen regularly by health care providers in the months after their injury.
Attention is directed to physical and cognitive impairments and depression is sometimes overlooked, he explains.
Every year some 1.7 million Americans suffer a mild to severe traumatic brain injury. Moderate to severe brain injury makes up about 25 percent of the total.
Psychological impairments represent significant causes of disability in these patients. Major depressive disorder may be the most common and debilitating of these conditions.
Poorer cognitive functioning, more aggression and anxiety, greater functional disability, poorer recovery, higher rates of suicide attempts, and greater health-care costs are more common when traumatic brain injury is followed by depression, says Jesse Fann, associate professor of psychiatry and behavioral sciences.
Patients who had major depression reported a lower quality of life, difficulty managing their daily routine, and less mobility, compared to similarly injured patients who were not depressed. The depressed patients also had a nine times higher rate of anxiety disorders, compared to the non-depressed patients.
Details appear in the Journal of the American Medical Association.
The findings suggest that proactive mental health care should be integrated into the treatment and rehabilitation of brain injured patients. Health-care providers working with recently brain injured patients should know that their patients are at high risk for depression, they note.
Screening patients for depression, and referring patients for appropriate treatment, may improve the patient’s quality of life and ability to function.
In many cases, the authors say, depression counseling therapy might need to be tailored to accommodate thinking difficulties that accompany some brain injuries, such as finding it hard to pay attention, losing a train of thought, poor memory, or not being able to multi-task.
Brain-injury patients with a previous history of depression or alcohol dependence were more likely to have an episode of major depression. However, 41 percent of the brain injury patients who became depressed had never had depression before.
The severity of the injury did not predict who would or would not become depressed. People ages 30 to 44 and women developed depression at a higher rate than did others in the study group. People age 60 and over had the lowest rate of depression in the study.
During the first year, 297 of 559 patients (53.1 percent) met criteria for major depressive disorder at least once. This rate is about eight times greater than would be expected in the general population.
Several features of major depressive disorder after traumatic brain injury are pertinent to future detection and treatment efforts, including the fact that about half of the patients who became depressed were identified by 3 months.
A window of opportunity might be available for early identification and prevention or treatment. Risk of major depression persists throughout the first year regardless of pre-injury depression history, and that risk of post-brain injury depression probably persists beyond one year, the researchers say.
More University of Washington news: http://uwnews.org/uwnhome.asp
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2 Comments
harley lee
Patients who have suffered traumatic brain and spinal cord injury, as well as other neurological or orthopedic injury, often have severe upper or lower extremity movement impairments. In short they have difficulty in doing the everyday living tasks that others take fro granted.
It is well documented in the literature that an important component in achieving optimal rehabilitation outcome is intensive active movement practice. Traditional Occupational and Physical therapy mainly provide the patient with task orientated training (TOT) also known as Task Specific Practice (TSP) or functional movement training. TSP is intensive repetition of everyday functional tasks or Active daily living tasks.
On a practical treatment aspect, many brain and spinal cord injury patients do not have sufficient movement ability to enable them to do repetitive active tasks or the active tasks can not be customized to work on their specific motor, sensory or cognitive impairment. This may lead to frustration and depression in itself!!
It is therefore an ongoing challenge for physical therapists and other health care professionals to find effective interventions that improve arm and hand function for patients with more severe paresis. Recently, additional rehabilitation tools such as the HandTutor have been developed that focus on evaluating and training isolated and co-ordinated movement parameters. Correct functional movement is dependent on normal kinematic movement parameters such as range, speed, and accuracy of movement. On a practical treatment level the HandTutor allows many patients that do not have sufficient movement ability to enable them to do repetitive active tasks, or the active tasks can not be customized to work on their specific motor, sensory or cognitive impairment. The HandTutor is a rehabilitation glove and software which offers impairment oriented training and augmented feedback. The HandTutor encourages active repetitive customized isolated or inter joint coordinated finger and wrist hand exercises and rehabilitates fine movements of the hand and wrist. The software is dedicated to rehabilitation and is easy to understand by both the patient and the therapist. This enables the exercises to be customized to the patients movement impairment so that they remain encouraged and motivated to continue intensive exercise practice. The HandTutor is used in hospitals and community hand therapy clinics as well as through tele rehabilitation. Examples of patients that are treated include Stroke, TBI, spinal cord injury CP, Orthopedic hand and arm surgery.
Well when your body goes through a traumatic experience I think your brain goes through a panic attack and your train of thought acts as though it resets and now that experience can change who you are and there would be a change in your everyday routine that will change decisions, judgement, and thoughts. I agree with this article because having self confidence vs. A low self esteem becomes a huge difference and the outcome is either depression or being normal after a stressful event.