Hellewell Sarah C, Beaton Caerwen S, Welton Thomas, Grieve Stuart M
Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Front Neurol. 2020 May 19;11:350. doi: 10.3389/fneur.2020.00350. eCollection 2020.
Mild traumatic brain injury (mTBI) is associated with depressed mood acutely post-injury, but there is little evidence regarding long-term depression. The aim of this study was to determine the odds ratio (OR) of depression chronically following mTBI. We searched Medline (PubMed), ProQuest, and Web of Science from date of database creation to January 23, 2019, for eligible studies examining depression at least 6 months post-injury in adult subjects with mTBI of any etiology, including civilians and military. Three authors independently reviewed titles and abstracts for study eligibility. Data were extracted and collated by two investigators. Risk of bias was assessed with the SIGN methodology. Study data were pooled using random-effects meta-analysis. The primary exposure was mTBI, and the primary outcome was depression. Secondary exploratory variables were time of assessment, age at injury, age at assessment, sex, and etiology. We included 47 cross-sectional studies ( = 25,103 mTBI and 29,982 control), 26 cohort studies ( = 70,119 mTBI, 262,034 control), four prospective observational studies ( = 1,058 mTBI and 733 control), two prospective longitudinal studies ( = 119 mTBI, 81 control), two case-control studies ( = 56 mTBI, 56 control), and one randomized controlled trial ( = 252 mTBI, 3,214 control). mTBI was associated with a 3.29-fold increased risk of depression (OR 3.29, 95% CI 2.68-4.03, = 96%). The OR for depression did not change when subjects were assessed at 6-12 months (OR 2.43, 1.45-4.07), years 1-2 (OR 4.12, 2.10-8.07); 2-10 (OR 3.28, 2.42-4.46), or 10+ (OR 3.42, 1.51-7.77). Similar risk of depression was sustained across different age at injury (<25: OR 2.26, 1.82-2.81; 25-35: OR 4.67, 3.06-7.14; >35: OR 2.69, 1.42-5.10) and different age at assessment (<40 years: OR 3.14, 2.48-3.99; >40 years: OR 4.57, 2.54-8.24). Female sex had a non-significant increase in OR (OR 19.97, 2.39-166.93) compared to male (OR 3.0, 2.33-3.86). mTBI etiology had no impact on depression. Those experiencing mTBI are more than three times more likely to experience depression compared to those without a history of mTBI, and this risk remains decades beyond the mTBI event. Future longitudinal studies are needed to identify and mitigate this risk.
轻度创伤性脑损伤（mTBI）与伤后急性情绪低落有关，但关于长期抑郁的证据很少。本研究的目的是确定mTBI后慢性抑郁的比值比（OR）。我们检索了Medline（PubMed）、ProQuest和Web of Science数据库，从数据库创建之日至2019年1月23日，查找符合条件的研究，这些研究调查了任何病因的成年mTBI患者伤后至少6个月的抑郁情况，包括平民和军人。三位作者独立审查标题和摘要以确定研究是否符合条件。数据由两名研究人员提取和整理。使用SIGN方法评估偏倚风险。研究数据采用随机效应荟萃分析进行汇总。主要暴露因素是mTBI，主要结局是抑郁。次要探索性变量是评估时间、受伤年龄、评估年龄、性别和病因。我们纳入了47项横断面研究（mTBI患者25103例，对照29982例）、26项队列研究（mTBI患者70119例，对照262034例）、4项前瞻性观察性研究（mTBI患者1058例，对照733例）、2项前瞻性纵向研究（mTBI患者119例，对照81例）、2项病例对照研究（mTBI患者56例，对照56例）和1项随机对照试验（mTBI患者252例，对照3214例）。mTBI与抑郁风险增加3.29倍相关（OR 3.29，95%CI 2.68 - 4.03，P = 96%）。在6 - 12个月（OR 2.43，1.45 - 4.07）、1 - 2年（OR 4.12，2.10 - 8.07）、2 - 10年（OR 3.28，2.42 - 4.46）或10年以上（OR 3.42，1.51 - 7.77）进行评估时，抑郁的OR没有变化。不同受伤年龄（<25岁：OR 2.26，1.82 - 2.81；25 - 35岁：OR 4.67，3.06 - 7.14；>35岁：OR 2.69，1.42 - 5.10）和不同评估年龄（<40岁：OR 3.14，2.48 - 3.99；>40岁：OR 4.57，2.54 - 8.24）的抑郁风险相似。与男性（OR 3.0，2.33 - 3.86）相比，女性的OR有不显著增加（OR 19.97，2.39 - 166.93）。mTBI病因对抑郁没有影响。与没有mTBI病史的人相比，经历过mTBI的人患抑郁的可能性高出三倍多，而且这种风险在mTBI事件发生后的几十年内仍然存在。未来需要进行纵向研究来识别和减轻这种风险。
