Depression Trajectories during the First Year after Traumatic Brain Injury
Depression Trajectories during the First Year after Traumatic Brain Injury
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DOI：
10.1089/neu.2015.4349
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发表时间：
2016-12-01
影响因子：
4.2
通讯作者：
Fann, Jesse R.
中科院分区：
文献类型：
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作者：
Bombardier, Charles H.;Hoekstra, Trynke;Fann, Jesse R.
重度抑郁症在创伤性脑损伤（TBI）后普遍存在，并与不良结局相关。关于TBI后抑郁的过程知之甚少。参与者是559名连续入院的轻度至重度TBI患者，他们是从华盛顿州西雅图的一级创伤中心Harborview医疗中心的住院部招募的。在受伤后1-6、8、10和12个月，使用患者健康问卷-9（PHQ-9）抑郁测量对参与者进行评估。我们使用PHQ-9总分的线性潜在类增长混合模型（LCGMM）来识别具有不同纵向轨迹的同质亚组。四级LCGMM具有良好的拟合指数和临床可解释性。轨迹组为：轻度抑郁（70.1%）、延迟性抑郁（13.2%）、抑郁恢复（10.4%）和持续性抑郁（6.3%）。多项逻辑回归分析用于区分基于基线人口统计学、精神病史和临床变量的轨迹类别。相对于低抑郁组，其他三组始终更有可能有其他精神健康障碍或重度抑郁症的损伤前病史，在受伤时对可卡因或安非他明进行阳性毒理学筛查，以及酒精依赖史。与商业保险相比，他们不太可能参加医疗保险。基于LCGMM的轨迹是表征TBI后抑郁的不同过程的经验和临床意义的方式。当与基线预测因子相结合时，这一系列研究可能会提高我们预测预后的能力，并针对可能从治疗或二级预防工作中受益的人群（例如，主动电话咨询）。
Major depression is prevalent after traumatic brain injury (TBI) and associated with poor outcomes. Little is known about the course of depression after TBI. Participants were 559 consecutively admitted patients with mild to severe TBI recruited from inpatient units at Harborview Medical Center, a Level I trauma center in Seattle, WA. Participants were assessed with the Patient Health Questionnaire-9 (PHQ-9) depression measure at months 1-6, 8, 10, and 12 post-injury. We used linear latent class growth mixture modeling (LCGMM) of PHQ-9 total scores to identify homogeneous subgroups with distinct longitudinal trajectories. A four-class LCGMM had good fit indices and clinical interpretability. Trajectory groups were: low depression (70.1%), delayed depression (13.2%), depression recovery (10.4%), and persistent depression (6.3%). Multinomial logistic regression analyses were used to distinguish trajectory classes based on baseline demographic, psychiatric history, and clinical variables. Relative to the low depression group, the other three groups were consistently more likely to have a pre-injury history of other mental health disorders or major depressive disorder, a positive toxicology screen for cocaine or amphetamines at the time of injury, and a history of alcohol dependence. They were less likely to be on Medicare versus commercial insurance. Trajectories based on LCGMM are an empirical and clinically meaningful way to characterize distinct courses of depression after TBI. When combined with baseline predictors, this line of research may improve our ability to predict prognosis and target groups who may benefit from treatment or secondary prevention efforts (e.g., proactive telephone counseling).