Abstract
Objective
To investigate the risk of psychiatric disorders after traumatic brain injury (TBI),
and to clarify whether the post-TBI rehabilitation was associated with a lower risk
of developing psychiatric disorders.
Design
A register-based, retrospective cohort design.
Setting
Using data from the National Health Insurance Research Database of Taiwan, we established
an exposed cohort with TBI and a nonexposed group without TBI matched by age and year
of diagnosis between 2000 and 2015.
Participants
This study included 231,894 patients with TBI and 695,682 patients without TBI (N=927,576).
Interventions
Rehabilitation therapies in TBI patients.
Main Outcome Measures
A multivariable Cox proportional hazards regression model was used to compare the
risk of developing psychiatric disorders.
Results
The incidence rate of psychiatric disorders was higher in the TBI group than the control
group. Compared with the control group, the risk of psychiatric disorders in the TBI
group was twofold (hazard ratio [HR]=2.072; 95% confidence interval [95% CI], 1.955-2.189;
P<.001). Among the participants with TBI, 49,270 (21.25%) had received rehabilitation
therapy and had a lower risk of psychiatric disorders (HR=0.691; 95% CI, 0.679-0.703;
P<.001). In the subgroup analysis, the medium- to high-level intensity rehabilitation
therapy was associated with lower risks of psychiatric disorder (HR=0.712 and 0.568,
respectively), but there was no significant finding in the low-intensity group.
Conclusions
We found that TBI was associated with a high risk for developing psychiatric disorders,
and that the post-TBI rehabilitation significantly reduced the risk of psychiatric
disorders in a dose-dependent manner.
Keywords
List of abbreviations:
95% CI (95% confidence interval), CCI (Charlson Comorbidity Index), HR (hazard ratio), ICD-9-CM (International Classification of Diseases–9th Revision–Clinical Modifications), ICU (intensive care unit), ISS (injury severity score), NHI (National Health Insurance), NHIRD (National Health Insurance Research Database), OT (occupational therapy), PT (physical therapy), PTSD (Posttraumatic stress disorder), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: January 06, 2020
Footnotes
Supported by the Medical Affairs Bureau, Ministry of Defense of Taiwan (grant no. MAB-107-084 ) and the Tri-Service General Hospital Research Foundation (grant nos. TSGH-C107-004 , TSGH-C107-106 , TSGH-C108-003 , and TSGH-C108-151 ).
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
