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Anxiety Trajectories the First 10 Years Following a Traumatic Brain Injury (TBI): A TBI Model Systems Study

Published:July 26, 2022DOI:https://doi.org/10.1016/j.apmr.2022.07.002
Anxiety Trajectories the First 10 Years Following a Traumatic Brain Injury (TBI): A TBI Model Systems Study
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      ABSTRACT

      Objective

      Determine anxiety trajectories and predictors up to 10 years post-traumatic brain injury (TBI).

      Design

      Prospective longitudinal, observational study.

      Setting

      Inpatient rehabilitation centers.

      Participants

      2,836 participants with moderate to severe TBI enrolled in the TBI Model Systems National Database who had ≥2 anxiety data collection points.

      Main Outcome Measure

      Generalized Anxiety Disorder-7 (GAD-7) at 1, 2, 5, and 10-year follow-ups.

      Results

      Linear mixed models showed higher GAD-7 scores were associated with Black race (p<.001), public insurance (p<.001), pre-injury mental health treatment (p<.001), 2 additional TBIs with loss of consciousness (LOC) (p=.003), violent injury (p=.047), and more years post-TBI (p=.023). An interaction between follow-up year and age was also related to GAD-7 scores (p=.006). A latent class mixed model identified three anxiety trajectories: low-stable (n=2,195), high-increasing (n=289), and high-decreasing (n=352). The high-increasing and high-decreasing groups had ≥mild GAD-7 scores up to 10 years. Compared to the low-stable group, the high-decreasing group was more likely to be Black (OR=2.25), have public insurance (OR=2.13), have had pre-injury mental health treatment (OR=1.77), and have had 2 prior TBIs (OR=3.16).

      Conclusions

      A substantial minority of participants had anxiety symptoms that either increased (10%) or decreased (13%) over 10 years, but never decreased below mild anxiety. Risk factors of anxiety included indicators of socioeconomic disadvantage (public insurance) and racial inequities (Black race) as well as having had pre-injury mental health treatment and two prior TBIs. Awareness of these risk factors may lead to identifying and proactively referring susceptible individuals to mental health services.

      Key Words

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      Article Info

      Publication History

      Accepted: July 2, 2022
      Received in revised form: May 27, 2022
      Received: November 8, 2021

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      We have no known conflict of interest to disclose.

      The contents of this manuscript were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers: IU 90DRTB0002, NTX 90DPTB0013, UAB 90DPTB0015, Spaulding/Harvard 90DPTB0011, Moss 90DPTB0004 University of Washington 90DPTB008,). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

      Dr. Finn's contributions to this manuscript are the result of work supported with resources and the use of facilities at the Minneapolis VA Health Care System, as well as the VA Polytrauma Rehabilitation Center Traumatic Brain Injury Model System, a funded collaboration between the Department of Veterans Affairs and the Department of HHS. The views, opinion, and/or findings contained in this article are those of the authors and should not be construed as an official position, policy, or decision of the US Department of Veterans Affairs or any other federal agency unless so designated by other official documentation.

      Related conference presentation: Neumann, D., Juengst, S.B., Bombardier, C.H., Finn, J.A., Miles, S., Zhang, Y., Kennedy, R.E., Rabinowitz, A.R., Thomas, A., Dreer, L.E. Trajectories and Predictors of Anxiety Over a Ten-year Duration after Traumatic BrainInjury: A TBIMS Study. ACRM 98th Annual Conference, Dallas, Texas (Virtual), September 26-29, 2021.

      Identification

      DOI: https://doi.org/10.1016/j.apmr.2022.07.002

      Copyright

      © 2022 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine

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