Dikmen Sureyya S, Bombardier Charles H, Machamer Joan E, Fann Jesse R, Temkin Nancy R
Department of Rehabilitation Medicine, University of Washington, Seattle 98195, USA.
Arch Phys Med Rehabil. 2004 Sep;85(9):1457-64. doi: 10.1016/j.apmr.2003.12.041.
To examine prospectively the rates, risk factors, and phenomenology of depression over 3 to 5 years after traumatic brain injury (TBI).
Inception cohort longitudinal study.
Level I trauma center.
Consecutive admissions of 283 adults with moderate to severe TBI.
Not applicable.
Center for Epidemiologic Studies Depression (CES-D) Scale.
The rates of moderate to severe depression ranged from 31% at 1 month to 17% at 3 to 5 years. With 1 exception, the relation between brain injury severity and depression was negligible. Less than high school education, preinjury unstable work history, and alcohol abuse predicted depression after injury. Examination of CES-D factors indicate that, in addition to somatic symptoms, both depressed affect and lack of positive affect contribute to elevated CES-D scores.
High rates of depressive symptoms cannot be dismissed on grounds that somatic symptoms related to brain injury are mistaken for depression. Depressed affect and lack of positive affect are also elevated in persons with TBI. Preinjury psychosocial factors are predictive of depression and knowing them should facilitate efforts to detect, prevent, and treat depression after TBI.
前瞻性研究创伤性脑损伤（TBI）后3至5年的抑郁症发病率、危险因素及症状表现。
起始队列纵向研究。
一级创伤中心。
283例中重度TBI成年患者连续入院病例。
不适用。
流行病学研究中心抑郁量表（CES-D）。
中重度抑郁症发病率从1个月时的31%降至3至5年时的17%。除1例例外，脑损伤严重程度与抑郁症之间的关系可忽略不计。高中以下学历、伤前工作经历不稳定和酗酒是伤后抑郁症的预测因素。对CES-D各项因素的检查表明，除躯体症状外，抑郁情绪和缺乏积极情绪均会导致CES-D评分升高。
不能以与脑损伤相关的躯体症状被误诊为抑郁症为由而忽视高比例的抑郁症状。TBI患者的抑郁情绪和缺乏积极情绪也较为突出。伤前心理社会因素可预测抑郁症，了解这些因素应有助于TBI后抑郁症的检测、预防和治疗。
