Abstract
Behavioral disorders are major sequelae of severe traumatic brain injury. Before considering care management of these disorders, and in the absence of a precise definition for TBI-related behavioral disorder, it is essential to refine, according to the data from the literature, incidence, prevalence, predictive factors of commonly admitted disruptive symptoms.
Methods
Systematic review of the literature targeting epidemiological data related to behavioral disorders after traumatic brain injury in order to elaborate good practice recommendations according to the methodology established by the French High Authority for Health.
Results
Two hundred and ninety-nine articles were identified. The responsibility of traumatic brain injury (TBI) in the onset of behavioral disorders is unequivocal. Globally, behavioral disorders are twice more frequent after TBI than orthopedic trauma without TBI (Masson et al., 1996). These disorders are classified into disruptive primary behaviors by excess (agitation 11–70%, aggression 25–39%, irritability 29–71%, alcohol abuse 7–26% drug abuse 2–20%), disruptive primary behaviors by default (apathy 20–71%), affective disorders – anxiety – psychosis (depression 12–76%, anxiety 0.8–24,5%, posttraumatic stress 11–18%, obsessive-compulsive disorders 1.2–30%, psychosis 0.7%), suicide attempts and suicide 1%.
Discussion
The improvement of care management for behavioral disorders goes through a first step of defining a common terminology. Four categories of posttraumatic behavioral clinical symptoms are defined: disruptive primary behaviors by excess, by default, affective disorders-psychosis-anxiety, suicide attempts and suicide. All these symptoms yield a higher prevalence than in the general population. They impact all of life’s domains and are sustainable over time.
1
Introduction
Behavioral disorders are common and contribute to the severity of the trauma, around 62% at one year from trauma, regardless of the initial TBI severity . These disorders are still present at 5 years posttrauma . They frequently appear right from the awakening period and family members of patients with severe TBI report at 3 months post-TBI that patients “are not the way they used to be” in 49% of cases vs. 60% at one year and 74% at 5 years . In this latter study by Brooks et al., the most frequently reported behavioral, affective or psychological changes concerned irritability (64%), bad temper (64%), tiredness (62%), depression (57%), rapid mood change (57%), anxiety (57%) and threat of violence (54%). At two years post-TBI, irritability was also reported as one of the most common problems by Ponsford et al. . Furthermore, authors noted that lack of initiative was present in 44% of cases, and inappropriate social behavior in 26% of cases.
However, no systematic review of the literature was recently conducted. Furthermore, no precise definition of behavioral disorder post-TBI was found. In the population of persons with intellectual disabilities, Tassé et al. defined serious behavioral disorders as “behaviors that are noxious for the health or physical integrity of the person”. One can consider that a behavioral disorder exists when the behavior of a person is deemed deviant, unacceptable or dangerous compared to what would be considered normal within a group of person sharing the same values and a common culture.
The objective of this work was to refine the incidence, predictive factors and progression of the different behavioral disorders encountered after moderate or severe traumatic brain injury in adults. These recommendations were elaborated by a group of expert following the HAS protocol ( http://www.has-sante.fr/portail/jcms/c_431294/recommandations-pour-la-pratique-clinique-rpc ) that includes several criteria of the PRISMA method (criteria 1, 2, 3, 6, 7, 13, 15) .
2
Methods
The steering group of this project, consisting of several experts in TBI care management, proposed to differentiate disruptive primary behaviors by excess from disruptive primary behaviors by default. Four subgroups of behavioral disorders were considered in this work:
- •
disruptive primary behaviors by excess;
- •
disruptive primary behaviors by default;
- •
affective disorders, anxiety and psychosis;
- •
suicide attempts and suicide.
Cognitive disorders were considered as a different entity and are not included in the framework of this article.
The review of the literature was conducted on Medline, in French and English from January 1990 to March 2012 as well as in books and articles not referenced in the Medline database, this search was conducted by the French High Authority for Health services. An additional search was conducted up to June 2015 without the help of the French High Authority for Health. Keywords used for the Medline search were the following: (“Craniocerebral Trauma” [Majr]) OR “Brain Injuries” [Majr] Or (Brain injur* Or Brain trauma* Or Head injur* Or Head trauma*) [title] AND “Mental Disorders” [Mesh] OR “Mood Disorders” [Mesh] OR “Anxiety” [Mesh] OR “Anxiety Disorders” [Mesh] OR “Depression” [Mesh] OR “Depressive Disorder” [Mesh] OR “Depressive Disorder, Major” [Mesh] OR “Psychotic Disorders” [Mesh] OR “Apathy” [Mesh] OR “Aggression” [Mesh] OR “Irritable Mood” [Mesh] OR “Anger” [Mesh] OR “Psychomotor Agitation” [Mesh] OR “Substance-Related Disorders” [Mesh] OR “Cognition Disorders” [Mesh] OR “Executive Function” [Mesh] OR “Awareness” [Mesh] OR “Agnosia” [Mesh] AND “Epidemiology” [Mesh] OR “Prevalence” [Mesh] OR “Incidence” [Mesh] NOT “Critical Care” [Mesh] OR “Child” [Mesh] OR “Infant” [Mesh]OR “Pediatrics” [Mesh] OR “Adolescent” [Mesh] Or (Critical care OR child* OR infan* Or paediatr* or pediatr* OR adolescent*).
Articles focusing on the prevalence or incidence of all types of behavioral disorders post-TBI were kept for this analysis (follow-up of cohorts, cross-sectional studies, longitudinal studies, case studies). Studies that had a more general approach on neuropsychiatric disorders post-TBI were also considered. Articles related to evaluation scales were not kept for this analysis, they are the focus of another article in this special thematic issue. Studies targeting other pathologies than moderate to severe TBI (other neurological diseases, mild TBI, TBI in war veterans) were excluded. Articles were analyzed taking into account potential biases (selection bias, heterogeneity of the population, inclusion delay, use of specific adapted scales).
2
Methods
The steering group of this project, consisting of several experts in TBI care management, proposed to differentiate disruptive primary behaviors by excess from disruptive primary behaviors by default. Four subgroups of behavioral disorders were considered in this work:
- •
disruptive primary behaviors by excess;
- •
disruptive primary behaviors by default;
- •
affective disorders, anxiety and psychosis;
- •
suicide attempts and suicide.
Cognitive disorders were considered as a different entity and are not included in the framework of this article.
The review of the literature was conducted on Medline, in French and English from January 1990 to March 2012 as well as in books and articles not referenced in the Medline database, this search was conducted by the French High Authority for Health services. An additional search was conducted up to June 2015 without the help of the French High Authority for Health. Keywords used for the Medline search were the following: (“Craniocerebral Trauma” [Majr]) OR “Brain Injuries” [Majr] Or (Brain injur* Or Brain trauma* Or Head injur* Or Head trauma*) [title] AND “Mental Disorders” [Mesh] OR “Mood Disorders” [Mesh] OR “Anxiety” [Mesh] OR “Anxiety Disorders” [Mesh] OR “Depression” [Mesh] OR “Depressive Disorder” [Mesh] OR “Depressive Disorder, Major” [Mesh] OR “Psychotic Disorders” [Mesh] OR “Apathy” [Mesh] OR “Aggression” [Mesh] OR “Irritable Mood” [Mesh] OR “Anger” [Mesh] OR “Psychomotor Agitation” [Mesh] OR “Substance-Related Disorders” [Mesh] OR “Cognition Disorders” [Mesh] OR “Executive Function” [Mesh] OR “Awareness” [Mesh] OR “Agnosia” [Mesh] AND “Epidemiology” [Mesh] OR “Prevalence” [Mesh] OR “Incidence” [Mesh] NOT “Critical Care” [Mesh] OR “Child” [Mesh] OR “Infant” [Mesh]OR “Pediatrics” [Mesh] OR “Adolescent” [Mesh] Or (Critical care OR child* OR infan* Or paediatr* or pediatr* OR adolescent*).
Articles focusing on the prevalence or incidence of all types of behavioral disorders post-TBI were kept for this analysis (follow-up of cohorts, cross-sectional studies, longitudinal studies, case studies). Studies that had a more general approach on neuropsychiatric disorders post-TBI were also considered. Articles related to evaluation scales were not kept for this analysis, they are the focus of another article in this special thematic issue. Studies targeting other pathologies than moderate to severe TBI (other neurological diseases, mild TBI, TBI in war veterans) were excluded. Articles were analyzed taking into account potential biases (selection bias, heterogeneity of the population, inclusion delay, use of specific adapted scales).
3
Results
The electronic searches (Medline 1990–2012) returned 162 citations and 42 in the additional research (Medline 2012–2015). After screening titles and abstracts, 124 records were discarded as irrelevant or obviously not meeting the selection criteria. Hand-searching identified 219 additional eligible articles, hence leaving a total of 299 articles.
3.1
Disruptive primary behaviors by excess
The analysis of the literature unveiled several symptoms such as agitation, opposition, wandering behaviors, disinhibition, irritability, impulsivity, screams and shouting, risk-taking attitudes, bulimia, addictions, hypersexuality, exhibitionism, Kluver-Bucy* syndrome, hostility, aggression, verbal and physical violence. Some themes such as opposition, aggression, circadian rhythm disorders, inappropriate wandering or motor behaviors, screams, motor disinhibition are symptoms similar to the ones present in Alzheimer’s disease and answer to the same characteristics (good practices recommendations: Alzheimer’s disease and related disorders: management of disruptive behavioral disorders – HAS website 2009). It was decided to classify the disorders into 5 sub-chapters:
- •
agitation;
- •
aggression;
- •
irritability;
- •
substance abuse: at-risk, excessive, dependent behavior;
- •
behavior with medicolegal consequences, felony and crime.
3.1.1
Posttraumatic agitation
Posttraumatic agitation is a common if not unavoidable characteristic of the coma-awakening period . It is related to the altered state of consciousness posttraumatic amnesia period , and decreases when cognitive functions improve . The duration is usually short (1 to 14 days) but can sometimes last longer or appear later on . No type of behavior defines agitation, it can be a combination of aggression, akathisia, disinhibition, emotional lability, motor restlessness or for others, impulsivity, disorganized thinking, perceptual disturbances, impaired capacity to sustain attention or reduced adaptation . The mean incidence of agitation is estimated at 46% with ranges going from 11 to 70%. Environmental causes, sleep disorders, pain promote agitation . The functional future is related to the duration and severity of the agitation (see Table 1 : main studies on agitation after TBI).
| References | Design | Level | Conclusion |
|---|---|---|---|
| Levin and Grossman, 1978 | Longitudinal study, n = 80 closed head injury of graded severity | 4 | Agitation: 35% |
| Reyes et al., 1981 | Longitudinal study, n = 87 traumatic head injury followed over 5 years or more from admission to post-discharge | 4 | Agitation: 50% |
| Brooke et al., 1992 | Longitudinal Study, n = 100 severe closed head injury admitted to a regional level I Trauma Center with a Glasgow Coma Scale < 8 + more than one hour of coma + more than one week of hospitalization. OAS | 4 | Aggression: 11% 11% exhibited episodic agitation. Eight subjects were agitated for one week, one for two weeks, one for three weeks, and one for four weeks Restlessness: 35% |
| Bogner and Corrigan, 1995 | 100 consecutive patients admitted in rehabilitation | 4 | 42% demonstrated agitation |
| Wolf et al., 1996 | Survey study. All skilled nursing facilities in the state of Connecticut (253) | 4 | One hundred and sixty-two, or 64%, responded to the survey, 39 (24%) of the facilities reported 140 individuals with a primary diagnosis of brain injury, 45% of the 39 facilities had brain-injured patients with agitation |
| Bogner et al., 2001 | Prospective longitudinal study, n = 340 consecutive TBI admitted in an acute brain injury rehabilitation. Age ≥ 14 years. Severe TBI 64%, moderate TBI 13%, mild TBI 22%. Assessment with ABS | 4 | 36% of agitation Agitation was associated with: longer length of stay and decreased functional independence in the cognitive realm at discharge |
| Nott et al., 2006 | Retrospective study, n = 80 TBI (graded severity) admitted for rehabilitation | 4 | 70% of patients demonstrated agitation during rehabilitation for an average of 32 days (86% in acute stage of rehabilitation) Agitated patients experienced increased length of stay, longer PTA duration, reduced functional independence at discharge |
3.1.2
Aggression
Aggression includes verbal aggression, physical aggression against objects, physical aggression against self, other persons but also severe irritability, violent, hostile, or assaultive behavior and “episodic dyscontrol” . After traumatic brain injury, hostile or explosive aggression is more frequent than goal-directed aggression . Aggression incidence varies between 25 and 39%. It is related to the severity of the initial trauma and the existence of a prefrontal injury (orbitofrontal) . Aggressive behaviors are more frequent in older male subjects, when there is associated language disorders, in a noisy environment, in the 24 hours following epileptic seizure . Depression and anxiety are more common in the aggressive TBI patient . Anger is more frequent in patients with executive function disorders (see Table 2 : main studies on aggression after TBI). More recently, a link between history of aggression and verbal aggression post-TBI was evidenced .
| References | Design | Level | Conclusion |
|---|---|---|---|
| Tateno et al., 2003 | Case-control study: 89 severe TBI matched 26 multiple trauma cases (without TBI) Assessment with the OAS in the 6 months after injury | 3 | 33.7% of the TBI group met the criteria for aggressive behavior compared with 11.5% of the non-TBI injured Major depressive disorder, history of alcohol and substance abuse, poor premorbid social functioning, frontal lobe lesion was more frequent in the aggressive group |
| Galski et al., 1994 | Prospective study, n = 13 TBI | 4 | Aggression: 39%: 29% physical aggression; 21% verbal aggression; 11% both |
| Johnson and Balleny, 1996 | Prospective study: n = 33 severe TBI. Short questionnaire using seven categories of behavior including physical and verbal aggression | 4 | 6% in hospital, 13% 18 months or less since injury, 55% more than 18 months since injury (family report) |
| Alderman et al., 1997 | Prospective study, n = 18 severe TBI. Assessment with OAS-MNR | 4 | 15 TBI have 76 aggressive behavior |
| Kant et al., 1998 | Longitudinal Prospective study: n = 13 closed head injury with aggression (mild TBI 5, moderate TBI 6, severe TBI 2). Assessment with OAS-M | 4 | OAS-M mean score for 13 TBI = 230.54 This study does not calculate incidence or prevalence |
| Baguley et al., 2006 | Retrospective study: 228 patients with moderate to severe TBI (post-discharge). Assessment with OAS at 6 months ( n = 149), at 24 months ( n = 133), at 60 months ( n = 60) | 4 | 25% of aggression at 6 months at any given follow-up period (but participants differ) Aggression was consistently associated with depression concurrent traumatic complaints, younger age at injury, and low satisfaction with life |
| Alderman, 2007 | Prospective study. Records of aggressive behaviour shown by 108 patients over 14 days Assessment with OAS-MNR | 4 | 729 physical assaults were made on others |
| Giles and Mohr, 2007 | Inter-rater reliability of an incident-based rating scale for aggressive behaviour following traumatic brain injury n = 17, TBI. Assessment with OAS-MNR-E | 4 | There were 199 observed aggressive behaviors: verbal aggression: 66, physical aggression against objects: 33, physical aggression against self: 7, and physical aggression against others: 97 |
| Rao et al., 2009 | Observational prospective study of the prevalence of aggression in the 3 months following TBI in a cohort of participants recruited within 3 months of trauma. n = 67, TBI. Assessment with OAS | 4 | Prevalence of aggression was found to be 28.4%, predominantly verbal aggression Post-TBI aggression was associated with new-onset major depression, poorer social functioning, and increased dependency in activities of daily living |
| Dickens et al., 2011 | Prospective study about OAS-MNR and Attacks scales to measure aggression during 6 weeks on a brain injury unit. n = 40 patients in National Brain Injury Center | 4 | 82.5% had demonstrated physical aggression against people during the 6-week period. The total number of incidents logged on the OAS-MNR was 1066. Two patients were involved in 841 (78.9%) of the incidents: severe aggression: 6%; moderate aggression: 66%; mild aggression: 26% |
3.1.3
Irritability
Irritability can be defined as an excessive reaction with unjustified anger fits. Its incidence ranges from 29 to 71% according to studies in patients with severe TBI. Risk factors of an irritable behavior in patients with TBI are: being male, age between 15 and 34, unemployment, social isolation, depression . Contrarily to irritability occurring after mild TBI, authors reported the absence of a correlation between cognitive impairment and irritability after severe TBI .
3.1.4
Addictions with abuse and excesses
If addictions with abuse and excesses of alcohol or illicit substances are problematic in the care pathway after TBI, the review of the literature showed that TBI did not induce more substance use after the trauma. The prevalence of alcohol or illicit substance abuse is even lower in the year following TBI . The use of tools based on self-assessment of the disorder by the patient is a probable confusion factor. Only rare studies have shown that alcohol consumption could worsen 2 to 5 years after TBI with a return to prior level of consumption before the trauma . However, if data from the literature are not univocal, experts consider that the risk of harmful use or dependence appear more important at a distance from TBI and especially after returning home post-discharge . Factors related to the detrimental use of substances or alcohol or substance/alcohol dependence are: being male, low educational attainment and low social level, depression. Drug or alcohol use before TBI could increase the risk of behavioral disorders after TBI, risk of dependence, depression and suicide .
We did not find any specific article on the use and/or abuse of cocaine, psycho-stimulants or opioids. Eating disorders are often described after TBI, but the review of the literature is quite scarce, limited most often to case studies . These symptoms, especially bulimia can be intertwined with other behavioral disruptions such as the Kluver-Bucy syndrome or endocrine disorders, common after TBI .
3.1.5
Behavior with medicolegal consequences
The issue of a relationship between TBI and a behavior with medicolegal consequences is often brought up. Several epidemiological studies, essentially American ones, looked for the prevalence of TBI history in incarcerated populations. The prevalence of TBI history was significantly higher in inmates than the prevalence estimated in the general population (meta-analyses by Farrer in 2011 and Shiroma in 2010, focusing on around 5000 inmates each) . The prevalence of TBI ranges from 9.7% to 100% according to the studies. Shiroma , found a 60.2% TBI prevalence in prisoners. Inmates with a history of TBI tend to be younger, with more health problems, more memory disorders, have longer incarceration periods, are more frequently incarcerated, more likely to have a substance abuse problem (alcohol or marijuana) and more anxiety-depression disorders than other inmates without TBI. If TBI occurs during childhood, it is associated with an increased risk of psychiatric disorders and criminality. Most studies are based on the self-reported presence of TBI. The absence of a control group and variability were other biases limiting the methodological quality of these studies.
3.2
Disruptive primary behaviors by default
Symptoms by default observed after TBI include apathy, apragmatism, athymhormia and abulia.
3.2.1
Apathy
Apathy is the most commonly studied behavior by default post-TBI . For Marin , it is characterized by a reduction of goal-targeted behaviors and involves motivational, emotional and/or cognitive aspects whether those are spontaneous behaviors and/or in reaction to external stimuli. Levy and Dubois defined three subtypes of disrupted processes: ‘emotional-affective’, ‘cognitive’ and ‘auto-activation’. Apathy diagnostic criteria proposed by the European Psychiatric Association, the French Association of Biological Psychiatry and the European Alzheimer’s Disease Consortium all report the criterion of decreased motivation, characterized by three symptoms:
- •
loss or decrease of goal-directed behaviors;
- •
loss or decrease of goal-directed cognitive activity;
- •
absence or decrease of emotions.
New models are being developed (see Arnould et al. in this issue). Its prevalence varies between 20 and 71% according to the different studies on patients with severe TBI. The association between apathy and depression is common but apathy can exist without depression and vice-versa, which suggests the implementation of distinct processes . If there is no specific scale to differentiate depression from apathy, the richness of the affects mobilized can help make the distinction. Some traits like anhedonia, social isolation, poorly organized speech and blunted affect are higher after TBI . Apathy can occur at a distance from the initial trauma. It is associated with dysexecutive syndrome correlated to the performances on the Behavioural Assessment of the Dysexecutive Syndrome (BADS) scale as well as emotional and motivational dysfunctions observed by neurovegetative symptoms with an inverse correlation between apathy and heart rate reactivity to stress . This symptom impairs rehabilitation, has an impact on autonomy at home, professional future and burden felt by families (see Table 3 : main studies on apathy after TBI).
| References | Design | Level | Conclusion |
|---|---|---|---|
| Andersson et al., 1999 | 72 consecutive in-patients (28 TBI, 30 stroke and 14 hypoxic brain injury) Rehabilitation unit in Norway Assessment with AES-C ≥ 34 | 3 | Apathy after TBI: 46%, after stroke: 56%, after hypoxic brain injury: 78% AES score is higher after hypoxic brain injury, subcortical damage, right hemispheric damage |
| Rao et al., 2007 | Case-control study: 12 patients with apathy matched with16 people with schizophrenia Assessment with SANS | 3 | Severe TBI: 50%, moderate TBI: 33.3%, mild TBI: 16% SANS: patients with schizophrenia had more severe anhedonia, blunted affect, and alogia |
| Andersson and Bergedalen, 2002 | n = 53 severe TBI Assessment with AES-C (cut-off > 34) | 4 | Time since TBI: 12.2 months (± 10.06) Apathy: 62.3% |
| Al-Adawi et al., 2004 | 80 TBI (6 mild, 2 moderate, 36 severe) Assessment with AES-S (cut-off > 34) | 4 | Time since TBI: 8.35 months (± 4.50) Apathy: 20% |
| Kant et al., 1998 | Prevalence study, n = 83 TBI seen in a neuropsychiatric clinic. (Severe TBI + moderate TBI: 20.5%) Assessment with AES-S ≥ 34 and BDI > 11 | 4 | Apathy: 71% with or without depression (59 patients) Group 1: apathy without depression: 10.8% (9 patients) (AES-S: 40.5 ± 6.26) Group 2: depression without apathy: 10.8% (9 patients) (BDI: 18 ± 5.26) Group 3: both depression and apathy: 60.2% (50 patients): (AES-S: 43.92 ± 7.56 and BDI: 23.5 ± 8.58) Group 4: neither depression nor apathy: 18.1% (15 TBI) Younger patients are more likely to be apathetic Older patients are more likely to be depressed Patients with severe injury were more likely to exhibit apathy alone |
| Lane-brown and Tate, 2009 | Cross-sectional study n = 34 severe TBI (> 6 months since TBI) Assessment with AES | 4 | Apathy alone: 10 patients Apathy and depression: 11 patients Depression without apathy: 4 patients |
| Ciurli et al., 2011 | n = 120 TBI Assessment with NPI | 4 | Time since TBI: 106 months (± 15.1) Apathy: 42% |
3.3
Affect disorders, depression, anxiety and psychosis
3.3.1
Depression
Depression is one of the most common psychiatric complications after TBI . There is no specificity regarding diagnostic criteria of depression in patients with TBI (see DSM 5) but anosognosia, communication disorders can interfere with the patient’s mood and render the diagnosis more difficult. A review of the literature conducted in 2010 by the American Health Agency identified 115 publications on this topic. The mean prevalence was reported at 30% after moderate to severe TBI (12 to 76%) , i.e. 7.5 times greater than in the general population , even when excluding analyses focusing on veterans, mild traumatic brain injury, studies not refining the severity of the trauma. Prevalence does not vary much over time, and affects about a third of patients at 3 months to a year post-TBI. Fatigue, distraction, sleep disorders are common in TBI patients in the absence of depression, which might be confusing for physicians and might lead them to overestimate the diagnosis. The risk of developing major depression after TBI is reinforced by a prior psychiatric pathology and low socio-economic status . There are numerous factors associated with depression: being a woman, being young, prior psychiatric pathology, depression at the time of the accident, lesions of the left hemisphere (dorsolateral prefrontal cortex and/or basal ganglia) , higher cognitive deficits, social aggression, unemployment, fear of losing one’s job or absence of a job, social isolation, low socio-economic status, substance abuse, perceived stress, litigation, pain, self-awareness of the severity of the disability. Anxiety disorders are most frequently associated with depression (31 to 61% of cases) with a reported 37% frequency rate for the association of posttraumatic stress and depression. The expression of depressive symptoms is lower in patients with anosognosia. Family support, psychosocial caregivers, availability of a confident, direct return home all have a protective effect against depression . Anxiety-related depression might be related to damages to the right hemisphere (see Table 4 : main studies on depression after TBI).
| Reference | Design | Level | Conclusion |
|---|---|---|---|
| Bombardier et al., 2010 | Prospective cohort, n = 559 TBI ( n = 1080 eligible) US study in Trauma Center Assessment with PHQ9 | 2 | Prevalence of depression was 31.1% at 1 month; 24.7% at 2 months; 24.5% at 3 months; 20.8% at 6 months; 24.2% at 8 months; 27.1% at 10 months; 23. 3% at 12 months |
| Hart et al., 2011 | Prospective cohort, n = 1570 TBI US Study, in Trauma Center Assessment with PHQ9 | 2 | Prevalence of depression > 12 months since TBI was: 22% of minor depression; 26% of major depression |
| Dunlop et al., 1991 | Prospective study, n = 68 TBI US study Assessment with NRS | 3 | Prevalence of depression 3 to 6 months since injury was 50%; 28% 6 to 12 months |
| McCleary et al., 1998 | Case-control study, n = 105 TBI matched with 40 individuals US study in tertiary care center Assessment with SCL90 et NRS | 3 | Prevalence of depression 6 to 12 months since TBI was 24.4% (SCL90); 33% (NRS) Prevalence of depression > 12 months was 20% (SCL90); 33% (NRS) |
| Curran et al., 2000 | Case-control study, n = 88 TBI matched with 61 patients with orthopedic injuries Australia, rehabilitation center Assessment with BDI | 3 | Prevalence of depression was 55.7% |
| Fann et al., 2004 | Case-control study TBI/non-TBI, n = 691 Assessment with SCID | 3 | Prevalence of major depression was 33% |
| Jorge et al., 2004 | Case-control study n = 91 TBI (mean GCS = 12.3)/matched with n = 27 trauma patients without central nervous system damage. US study Assessment with SCID | 3 | Prevalence of depression was 20.2%; 32.4%, 3 to 6 months since injury; 40.5%, 6 to 12 months since injury |
| Popovic et al., 2004 | Case-control study, n = 67 TBI/78 healthy patients Serbian in Tertiary care center Assessment with ZDS | 3 | Prevalence of depression > 12 months since TBI was 46.3% |
| Frenisy et al., 2006 | Case-control study, n = 25 TBI (GCS mean = 12.5) versus 25 multiple trauma cases French study in Tertiary care center Assessment with NRS-R, and SCL90-R | 3 | Prevalence of depression > 12 months since TBI was 76% |
| Gagnon et al., 2006 | Case-control studies, n = 30 severe or moderate TBI matched with 30 participants without TBI Canadian study in Rehabilitation center Assessment with BDI | 3 | Prevalence of depression > 12 months since TBI was 50% |
| Ziino and Ponsford, 2006 | Case-control study, n = 46 TBI Australian study Assessment with HADS | 3 | Prevalence of depression > 12 months since TBI was 39.1% |
| Hawthorne et al., 2009 | Case-control studies. n = 66 TBI/66 participants without TBI Canadian Study in Trauma Center Assessment with HADS | 3 | Prevalence of depression > 12 months since TBI was 22.7% |
| Varney et al., 1987 | n = 120 closed TBI Assessment with DSM-III | 4 | Prevalence of depression was 76.7% |
| Jorge et al., 1993 | Cross-sectional study. n = 66 TBI US study in Trauma center Assessment with SCID | 4 | Prevalence of depression was 28.8%; 29.6% 3 to 6 months since injury; 25.6% 6 to 12 months; 25.6% > 12 months |
| Fann et al., 1995 | Cross-sectional study, n = 50 TBI US study in Rehabilitation center Assessment with SCID | 4 | Prevalence of depression > 12 months since TBI was 54% |
| Gomez-Hernandez et al., 1997 | Longitudinal study + cross-sectional, n = 65 TBI Spain study Assessment with SCID | 4 | Prevalence of depression was 35.4%; 37.5% 3 to 6 months since injury; 38.1% 6 to 12 months; 27% > 12 months since injury since injury |
| Kant et al., 1998 | Cross-sectional study, n = 83 TBI US study in psychiatric center Assessment with BDI and AES | 4 | Prevalence of depression was 11% (BDI) and 60% (AES) |
| Deb et al., 1999 | Cross-sectional study, n = 164 TBI including 30 TBIM/S UK study in Tertiary care center Assessment with SCAN and Behavior Checklist | 4 | Prevalence of depression > 12 months since TBI was 12.8% (SCAN); 19.5% (behavior checklist) |
| Sherman et al., 2000 | Cross-sectional study, n = 175 TBI Canadian study Assessment with MMPI | 4 | Prevalence of depression > 12 months since TBI was 33% for all severity 36% for severe and moderate TBI |
| Van Reekum et al., 2000 | Review | – | Prevalence of major depression was 44.3% |
| Bryant et al., 2001 | Cross-sectional study, n = 96 TBI (mean GCS: 8) Australian study in Rehabilitation center Assessment with BDI | 4 | Prevalence of depression > 12 months since TBI was 45.8% |
| Kersel et al., 2001 | Longitudinal study, n = 58 TBI severe (123 eligible) New Zealand study in Tertiary care center Assessment with BDI | 4 | Prevalence of depression 6 to 12 months since injury was 24% 24.1% > 12 months since injury |
| Rapoport et al., 2002 | Cross-sectional study, n = 282 TBI (323 eligible with139 severe TBI) Canadian study in Tertiary care center Assessment with NRS (NR) | 4 | Prevalence of depression was 34.3% Prevalence of major depression 3 to 6 months since injury was 48.9% |
| Seel et al., 2003 | n = 666 TBI (GCS = 8.6) US study in Rehabilitation center Assessment with NFI-D | 4 | Prevalence of depression > 12 months since TBI was 27% |
| Ashman et al., 2004 | Cross-sectional and longitudinal study, n = 188 TBI US study in Tertiary care center. Assessment with SCID | 4 | Prevalence of depression was 35% (T1 = 3 months–4 years), 24% 12 months after T1, 21% 24 months after T1 |
| Franulic et al., 2004 | Cross-sectional study, n = 71 TBI Chilean study in Tertiary care center Assessment with HAMD | 4 | Prevalence of depression > 12 months since TBI was 42.3% |
| Evans et al., 2005 | Cross-sectional study, n = 96 TBI/135 US study in rehabilitation center. Assessment with CES-D | 4 | Prevalence of depression was 54% |
| Huang et al., 2005 | Cross-sectional study n = 59 TBI including 17 severe cases US study in Rehabilitation center Assessment with SCID and ZDS | 4 | Prevalence of depression > 12 months since injury was (SCID) 13.6% (41% for severe TBI), 16.9% (ZDS) (59% for severe TBI) |
| Kennedy et al., 2005 | Cross-sectional study, n = 78 TBI (mean GCS = 9.3) (severe = 43%) US study Assessment with SCID | 4 | Prevalence of depression > 12 months since TBI was 30% |
| Chiu et al., 2006 | Cross-sectional study, n = 199 TBI (7.5% severe) Taiwan study in Tertiary care center Assessment with CES-D | 4 | Prevalence of depression > 12 months since TBI was 23.9% |
| Rapoport et al., 2006 | n = 69, Assessment with SCID | 4 | Prevalence of depression was 12.2% |
| Al-Adawi et al., 2007 | Cross-sectional study, n = 68 TBI Oman study in Tertiary care center. Assessment with CIDI and HADS | 4 | Prevalence of depression > 12 months since TBI was 57.4% (CIDI), 19.1% (HADS) |
| Kim, 2007 | Review | – | Prevalence of depression was 15.6 to 61% |
| Sherer et al., 2007 | Cross-sectional study, n = 49 severe TBI (69 eligible) US study in Rehabilitation unit Assessment with CES-D | 4 | Prevalence of depression was 31.9% |
| Hawley and Joseph, 2008 | Cross-sectional study, n = 165 TBI (563 eligible/103 severe) UK study. In rehabilitation center Assessment with HADS | 4 | Prevalence of depression was 20.5% (17.2% for severe TBI) 6 to 12 months since TBI |
| Whelan-Goodinson et al., 2008 | Cross-sectional study, n = 100 TBI Australian study in Tertiary care center Assessment with SCID | 4 | Prevalence of depression was 34% > 12 months since TBI |
| Fann et al., 2009 | Cross-sectional study, n = 145 TBI (19.3% severe TBI) US study in Trauma center Assessment with PHQ-9 | 4 | Prevalence of depression was 25.5% |
| Peleg et al., 2009 | Cross-sectional study, 65 patients TBI Israeli study in Rehabilitation center Assessment with BDI | 4 | Prevalence of depression was 73.9% > 12 months since TBI |
| Rao et al., 2009 | Cross-sectional study, n = 67 TBI (107 eligible) US study in Rehabilitation unit Assessment with SCID | 4 | Prevalence of depression was 11.9% |
| Ponsford and Schönberger, 2010 | Cross-sectional study, n = 301 TBI Australian study in Tertiary care center Assessment with HADS; 266 patients at 60 months | 4 | Prevalence of depression was 45% at 24 months 44% at 60 months |
| Seel et al., 2010 | n = 666 moderate and severe TBI | 4 | Fatigue: 29% Attention and concentration disturbances: 28% Anger and irritability: 28% Ruminations: 25% 27% major depressive episode |
Related posts:
Behavioral disorders after traumatic brain injury: Why and how did French recommendations for good practice emerge?
Behavioral disorders after traumatic brain injury: Why a special issue in the Annals of Physical and Rehabilitation Medicine?
Drugs for behavior disorders after traumatic brain injury: Systematic review and expert consensus leading to French recommendations for good practice
Behavioral and affective disorders after brain injury: French guidelines for prevention and community supports
France establishes guidelines for treating neurobehavioral disorders following traumatic brain injury
Care management of the agitation or aggressiveness crisis in patients with TBI. Systematic review of the literature and practice recommendations
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
