Fann Jesse R, Burington Bart, Leonetti Alexandra, Jaffe Kenneth, Katon Wayne J, Thompson Robert S
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98105-6560, USA.
Arch Gen Psychiatry. 2004 Jan;61(1):53-61. doi: 10.1001/archpsyc.61.1.53.
Psychiatric illness after traumatic brain injury (TBI) has been shown to be prevalent in hospitalized and tertiary care patient populations.
To determine the risk of psychiatric illness after TBI in an adult health maintenance organization population.
Prospective cohort study.
Large staff-model health maintenance organization.
Nine hundred thirty-nine health plan members diagnosed as having TBI in 1993 and enrolled in the prior year, during which no TBI was ascertained. Three health plan members per TBI-exposed subject were randomly selected as unexposed comparisons, matched for age, sex, and reference date.
Psychiatric illness in the 3 years after the TBI reference date, determined using computerized records of psychiatric diagnoses according to the International Classification of Diseases, Ninth Revision, Clinical Modification, prescriptions, and service utilization.
Prevalence of any psychiatric illness in the first year was 49% following moderate to severe TBI, 34% following mild TBI, and 18% in the comparison group. Among subjects without psychiatric illness in the prior year, the adjusted relative risk for any psychiatric illness in the 6 months following moderate to severe TBI was 4.0 (95% confidence interval [CI], 2.4-6.8) and following mild TBI was 2.8 (95% CI, 2.1-3.7; P<.001) compared with those without TBI. Among subjects with prior psychiatric illness, the adjusted relative risk for any psychiatric illness in the 6 months following moderate to severe TBI was 2.1 (95% CI, 1.3-3.3) and following mild TBI was 1.6 (95% CI, 1.2-2.0; P =.005). Prior psychiatric illness significantly modified the relationship between TBI and subsequent psychiatric illness (P =.04) and was a significant predictor (P<.001). Persons with mild TBI and prior psychiatric illness had evidence of persisting psychiatric illness.
Both moderate to severe and mild TBI are associated with an increased risk of subsequent psychiatric illness. Whereas moderate to severe TBI is associated with a higher initial risk, mild TBI may be associated with persistent psychiatric illness.
创伤性脑损伤（TBI）后的精神疾病在住院患者和三级护理患者群体中普遍存在。
确定成人健康维护组织人群中TBI后精神疾病的风险。
前瞻性队列研究。
大型员工模式健康维护组织。
1993年被诊断患有TBI且上一年入组的939名健康计划成员，上一年未确诊TBI。每例TBI暴露受试者随机选取3名健康计划成员作为未暴露对照，按年龄、性别和参考日期进行匹配。
TBI参考日期后3年内的精神疾病，根据《国际疾病分类》第九版临床修订版的精神疾病诊断计算机记录、处方和服务利用情况确定。
中度至重度TBI后第一年任何精神疾病的患病率为49%，轻度TBI后为34%，对照组为18%。在之前一年无精神疾病的受试者中，中度至重度TBI后6个月内任何精神疾病的校正相对风险为4.0（95%置信区间[CI]，2.4 - 6.8），轻度TBI后为2.8（95% CI，2.1 - 3.7；P <.001），与无TBI者相比。在之前有精神疾病的受试者中，中度至重度TBI后6个月内任何精神疾病的校正相对风险为2.1（95% CI，1.3 - 3.3），轻度TBI后为1.6（95% CI，1.2 - 2.0；P =.005）。既往精神疾病显著改变了TBI与随后精神疾病之间的关系（P =.04），且是一个显著的预测因素（P <.001）。轻度TBI且既往有精神疾病的人有持续精神疾病的证据。
中度至重度和轻度TBI均与随后精神疾病风险增加相关。中度至重度TBI与较高的初始风险相关，而轻度TBI可能与持续性精神疾病相关。
