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.
“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.
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