Early
identification of patients at high risk for
depression after mild brain injury
Considerable
morbidity accompanies mild traumatic brain
injury (MTBI) during the 3 months following
injury and about 18% of patients with MTBI
develop a psychiatric illness within 1 year,
depression being the most frequent. Identifying
patients at high risk for major depression early
after brain injury is essential to enable early
treatment to avoid the progression of symptoms.
Developing a model for screening patients at
risk for depression at 3 months after brain
injury was the objective of a recent study.
129 patients with head trauma were prospectively
recruited with MTBI with a Glasgow Coma Scale
score of 13 to 15 and followed up at 1 week and
3 months’ postinjury. Computed tomographic
(CT) scans of the brain were obtained within 24
hours of the injury. The diagnosis of depression
was determined using the current major
depressive episode module of the Structured
Clinical Interview for the DSM-IV. The severity
of depressive symptoms was assessed using the
20-item self-report questionnaire Center for
Epidemiologic Studies Depression (CES-D)
Scale.
At 3 months’ postinjury major depressive
episode was present in 15 subjects (11.6%). A
logistic regression was used to generate a
prediction model of major depressive episode at
3 months’ postinjury. The odds ratios for
predictors of major depressive episode were 1.05
for age, 1.11 for 1-week CES-D score, and 7.68
for abnormal CT scan. Sensitivity and
specificity of this prediction model were 93%
and 62%, respectively.
The findings show that a high 1-week CES-D total
score, older age, and a brain lesion seen on CT
scan are risk factors for the onset of a major
depressive episode during the first 3 months
postinjury. Use of this brief screening measure
within 1 week of traumatic injury should permit
the identification of patients at risk and
enable prompt treatment of depression and spare
patients the worse cognitive and functional
outcomes. Levin
HS, McCauley SR, Josic CP, Boake C, Brown SA,
Goodman HS, Merritt SG, Brundage SI. Predicting
depression following mild traumatic brain
injury. Arch Gen Psychiatry 2005,
62:523-528.