Over 2 million Americans experience a traumatic brain injury (TBI) each year, according to the Centers for Disease Control and Prevention. A TBI is lasting brain damage from a blow to the head such as from a fall or car accident. TBI can be mild, moderate, or severe. Some people with TBI may develop mental or emotional challenges after their injury. Two of the most common challenges are depression (including feeling chronically sad or down, and losing interest or pleasure in doing things), and behavior issues, such as becoming more impulsive or having trouble making decisions. These challenges can result from the difficulties of adjusting to a new disability, as well as brain changes after TBI. In a recent NIDILRR-funded study, researchers looked at the connections between depression and behavior problems during the first year after a TBI. They wanted to find out how the rates of experiencing both problems change over the first year after a TBI, and whether experiencing one problem 6 months after a TBI was associated with experiencing the other problem 12 months after the TBI.
Researchers at the project on Rehabilomics: Revolutionizing 21st Century TBI Care and Research looked at data from 88 people with moderate or severe TBI. The data were collected as part of two larger studies conducted at the University of Pittsburgh. The participants were 16-79 years old and had a diagnosis of moderate or severe TBI. The participants completed questionnaires at 6 months and 12 months after their TBI. At each time point, they completed standardized questionnaires measuring depression and behavior problems. On the depression questionnaire, the participants were asked if they had recently experienced symptoms of depression. These symptoms were feeling down, little interest or pleasure in doing things, feeling bad about oneself, or feeling suicidal, as well as physical changes in appetite or sleep, loss of energy, trouble concentrating, or feeling physically and mentally sluggish. A total symptom score was calculated with higher scores indicating more depression. The researchers categorized participants as having depression if they reported depressed mood or loss of interest, plus at least four other symptoms. On the behavior problems questionnaire, the participants were asked how often they experienced difficulties with impulse control, planning and decision-making, or apathy (not caring about things or a lack of motivation). A total score was calculated for each participant, and the researchers categorized those participants with a standardized score higher than 65 as having behavior problems. The researchers also looked at whether the participants had any pre-injury history of psychiatric conditions and treatment.
The researchers found that at 6 months after their TBI, 13% of the participants had depression alone, 16% had behavior problems alone, and 19% had both. By the 12-month evaluation, 7% had depression alone, 23% had behavior problems alone, and 19% had both.
When the researchers looked at the links between levels of depression and behavior problems at 6 months and levels of both problems at 12 months, they found that having more depression symptoms at 6 months was strongly linked to levels of depression and behavior problems at 12 months. People who had more depression symptoms at 6 months showed a larger increase in behavior problems by 12 months than the participants with less depression symptoms at 6 months. The participants with higher levels of behavior problems at 6 months also reported slightly more depression symptoms at 12 months than the participants with lower levels of behavior problems. However, this connection was weaker than the connection between depression levels at 6 months and behavior problem levels at 12 months.
The authors noted that about 20% of the participants had some history of mental health issues before their TBI and these may have continued after injury. A larger study could provide more insight into how these conditions change after a person experiences a brain injury, or how injury type may influence depression and behavior.
According to the authors, about half of the participants in this study reported either depression, behavior problems, or both during the first 6 months after their TBI. People with TBI may face a substantial risk of developing depression or behavior problems in the first months following their injury. People who develop depression soon after their TBI may be especially at risk to develop behavior problems later. Clinicians may want to screen people with TBI for early signs of depression and offer treatment options to those who screen positive, including antidepressant medications or counseling. Future research may be useful in identifying the impacts of TBI that might underlie the link between depression and behavior problems for people with TBI.
To Learn More
The Model Systems Knowledge Translation Center (MSKTC) offers many resources for people with TBI and their families, developed with the researchers from the TBI Model System Centers. These include:
- Hot Topic Module on TBI and Depression, featuring interviews with TBI survivors, family, and rehabilitation researchers: http://www.msktc.org/tbi/Hot-Topics/depression
- InfoComics on emotional changes after TBI: http://www.msktc.org/tbi/infocomic
- Clinicians may be interested in this systematic review of treatment for depression following TBI: http://www.msktc.org/tbi/research/systematic-reviews/Treatment-For-Depre...
Brainline.org offers many resources for TBI survivors and caregivers, and the professionals who support them. These include:
- Articles, videos, and research on emotional symptoms after TBI: https://www.brainline.org/topic/behavioral-emotional-symptoms
- TBI 101: Behavioral and Emotional Symptoms: https://www.brainline.org/article/tbi-101-behavioral-emotional-symptoms
To Learn More About this Study
Juengst, S.B., Myrga, J.M., Fann, J.R., and Wagner, A.K. (2017) Cross-lagged panel analysis of depression and behavioral dysfunction in the first year after moderate-to-severe traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences, 29(3), 260-266. This article is available from the NARIC collection under Accession Number J76050.