Abstract
Objective
To determine at 1 year after moderate to severe traumatic brain injury the (1) rate
of clinically significant anxiety; (2) rates of specific symptoms of anxiety; (3)
risk factors for anxiety; and (4) associations of anxiety with other 1-year outcomes,
including participation and quality of life.
Design
Prospective longitudinal observational study.
Setting
Inpatient rehabilitation centers, with data capture at injury and 1-year follow-up.
Participants
Persons with moderate to severe traumatic brain injury who were enrolled in the Traumatic
Brain Injury Model Systems database (N=1838).
Interventions
Not applicable.
Main Outcome Measures
The 7-item Generalized Anxiety Disorder Scale, Patient Health Questionnaire (9-item
screen for depression), FIM, Participation Assessment with Recombined Tools-Objective,
and Satisfaction with Life Scale.
Results
Clinically significant anxiety was reported by 21% of the participants. Of these,
>80% reported interference with daily activities, with the most common symptoms being
excessive worry and irritability. A common pattern was comorbid anxiety and depression,
with smaller proportions reporting either disorder alone. Anxiety had large effect
sizes with respect to life satisfaction and cognitive disability and medium to small
effect sizes relative to societal participation and self-care. Middle age, black race,
lower socioeconomic status, preinjury mental health treatment, and at least 1 traumatic
brain injury prior to the index injury were all risk factors for later anxiety.
Conclusions
Anxiety should be screened, fully evaluated, and treated after moderate to severe
traumatic brain injury. Worry and irritability might be treated with pharmacologic
agents or relatively simple behavioral interventions, which should be further researched
in this population.
Keywords
List of abbreviations:
GAD-7 (7-item Generalized Anxiety Disorder Scale), PART-O (Participation Assessment with Recombined Tools-Objective), PHQ-9 (Patient Health Questionnaire (9-item screen for depression)), PTA (posttraumatic amnesia), PTSD (posttraumatic stress disorder), SWLS (Satisfaction With Life Scale), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems)To read this article in full you will need to make a payment
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References
- The nature, frequency and course of psychiatric disorders in the first year after traumatic brain injury: a prospective study.Psychol Med. 2011; 41: 2099-2109
- The manifestation of anxiety disorders after traumatic brain injury: a review.J Neurotrauma. 2015; 32: 411-421
- Association between cognitive impairments and anxiety disorders following traumatic brain injury.J Clin Exp Neuropsychol. 2014; 36: 1-14
- Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment.Gen Hosp Psychiatry. 2008; 30: 191-199
- Depression and anxiety in the United States: findings from the 2006 Behavioral Risk Factor Surveillance System.Psychiatr Serv. 2008; 59: 1383-1390
- Rates of major depressive disorder and clinical outcomes following traumatic brain injury.JAMA. 2010; 303: 1938-1945
- The psychiatric sequelae of traumatic injury.Am J Psychiatry. 2010; 167: 312-320
- Psychiatric disorders following traumatic brain injury: their nature and frequency.J Head Trauma Rehabil. 2009; 24: 324-332
- Predictors of psychiatric disorders following traumatic brain injury.J Head Trauma Rehabil. 2010; 25: 320-329
- Racial/ethnic disparities in mental health over the first 2 years after traumatic brain injury: a model systems study.Arch Phys Med Rehabil. 2014; 95: 2288-2295
- Prediction of depression and anxiety 1 year after moderate-severe traumatic brain injury.Appl Neuropsychol. 2010; 17: 183-189
- Association between psychiatric state and outcome following traumatic brain injury.J Rehabil Med. 2008; 40: 850-857
- Psychosocial and emotional outcomes 10 years following traumatic brain injury.J Head Trauma Rehabil. 2007; 22: 278-287
- Functional outcome 10 years after traumatic brain injury: its relationship with demographic, injury severity, and cognitive and emotional status.J Int Neuropsychol Soc. 2008; 14: 233-242
- Prediction of functional and employment outcome 1 year after traumatic brain injury: a structural equation modelling approach.J Neurol Neurosurg Psychiatry. 2011; 82: 936-941
- Introduction: The Traumatic Brain Injury Model Systems of Care.Arch Phys Med Rehabil. 2003; 84: 151-152
- A brief measure for assessing generalized anxiety disorder: the GAD-7.Arch Intern Med. 2006; 166: 1092-1097
- Behavioral risk factor surveillance system user's guide.U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta1998
- U.S. Department of Health and Human Services. National household survey on drug abuse: population estimates. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Rockville1998
- Initial reliability and validity of the Ohio State University TBI Identification Method.J Head Trauma Rehabil. 2007; 22: 318-329
- Prior history of traumatic brain injury among persons in the Traumatic Brain Injury Model Systems National Database.Arch Phys Med Rehabil. 2013; 94: 1940-1950
- The Galveston Orientation and Amnesia Test: a practical scale to assess cognition after head injury.J Nerv Ment Dis. 1979; 167: 675-684
- Effective serial measurement of cognitive orientation in rehabilitation: the Orientation Log.Arch Phys Med Rehabil. 1998; 79: 718-720
- Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection.Ann Intern Med. 2007; 146: 317-325
- The PHQ-9: validity of a brief depression severity measure.J Gen Intern Med. 2001; 16: 606-613
- Clinical considerations for the diagnosis of major depression after moderate to severe TBI.J Head Trauma Rehabil. 2010; 25: 99-112
- Prediction of rehabilitation outcomes with disability measures.Arch Phys Med Rehabil. 1994; 75: 133-143
- Development of the Participation Assessment with Recombined Tools-Objective (PART-O) for use after traumatic brain injury.Arch Phys Med Rehabil. 2011; 92: 542-551
- Comparison of scoring methods for the Participation Assessment with Recombined Tools.Arch Phys Med Rehabil. 2011; 92: 552-563
- The Satisfaction With Life Scale.J Pers Assess. 1985; 49: 71-75
- Recommendations for the use of common outcome measures in traumatic brain injury research.Arch Phys Med Rehabil. 2010; 91: 1650-1660.e1617
- Psychometric properties of the Satisfaction With Life Scale in Parkinson's disease.Acta Neurol Scand. 2015; 132: 164-170
- The importance of detecting anxiety in primary care.J Prim Health Care. 2012; 4: 4
- Multiple imputation for non-response in surveys.John Wiley, New York1997
- Validity of the Patient Health Questionnaire-9 in assessing depression following traumatic brain injury.J Head Trauma Rehabil. 2005; 20: 501-511
- Systematic bias in traumatic brain injury outcome studies because of loss to follow-up.Arch Phys Med Rehabil. 2003; 84: 153-160
- Concussion treatment after combat trauma: development of a telephone based, problem solving intervention for service members.Contemp Clin Trials. 2015; 40: 54-62
- Anger self-management in chronic traumatic brain injury: protocol for a psycho-educational treatment with a structurally equivalent control and an evaluation of treatment enactment.Contemp Clin Trials. 2015; 40: 180-192
- Effectiveness of amantadine hydrochloride in the reduction of chronic traumatic brain injury irritability and aggression.J Head Trauma Rehabil. 2014; 29: 391-399
- US population estimates of health and social outcomes 5 years after rehabilitation for traumatic brain injury.J Head Trauma Rehabil. 2014; 29: E1-9
- Life satisfaction across the lifespan: findings from two nationally representative panel studies.Soc Indic Res. 2010; 99: 183-203
- Social role participation and the life course in healthy adults and individuals with osteoarthritis: are we overlooking the impact on the middle-aged?.Soc Sci Med. 2013; 81: 87-93
- Early trajectory of psychiatric symptoms after traumatic brain injury: relationship to patient and injury characteristics.J Neurotrauma. 2014; 31: 610-617
- Racial differences in caregiving patterns, caregiver emotional function and sources of emotional support following traumatic brain injury.J Head Trauma Rehabil. 2007; 22: 122-131
- Determination of the minimal clinically important difference in the FIM instrument in patients with stroke.Arch Phys Med Rehabil. 2006; 87: 32-39
- A preliminary model for posttraumatic brain injury depression.Arch Phys Med Rehabil. 2010; 91: 1087-1097
- The role of self-discrepancy theory in understanding post-traumatic brain injury affective disorders: a pilot study.J Head Trauma Rehabil. 2005; 20: 527-543
- Evaluating a theory of stress and adjustment when predicting long-term psychosocial outcome after brain injury.J Int Neuropsychol Soc. 2006; 12: 359-367
- The origins and current status of behavioral activation treatments for depression.Annu Rev Clin Psychol. 2011; 7: 1-38
- Behavioral activation as a primary care-based treatment for PTSD and depression among returning veterans.J Trauma Stress. 2010; 23: 491-495
- Behavioral activation and therapeutic exposure: an investigation of relative symptom changes in PTSD and depression during the course of integrated behavioral activation, situational exposure, and imaginal exposure techniques.Behav Modif. 2012; 36: 580-599
Article info
Publication history
Published online: December 18, 2015
Footnotes
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (grant nos. 90DP0037, 90DP0040, 90DP0038, and 90DP0041).
These contents do not necessarily represent the policy of the Department of Health and Human Services, and you should not assume endorsement by the Federal Government. The funder had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript, and decision to submit the manuscript for publication.
Disclosures: none.
Identification
Copyright
© 2015 The American Congress of Rehabilitation Medicine.
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