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



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


      Prospective longitudinal, observational study.


      Inpatient rehabilitation centers.


      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.


      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).


      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect