Natural history of depression in traumatic brain injury
Natural history of depression in traumatic brain injury
复制标题
DOI：
10.1016/j.apmr.2003.12.041
复制
发表时间：
2004-09-01
影响因子：
4.3
通讯作者：
Temkin, NR
中科院分区：
文献类型：
--
作者：
Dikmen, SS;Bombardier, CH;Temkin, NR
目的：探讨创伤性脑损伤（TBI）后3 ~ 5年内抑郁的发生率、危险因素和症状。设计：初始队列纵向研究。地点：一级创伤中心。参与者：连续入院的283名中度至重度TBI成人。干预措施：不适用。主要结果测量：流行病学研究中心抑郁症（CES-D）量表。结果：中重度抑郁症发生率从1个月时的31%到3 ~ 5年时的17%不等。除了1个例外，脑损伤严重程度与抑郁症之间的关系可以忽略不计。受教育程度低于高中、伤前不稳定的工作经历和酗酒与伤后抑郁有关。对CES-D因素的检查表明，除了躯体症状外，抑郁情绪和缺乏积极情绪也会导致CES-D评分升高。结论：高比例的抑郁症状不能因为与脑损伤相关的躯体症状被误认为抑郁症而被忽视。创伤性脑损伤患者的抑郁情绪和缺乏积极情绪也有所增加。损伤前心理社会因素可以预测抑郁症，了解这些因素有助于发现、预防和治疗创伤性脑损伤后的抑郁症。
Objective: To examine prospectively the rates, risk factors, and phenomenology of depression over 3 to 5 years after traumatic brain injury (TBI).Design: Inception cohort longitudinal study.Setting: Level I trauma center.Participants: Consecutive admissions of 283 adults with moderate to severe TBI.Interventions: Not applicable.Main Outcome Measure: Center for Epidemiologic Studies Depression (CES-D) Scale.Results: The rates of moderate to severe depression ranged from 31% at 1 month to 17% at 3 to 5 years. With 1 exception, the relation between brain injury severity and depression was negligible. Less than high school education, preinjury unstable work history, and alcohol abuse predicted depression after injury. Examination of CES-D factors indicate that, in addition to somatic symptoms, both depressed affect and lack of positive affect contribute to elevated CES-D scores.Conclusions: High rates of depressive symptoms cannot be dismissed on grounds that somatic symptoms related to brain injury are mistaken for depression. Depressed affect and lack of positive affect are also elevated in persons with TBI. Preinjury psychosocial factors are predictive of depression and knowing them should facilitate efforts to detect, prevent, and treat depression after TBI.