February 4, 2019Psychiatry
According to an article published in JAMA Psychiatry (30 January 2019), results showed that approximately 1 in 5 individuals may experience mental health symptoms up to six months after mild traumatic brain injury (mTBI), suggesting the importance of follow-up care for these patients. The authors also identified factors that may increase the risk of developing post-traumatic stress disorder (PTSD) and/or major depressive disorder following mild mTBI or concussion through analysis of the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study cohort.
The study investigated mental health outcomes in 1,155 people who had experienced a mild TBI and were treated in the emergency department. At three, six, and 12 months after injury, study participants completed various questionnaires related to PTSD and major depressive disorder. For a comparison group, the authors also surveyed individuals who had experienced orthopedic traumatic injuries, such as broken legs, but did not have head injury. Results showed that at three and six months following injury, people who had experienced mTBI were more likely than orthopedic trauma patients to report symptoms of PTSD and/or major depressive disorder. For example, three months after injury, 20% of mTBI patients reported mental health symptoms compared to 8.7% of orthopedic trauma patients. At six months after injury, mental health symptoms were reported by 21.2% of people who had experienced head injury and 12.1% of orthopedic trauma patients.
The authors also used the data to determine risk factors for PTSD and major depressive disorder after mTBI. The findings revealed that lower levels of education, self-identifying as African-American, and having a history of mental illness increased risk. In addition, if the head injury was caused by an assault or other violent attack, that increased the risk of developing PTSD, but not major depressive disorder. However, risk of mental health symptoms was not associated with other injury-related occurrences such as duration of loss of consciousness or posttraumatic amnesia. According to the authors, contrary to common assumptions, mild head injuries can cause long-term effects and the study findings suggest that follow-up care after head injury, even for mild cases, is crucial, especially for patients showing risk factors for PTSD or depression.
The TRACK-TBI initiative, which is a large, long-term study of patients treated in the emergency department for mTBI. The goal of the study is to improve understanding of the effects of concussions by establishing a comprehensive database of clinical measures including brain images, blood samples, and outcome data for 3,000 individuals, which may help identify biomarkers of TBI, risk factors for various outcomes, and improve our ability to identify and prevent adverse outcomes of head injury. To date, more than 2,700 individuals have enrolled in TRACK-TBI.
A recent study coming out of TRACK-TBI suggested that many TBI patients were not receiving recommended follow-up care.