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Psychiatric Disorders After Traumatic Brain Injury: A Nationwide Population-Based Cohort Study and the Effects of Rehabilitation Therapies

  • Ta-Chuan Yeh
    Affiliations
    Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Department of Psychiatry, Tri-Service General Hospital, Penghu Branch, Penghu, Taiwan, Republic of China
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  • Wu-Chien Chien
    Affiliations
    Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China

    School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
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  • Chi-Hsiang Chung
    Affiliations
    Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China

    School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan, Republic of China
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  • Chih-Sung Liang
    Affiliations
    Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
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  • Hsin-An Chang
    Affiliations
    Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
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  • Yu-Chen Kao
    Affiliations
    Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan, Republic of China
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  • Hui-Wen Yeh
    Affiliations
    Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Institute of Bioinformatics and System Biology, National Chiao Tung University, Hsin-Chu, Taiwan, Republic of China

    Department of Nursing, Tri-Service General Hospital, School of Nursing, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Department of Nursing, Kang Ning University (Taipei Campus), Taipei, Taiwan, Republic of China
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  • Yun-Ju Yang
    Affiliations
    Department of Surgery, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
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  • Nian-Sheng Tzeng
    Correspondence
    Corresponding author Nian-Sheng Tzeng, MD, Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, 325, Section 2, Cheng-Kung Road, Neihu District, Taipei, Taiwan 11490, Republic of China.
    Affiliations
    Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China
    Search for articles by this author
Published:January 06, 2020DOI:https://doi.org/10.1016/j.apmr.2019.12.005

      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)
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      References

        • Lee Y.K.
        • Hou S.W.
        • Lee C.C.
        • Hsu C.Y.
        • Huang Y.S.
        • Su Y.C.
        Increased risk of dementia in patients with mild traumatic brain injury: a nationwide cohort study.
        PLoS One. 2013; 8 (e62422)
        • Fann J.R.
        • Ribe A.R.
        • Pedersen H.S.
        • et al.
        Long-term risk of dementia among people with traumatic brain injury in Denmark: a population-based observational cohort study.
        Lancet Psychiatry. 2018; 5: 424-431
        • Wang H.K.
        • Lin S.H.
        • Sung P.S.
        • et al.
        Population based study on patients with traumatic brain injury suggests increased risk of dementia.
        J Neurol Neurosurg Psychiatry. 2012; 83: 1080-1085
        • Ho C.H.
        • Hsieh K.Y.
        • Liang F.W.
        • et al.
        Pre-existing hyperlipidaemia increased the risk of new-onset anxiety disorders after traumatic brain injury: a 14-year population-based study.
        BMJ Open. 2014; 4e005269
        • Tsai M.C.
        • Tsai K.J.
        • Wang H.K.
        • et al.
        Mood disorders after traumatic brain injury in adolescents and young adults: a nationwide population-based cohort study.
        J Pediatr. 2014; 164: 136-141
        • Seel R.T.
        • Kreutzer J.S.
        • Rosenthal M.
        • Hammond F.M.
        • Corrigan J.D.
        • Black K.
        Depression after traumatic brain injury: a National Institute on Disability and Rehabilitation Research Model Systems multicenter investigation.
        Arch Phys Med Rehabil. 2003; 84: 177-184
        • Osborn A.J.
        • Mathias J.L.
        • Fairweather-Schmidt A.K.
        • Anstey K.J.
        Traumatic brain injury and depression in a community-based sample: a cohort study across the adult life span.
        J Head Trauma Rehabil. 2018; 33: 62-72
        • Huang M.F.
        • Su C.H.
        • Tu H.P.
        • et al.
        Association between bipolar disorder and subsequent traumatic brain injury in patients who received inpatient treatment.
        Psychiatry Res. 2018; 261: 517-521
        • Bayley P.J.
        • Kong J.Y.
        • Helmer D.A.
        • et al.
        • MIND Study Group
        Challenges to be overcome using population-based sampling methods to recruit veterans for a study of post-traumatic stress disorder and traumatic brain injury.
        BMC Med Res Methodol. 2014; 14: 48
        • Molloy C.
        • Conroy R.M.
        • Cotter D.R.
        • Cannon M.
        Is traumatic brain injury a risk factor for schizophrenia? A meta-analysis of case-controlled population-based studies.
        Schizophr Bull. 2011; 37: 1104-1110
        • Mainio A.
        • Kyllonen T.
        • Viilo K.
        • Hakko H.
        • Sarkioja T.
        • Rasanen P.
        Traumatic brain injury, psychiatric disorders and suicide: a population-based study of suicide victims during the years 1988-2004 in Northern Finland.
        Brain Inj. 2007; 21: 851-855
        • Roozenbeek B.
        • Maas A.I.
        • Menon D.K.
        Changing patterns in the epidemiology of traumatic brain injury.
        Nat Rev Neurol. 2013; 9: 231-236
        • Hoofien D.
        • Gilboa A.
        • Vakil E.
        • Donovick P.J.
        Traumatic brain injury (TBI) 10-20 years later: a comprehensive outcome study of psychiatric symptomatology, cognitive abilities and psychosocial functioning.
        Brain Inj. 2001; 15: 189-209
        • Dijkers M.P.
        Quality of life after traumatic brain injury: a review of research approaches and findings.
        Arch Phys Med Rehabil. 2004; 85: 21-35
        • Bayen E.
        • Pradat-Diehl P.
        • Jourdan C.
        • et al.
        Steering Committee of the PariS-TBI study. Predictors of informal care burden 1 year after a severe traumatic brain injury: results from the PariS-TBI study.
        J Head Trauma Rehabil. 2013; 28: 408-418
        • Mills A.L.
        • Kreutzer J.S.
        Theoretical applications of positive psychology to vocational rehabilitation after traumatic brain injury.
        J Occup Rehabil. 2016; 26: 20-31
        • Kanchan A.
        • Singh A.R.
        • Khan N.A.
        • Jahan M.
        • Raman R.
        • Rao T.S.
        Impact of neuropsychological rehabilitation on activities of daily living and community reintegration of patients with traumatic brain injury.
        Indian J Psychiatry. 2018; 60: 38-48
        • Bombardier C.H.
        • Fann J.R.
        • Ludman E.J.
        • et al.
        The relations of cognitive, behavioral, and physical activity variables to depression severity in traumatic brain injury: reanalysis of data from a randomized controlled trial.
        J Head Trauma Rehabil. 2017; 32: 343-353
        • Ho Chan W.
        Taiwan’s healthcare report 2010.
        EPMA J. 2010; 1: 563-585
        • National Health Insurance Research Database
        (Available at:)
        http://nhird.nhri.org.tw/en/index.htm
        Date accessed: November 1, 2019
        • Chien W.C.
        • Chung C.H.
        • Lin F.H.
        • et al.
        The risk of injury in adults with attention-deficit hyperactivity disorder: a nationwide, matched-cohort, population-based study in Taiwan.
        Res. Dev Disabil. 2017; 65: 57-73
        • Chien W.C.
        • Chung C.H.
        • Lai C.H.
        • Chou C.H.
        A retrospective population-based study of injury types among elderly in Taiwan.
        Int J Inj Contr Saf Promot. 2014; 21: 3-8
        • Chang S.Y.
        • Chien W.C.
        • Chung C.H.
        • et al.
        Risk of dementia after charcoal-burning suicide attempts: a nationwide cohort study in Taiwan.
        J Investig Med. 2018; 66: 1070-1082
        • Chu C.W.
        • Chien W.C.
        • Chung C.H.
        • et al.
        Electroconvulsive therapy and risk of dementia-a nationwide cohort study in Taiwan.
        Front Psychiatry. 2018; 9: 397
        • Tzeng N.S.
        • Chung C.H.
        • Lin F.H.
        • et al.
        Anti-herpetic medications and reduced risk of dementia in patients with herpes simplex virus infections-a nationwide, population-based cohort study in Taiwan.
        Neurotherapeutics. 2018; 15: 417-429
        • Tzeng N.S.
        • Chung C.H.
        • Lin F.H.
        • et al.
        Risk of dementia in adults with ADHD: a nationwide, population-based cohort study in Taiwan.
        J Atten Disord. 2019; 23: 995-1006
        • Hsieh C.Y.
        • Su C.C.
        • Shao S.C.
        • et al.
        Taiwan’s National Health Insurance Research Database: past and future.
        Clin Epidemiol. 2019; 11: 349-358
        • Cheng C.L.
        • Kao Y.H.
        • Lin S.J.
        • Lee C.H.
        • Lai M.L.
        Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan.
        Pharmacoepidemiol Drug Saf. 2011; 20: 236-242
        • Liang J.A.
        • Sun L.M.
        • Muo C.H.
        • Sung F.C.
        • Chang S.N.
        • Kao C.H.
        The analysis of depression and subsequent cancer risk in Taiwan.
        Cancer Epidemiol Biomarkers Prev. 2011; 20: 473-475
        • Baker S.P.
        • O'Neill B.
        • Haddon Jr., W.
        • Long W.B.
        The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.
        J Trauma. 1974; 14: 187-196
        • Stoner H.B.
        • Heath D.F.
        • Yates D.W.
        • Frayn K.N.
        Measuring the severity of injury.
        J R Soc Med. 1980; 73: 19-22
        • Chang C.Y.
        • Chen W.L.
        • Liou Y.F.
        • et al.
        Increased risk of major depression in the three years following a femoral neck fracture--a national population-based follow-up study.
        PLoS One. 2014; 9e89867
        • Needham D.M.
        • Scales D.C.
        • Laupacis A.
        • Pronovost P.J.
        A systematic review of the Charlson comorbidity index using Canadian administrative databases: a perspective on risk adjustment in critical care research.
        J Crit Care. 2005; 20: 12-19
        • Fine J.P.
        • Gray R.J.
        A proportional hazards model for the subdistribution of a competing risk.
        J Am Stat Assoc. 1999; 94: 496-509
        • Tzeng N.S.
        • Chung C.H.
        • Lin F.H.
        • et al.
        Headaches and risk of dementia.
        Am J Med Sci. 2017; 353: 197-206
        • IBM SPSS Predictive Analytics
        IBM SPSS predictive analytics gallery.
        (Available at:)
        http://ibmpredictiveanalytics.github.io/
        Date accessed: November 1, 2019
        • Perry D.C.
        • Sturm V.E.
        • Peterson M.J.
        • et al.
        Association of traumatic brain injury with subsequent neurological and psychiatric disease: a meta-analysis.
        J Neurosurg. 2016; 124: 511-526
        • McMillan T.M.
        • Teasdale G.M.
        • Stewart E.
        Disability in young people and adults after head injury: 12-14 year follow-up of a prospective cohort.
        J Neurol Neurosurg Psychiatry. 2012; 83: 1086-1091
        • Harrison-Felix C.
        • Kolakowsky-Hayner S.A.
        • Hammond F.M.
        • et al.
        Mortality after surviving traumatic brain injury: risks based on age groups.
        J Head Trauma Rehabil. 2012; 27: E45-E56
        • Bigler E.D.
        • Maxwell W.L.
        Neuropathology of mild traumatic brain injury: relationship to neuroimaging findings.
        Brain Imaging Behav. 2012; 6: 108-136
        • Shiel A.
        • Burn J.P.
        • Henry D.
        • Clark J.
        • Wilson B.A.
        • Burnett M.E.
        • McLellan D.L.
        The effects of increased rehabilitation therapy after brain injury: results of a prospective controlled trial.
        Clin Rehabil. 2001; 15: 501-514
        • Skandsen T.
        • Finnanger T.G.
        • Andersson S.
        • Lydersen S.
        • Brunner J.F.
        • Vik A.
        Cognitive impairment 3 months after moderate and severe traumatic brain injury: a prospective follow-up study.
        Arch Phys Med Rehabil. 2010; 91: 1904-1913
        • Meares S.
        • Shores E.A.
        • Taylor A.J.
        • et al.
        Mild traumatic brain injury does not predict acute postconcussion syndrome.
        J Neurol Neurosurg Psychiatry. 2008; 79: 300-306
        • Bangirana P.
        • Giordani B.
        • Kobusingye O.
        • et al.
        Patterns of traumatic brain injury and six-month neuropsychological outcomes in Uganda.
        BMC Neurol. 2019; 19: 18
        • Thompson J.N.
        • Majumdar J.
        • Sheldrick R.
        • Morcos F.
        Acute neurorehabilitation versus treatment as usual.
        Br J Neurosurg. 2013; 27: 24-29
        • Lee S.Y.
        • Amatya B.
        • Judson R.
        • et al.
        Clinical practice guidelines for rehabilitation in traumatic brain injury: a critical appraisal.
        Brain Inj. 2019; 33: 1263-1271
        • Zhu X.
        • Poon W.
        • Chan C.C.
        • Chan S.S.
        Does intensive rehabilitation improve the functional outcome of patients with traumatic brain injury (TBI)? A randomized controlled trial.
        Brain Inj. 2007; 21: 681-690
        • Sarajuuri J.M.
        • Kaipio M.-L.
        • Koskinen S.K.
        • Niemelä M.R.
        • Servo A.R.
        • Vilkki J.S.
        Outcome of a comprehensive neurorehabilitation program for patients with traumatic brain injury.
        Arch Phys Med Rehabil. 2005; 86: 2296-2302
        • Königs M.
        • Beurskens E.A.
        • Snoep L.
        • Scherder E.J.
        • Oosterlaan J.
        Effects of timing and intensity of neurorehabilitation on functional outcome after traumatic brain injury: a systematic review and meta-analysis.
        Arch Phys Med Rehabil. 2018; 99: 1149-1159
        • Turner-Stokes L.
        • Pick A.
        • Nair A.
        • Disler P.B.
        • Wade D.T.
        Multi-disciplinary rehabilitation for acquired brain injury in adults of working age.
        Cochrane Database Syst Rev. 2015; 12: CD004170
        • Griesbach G.S.
        • Hovda D.A.
        • Molteni R.
        • Wu A.
        • Gomez-Pinilla F.
        Voluntary exercise following traumatic brain injury: brain-derived neurotrophic factor upregulation and recovery of function.
        Neuroscience. 2004; 125: 129-139
        • Piao C.S.
        • Stoica B.A.
        • Wu J.
        • et al.
        Late exercise reduces neuroinflammation and cognitive dysfunction after traumatic brain injury.
        Neurobiol Dis. 2013; 54: 252-263
        • Wheeler S.
        • Acord-Vira A.
        • Davis D.
        Effectiveness of interventions to improve occupational performance for people with psychosocial, behavioral, and emotional impairments after brain injury: a systematic review.
        Am J Occup Ther. 2016; 70: 1-9
        • Draper K.
        • Ponsford J.
        • Schönberger M.
        Psychosocial and emotional outcomes 10 years following traumatic brain injury.
        J Head Trauma Rehabil. 2007; 22: 278-287
        • Whelan-Goodinson R.
        • Ponsford J.
        • Schonberger M.
        Association between psychiatric state and outcome following traumatic brain injury.
        J Rehabil Med. 2008; 40: 850-857
        • Akerlund E.
        • Esbjornsson E.
        • Sunnerhagen K.S.
        • Bjorkdahl A.
        Can computerized working memory training improve impaired working memory, cognition and psychological health?.
        Brain Inj. 2013; 27: 1649-1657
        • Foreman B.P.
        • Caesar R.R.
        • Parks J.
        • et al.
        Usefulness of the abbreviated injury score and the injury severity score in comparison to the Glasgow Coma Scale in predicting outcome after traumatic brain injury.
        J. Trauma. 2007; 62: 946-950