Juengst Shannon B, Wagner Amy K, Ritter Anne C, Szaflarski Jerzy P, Walker William C, Zafonte Ross D, Brown Allen W, Hammond Flora M, Pugh Mary Jo, Shea Timothy, Krellman Jason W, Bushnik Tamara, Arenth Patricia M
Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States.
Physical Medicine & Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA, United States; Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, United States; Center for Neuroscience at University of Pittsburgh, Pittsburgh, PA, United States.
Epilepsy Behav. 2017 Aug;73:240-246. doi: 10.1016/j.yebeh.2017.06.001. Epub 2017 Jun 26.
Research suggests that there are reciprocal relationships between mental health (MH) disorders and epilepsy risk. However, MH relationships to post-traumatic epilepsy (PTE) have not been explored. Thus, the objective of this study was to assess associations between PTE and frequency of depression and/or anxiety in a cohort of individuals with moderate-to-severe TBI who received acute inpatient rehabilitation.
Multivariate regression models were developed using a recent (2010-2012) cohort (n=867 unique participants) from the TBI Model Systems (TBIMS) National Database, a time frame during which self-reported seizures, depression [Patient Health Questionnaire (PHQ)-9], and anxiety [Generalized Anxiety Disorder (GAD-7)] follow-up measures were concurrently collected at year-1 and year-2 after injury.
PTE did not significantly contribute to depression status in either the year-1 or year-2 cohort, nor did it contribute significantly to anxiety status in the year-1 cohort, after controlling for other known depression and anxiety predictors. However, those with PTE in year-2 had 3.34 times the odds (p=.002) of having clinically significant anxiety, even after accounting for other relevant predictors. In this model, participants who self-identified as Black were also more likely to report clinical symptoms of anxiety than those who identified as White. PTE was the only significant predictor of comorbid depression and anxiety at year-2 (Odds Ratio 2.71; p=0.049).
Our data suggest that PTE is associated with MH outcomes 2years after TBI, findings whose significance may reflect reciprocal, biological, psychological, and/or experiential factors contributing to and resulting from both PTE and MH status post-TBI. Future work should consider temporal and reciprocal relationships between PTE and MH as well as if/how treatment of each condition influences biosusceptibility to the other condition.
研究表明心理健康（MH）障碍与癫痫风险之间存在相互关系。然而，尚未探讨MH与创伤后癫痫（PTE）之间的关系。因此，本研究的目的是评估在接受急性住院康复治疗的中重度创伤性脑损伤（TBI）患者队列中，PTE与抑郁和/或焦虑频率之间的关联。
使用创伤性脑损伤模型系统（TBIMS）国家数据库中最近（2010 - 2012年）的队列（n = 867名独特参与者）建立多元回归模型，在该时间段内，于受伤后第1年和第2年同时收集自我报告的癫痫发作、抑郁[患者健康问卷（PHQ）-9]和焦虑[广泛性焦虑障碍（GAD - 7）]的随访测量数据。
在控制了其他已知的抑郁和焦虑预测因素后，PTE在第1年或第2年的队列中对抑郁状态均无显著贡献，在第1年的队列中对焦虑状态也无显著贡献。然而，在第2年患有PTE的患者出现具有临床意义的焦虑的几率是其他患者的3.34倍（p = 0.002），即使在考虑了其他相关预测因素之后。在该模型中，自我认定为黑人的参与者比认定为白人的参与者更有可能报告焦虑的临床症状。PTE是第2年合并抑郁和焦虑的唯一显著预测因素（优势比2.71；p = 0.049）。
我们的数据表明，PTE与TBI后2年的心理健康结果相关，这些发现的意义可能反映了导致PTE和TBI后MH状态以及由它们导致的相互、生物学、心理和/或经验因素。未来的研究应考虑PTE与MH之间的时间和相互关系，以及每种疾病的治疗是否/如何影响对另一种疾病的生物易感性。
