Abstract
Objective
Determine anxiety trajectories and predictors up to 10 years posttraumatic brain injury
(TBI).
Design
Prospective longitudinal, observational study.
Setting
Inpatient rehabilitation centers.
Participants
2836 participants with moderate to severe TBI enrolled in the TBI Model Systems National
Database who had ≥2 anxiety data collection points (N=2836).
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 (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 3 anxiety trajectories: low-stable (n=2195),
high-increasing (n=289), and high-decreasing (n=352). The high-increasing and high-decreasing
groups had mild or higher 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 2 prior TBIs. Awareness of these risk factors may lead to identifying
and proactively referring susceptible individuals to mental health services.
Keywords
List of abbreviations:
GAD (generalized anxiety disorder), GAD-7 (Generalized Anxiety Disorder-7), LOC (loss of consciousness), SES (socioeconomic status), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems)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 accessOne-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:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Rates of major depressive disorder and clinical outcomes following traumatic brain injury.JAMA. 2010; 303: 1938-1945
- Major and minor depression after traumatic brain injury.Arch Phys Med Rehabil. 2011; 92: 1211-1219
- A longitudinal study of major and minor depression following traumatic brain injury.Arch Phys Med Rehabil. 2012; 93: 1343-1349
- Prevalence, risk factors, and correlates of anxiety at 1 year after moderate to severe traumatic brain injury.Arch Phys Med Rehabil. 2016; 97: 701-707
- Psychiatric disorders following traumatic brain injury: their nature and frequency.J Head Trauma Rehabil. 2009; 24: 324-332
- Prevalence of anxiety following adult traumatic brain injury: a meta-analysis comparing measures, samples and postinjury intervals.Neuropsychology. 2016; 30: 247-261
- A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury.Psychol Med. 2016; 46: 1331-1341
- Epidemiology and natural history of psychiatric disorders after TBI.J Neuropsychiatry Clin Neurosci. 2018; 30: 262-270
- Affective state and community integration after traumatic brain injury.Am J Phys Med Rehabil. 2014; 93: 1086-1094
- Post-traumatic epilepsy associations with mental health outcomes in the first two years after moderate to severe TBI: a TBI Model Systems analysis.Epilepsy Behav. 2017; 73: 240-246
- Anxiety as a primary predictor of functional impairment after acquired brain injury: a brief report.Rehabil Psychol. 2013; 58: 429-435
- Suicidal ideation following traumatic brain injury: prevalence rates and correlates in adults living in the community.J Head Trauma Rehabil. 2011; 26: 265-275
- Predictors of psychiatric disorders following traumatic brain injury.J Head Trauma Rehabil. 2010; 25: 320-329
- Association between psychiatric state and outcome following traumatic brain injury.J Rehabil Med. 2008; 40: 850-857
- 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
- Psychosocial and emotional outcomes 10 years following traumatic brain injury.J Head Trauma Rehabil. 2007; 22: 278-287
- Epidemiology of anxiety disorders in the 21st century.Dialogues Clin Neurosci. 2015; 17: 327-335
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V).5th ed. American Psychiatric Association, Arlington2013
- Prediction of depression and anxiety 1 year after moderate-severe traumatic brain injury.Appl Neuropsychol. 2010; 17: 183-189
- Psychotropic medication use among Medicare beneficiaries following traumatic brain injury.Am J Geriatr Psychiatry. 2017; 25: 415-424
- Prevalence of and risk factors for anxiety and depressive disorders after traumatic brain injury: a systematic review.J Neurotrauma. 2016; 33: 1969-1994
- Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand.Br J Gen Pract. 2016; 66: e16-e23
- Psychometric evaluation of anxiety, depression, and sleep quality after a mild traumatic brain injury: a longitudinal study.Behav Neurol. 2019; 20194364592
- Group-based trajectory analysis of emotional symptoms among survivors after severe traumatic brain injury.J Head Trauma Rehabil. 2017; 32: e29-e37
- A brief measure for assessing generalized anxiety disorder: the GAD-7.Arch Intern Med. 2006; 166: 1092-1097
- Health insurance coverage and health—what the recent evidence tells us.N Engl J Med. 2017; 377: 586-593
- Comorbid conditions among adults 50 years and older with traumatic brain injury: examining associations with demographics, healthcare utilization, institutionalization, and 1-year outcomes.J Head Trauma Rehabil. 2019; 34: 224-232
- Screening and identification of TBI.J Head Trauma Rehabil. 2007; 22: 315-317
- Initial reliability and validity of the Ohio State University TBI identification method.J Head Trauma Rehabil. 2007; 22: 318-329
- Applied mixed models in medicine.Statistics in practice. 3rd ed. Wiley, Chichester, England2015
- A new look at the statistical model identification.IEEE Trans Automat Contr. 1974; 19: 716-723
- Estimation of extended mixed models using latent classes and latent processes: the R package lcmm.J Stat Softw. 2017; 78: 1-56
- 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 influence of internalized racism on the relationship between discrimination and anxiety.Cultur Divers Ethnic Minor Psychol. 2020; 26: 570-580
- Prevalence and correlates of anxiety symptoms among Black people in Canada: a significant role for everyday racial discrimination and racial microaggressions.J Affect Disord. 2022; 308: 545-553
- Racial discrimination predicts mental health outcomes beyond the role of personality traits in a community sample of African Americans.Clin Psychol Sci. 2021; 9: 183-196
- Racial differences in attitudes toward professional mental health treatment: the mediating effect of stigma.J Gerontol Soc Work. 2009; 52: 695-712
- African American men and women's attitude toward mental illness, perceptions of stigma, and preferred coping behaviors.Nurs Res. 2013; 62: 185-194
- Medicaid.(editor)in: Moffitt R Means-tested transfer programs in the United States. University of Chicago Press, Chicago, IL2003: 15-78
- How socioeconomic status affects patient perceptions of health care: a qualitative study.J Prim Care Community Health. 2017; 8: 169-175
- Association of socioeconomic status with ideal cardiovascular health in Black men.J Am Heart Assoc. 2021; 10e020184
- Understanding the highs and lows of socioeconomic status.J Allergy Clin Immunol. 2022; 149: 1585-1586
- A Population-based analysis of socioeconomic status and insurance status and their relationship with pediatric trauma hospitalization and mortality rates.Res Pract. 2003; 93: 461-466
- Measurement of socioeconomic status in health disparities research.J Natl Med Assoc. 2007; 99: 1013-1023
- The impact of previous traumatic brain injury on health and functioning: a TRACK-TBI study.J Neurotrauma. 2013; 30: 2014-2020
- 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
- Traumatic brain injury as a chronic health condition.Arch Phys Med Rehabil. 2013; 94: 1199-1201
- The effectiveness of cognitive behaviour therapy for reducing anxiety symptoms following traumatic brain injury: a meta-analysis and systematic review.NeuroRehabilitation. 2021; 48: 67-82
Article Info
Publication History
Published online: July 26, 2022
Accepted:
July 2,
2022
Received in revised form:
May 27,
2022
Received:
November 8,
2021
Footnotes
Related conference presentation: Neumann D, Juengst SB, Bombardier CH, et al. Trajectories and predictors of anxiety over a ten-year duration after traumatic brain injury: a TBIMS study. ACRM 98th Annual Conference, Dallas, Texas (Virtual), September 26-29, 2021.
The contents of this article were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR Grant Nos. 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 article 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 article 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.
Disclosures: none.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
