1 University of Maryland School of Medicine, Baltimore, Maryland.
2 OptumLabs, Visiting Fellow, Cambridge, Massachusetts.
J Neurotrauma. 2019 Jan 15;36(2):300-307. doi: 10.1089/neu.2017.5608. Epub 2018 Aug 10.
Depression is associated with poorer recovery after traumatic brain injury (TBI), yet awareness of depression risk post-TBI among providers and patients is low. The aim of this study was to estimate risk of depression post-TBI among adults 18 years of age and older and to identify risk factors associated with developing depression post-TBI. We conducted a retrospective, matched cohort study using claims data for privately insured and Medicare Advantage enrollees in a large U.S. health plan. Adults ≥18 years of age diagnosed with TBI (n = 207,354) with 12 months continuous insurance coverage pre-TBI and 24 months post-TBI were matched to controls without TBI (n = 414,708). We identified the presence of depression on any in- or outpatient claim occurring during the study period (both before and after TBI). Of the initial 622,062 individuals, 62,963 (10%) had depression pre-TBI and were excluded from incidence calculations. Incidence of depression post-TBI was 79.5 (95% confidence interval [CI], 78.5,80.5) per 1,000 person-years compared to 33.5 (95% CI, 33.1,34.0) per 1,000 person-years for those without TBI. The adjusted hazard ratio for depression post-TBI was 1.83 (95% CI, 1.79,1.86). We observed effect modification by sex and age, with males and older adults at increased risk. History of neuropsychiatric disturbances pre-TBI was the strongest predictor of depression post-TBI. Risk of depression increases substantially post-TBI. Groups at increased risk include those with a history of neuropsychiatric disturbances, older adults, and men. This study highlights the importance of long-term monitoring for depression post-TBI.
抑郁症与创伤性脑损伤 (TBI) 后的恢复较差有关，但提供者和患者对 TBI 后抑郁风险的认识较低。本研究的目的是估计 18 岁及以上成年人 TBI 后发生抑郁的风险，并确定与 TBI 后发生抑郁相关的危险因素。我们使用美国一家大型健康计划中私人保险和医疗保险优势计划参保者的索赔数据进行了回顾性、匹配队列研究。≥18 岁被诊断为 TBI（n=207354）且在 TBI 前有 12 个月连续保险覆盖期和 TBI 后有 24 个月保险覆盖期的成年人与未患 TBI 的对照者（n=414708）相匹配。我们在研究期间（TBI 前后）的任何门诊或住院索赔中确定了抑郁的存在。在最初的 622062 人中，有 62963 人（10%）在 TBI 前患有抑郁症，因此不在发病率计算范围内。TBI 后抑郁的发病率为每 1000 人年 79.5（95%置信区间 [CI]，78.5，80.5），而未患 TBI 的人每 1000 人年 33.5（95% CI，33.1，34.0）。TBI 后抑郁的调整后风险比为 1.83（95% CI，1.79，1.86）。我们观察到性别和年龄存在效应修饰，男性和老年人的风险增加。TBI 前神经精神障碍史是 TBI 后抑郁的最强预测因素。TBI 后抑郁的风险大大增加。风险增加的人群包括有神经精神障碍史、老年人和男性。本研究强调了 TBI 后长期监测抑郁的重要性。
