番茄社区

One in five people experienced post traumatic stress disorder (PTSD) or major depressive disorder 6 months after mild traumatic brain injury (TBI), the study found.

And people who were black, had a self-reported psychiatric history, or -- in the case of PTSD -- had injuries resulting from assault or other violence were at increased risk, reported Murray Stein, MD, MPH, of the University of California San Diego, and colleagues in .

TRACK-TBI, a prospective longitudinal cohort study supported by the National Institute of Neurological Disorders and Stroke (NINDS), previously showed that most concussion patients had no follow-up care after they were discharged from the emergency department (ED).

"Mental health disorders after concussion have been studied primarily in military populations, and not much is known about these outcomes in civilians," NINDS program director Patrick Bellgowan, PhD, said in a statement. "These results may help guide follow-up care and suggest that doctors may need to pay particular attention to the mental state of patients many months after injury."

The analysis looked at 1,155 adults from EDs at 11 academic level 1 trauma centers in the U.S. from 2014 to 2016. Patients were evaluated within 24 hours of head injury, had of 13 to 15 (usually consistent with mild TBI diagnosis), and received a CT scan. Most patients were men (65.1%) and had an average age of about 40.

Researchers also studied a comparison group of 230 patients who had non-head orthopedic trauma injuries but no probable TBI. The two groups were similar, except that assault or violence was less likely to be the cause of injury for the orthopedic group (1%) than the mild TBI group (6%), and the orthopedic group was less likely to have been admitted to the ICU (7.4% vs 24.5%).

Both groups were assessed with the and the Patient Health Questionnaire-9 (). Data from each group were analyzed using separate propensity weights to account for missing data at follow-up visits.

In the mild TBI group, the weights-adjusted prevalence of PTSD or major depressive disorder was 20.0% at 3 months, compared with 8.7% in the orthopedic trauma group (P<0.001). At 6 months, the prevalence was 21.2% for the mild TBI group and 12.1% for the orthopedic group (P=0.03).

Risk factors for PTSD at 6 months included:

• Black race (adjusted OR 5.11; 95% CI 2.89-9.05)
• Self-reported psychiatric history (adjusted OR 3.57; 95% CI 2.09-6.09)
• Injury stemming from assault or other violence (adjusted OR 3.43; 95% CI 1.56-7.54)
• Less education (adjusted OR 0.89 per year; 95% CI 0.82-0.97)

Risk factors for probable major depressive disorder were similar, except for cause of injury. Other factors like duration of loss of consciousness, post-traumatic amnesia, or evidence of brain injury on CT scan were not correlated with either PTSD or major depressive disorder risk.

This paper helps identify who may need follow-up care, noted Mary Iaccarino, MD, of Massachusetts General Hospital, who was not involved with the study.

"We see a number of patients who are not recovering well, and we are trying to figure out how to triage these people appropriately," Iaccarino told 番茄社区. "Concussions are a very common injury and not everybody needs specialty care, but a significant minority does."

"We used to think that the more severe the initial presentation was, the more likely it would be that you would have a protracted recovery," Iaccarino continued. "Now we know that, in a lot of cases, the severity of concussion might not be the most important factor. Certainly it is important, but it's not coming out as the most important factor in the research."

Traumatic brain injury may be a forerunner to other psychiatric or neurodegenerative disorders including bipolar disorder, dementia, and Parkinson's disease, Stein and colleagues noted. "These observations suggest either that TBI is a risk factor for a variety of disparate pathological processes or that TBI increases risk for these disorders through a common mechanistic pathway," they wrote.

Mechanisms may include damage to white matter tracks linking frontocortical regulatory regions with other brain regions, neuroinflammation, and stress-related oxidative damage, they suggested.

The researchers noted several limitations to their study: patients were seen at academic level 1 trauma centers and findings might not apply to concussion patients seen at other medical centers. They relied on patient reports about prior mental health history, which may be subject to recall or reporting bias.

The researchers also did not know why black patients were at increased risk for mental disorders after concussion. The findings could not be explained by socioeconomic status or cause of injury; unmeasured covariates may be a factor, they noted.

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