A longitudinal study of major and minor depression following traumatic brain injury

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Study examined patterns of change and factors associated with change in both major depressive disorder (MDD) and minor depression between 1 and 2 years after traumatic brain injury (TBI). Participants were 1,089 people enrolled in the TBI Model Systems database, who completed the Patient Health Questionnaire-9 at 1- and 2-year follow-ups. Among participants not depressed at 1 year, close to three fourths remained so at 2-year follow-up. However, 26 percent developed MDD or minor depression between the first and second years postinjury. Over half of participants with MDD at year 1 also reported MDD the following year, with another 22 percent reporting minor depression; thus three fourths of those with MDD at year 1 experienced clinically significant symptoms at year 2. Almost one third of those with minor depression at year 1 traversed to MDD at year 2. Analysis confirmed that worse depression at year 1 was associated with higher odds of depression a year later. For those without depression at year 1, symptom worsening over time was related to year 2 problematic substance use and lower Functional Independence Measure (FIM) motor and cognitive scores. For those with depression at year 1, worsening was associated with lower cognitive FIM, poor social support, and pre-injury mental health issues including substance abuse. The findings suggest that major and minor depression exist on a continuum along which individuals with TBI may traverse over time. Predictors of change differ according to symptom onset. Results highlight importance of long-term monitoring for depression, treating minor as well as major depression, and developing interventions for comorbid depression and substance abuse.

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