A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury

Y Alway, K. R. Gould, L. Johnston, D. McKenzie, J. Ponsford

Research output: Contribution to journalArticleResearchpeer-review

29 Citations (Scopus)

Abstract

Background: Psychiatric disorders commonly emerge during the first year following traumatic brain injury (TBI). However, it is not clear whether these disorders soon remit or persist for long periods post-injury. This study aimed to examine, prospectively: (1) the frequency, (2) patterns of co-morbidity, (3) trajectory, and (4) risk factors for psychiatric disorders during the first 5 years following TBI. Method: Participants were 161 individuals (78.3 male) with moderate (31.2 ) or severe (68.8 ) TBI. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV, administered soon after injury and 3, 6 and 12 months, and 2, 3, 4 and 5 years post-injury. Disorder frequencies and generalized estimating equations were used to identify temporal relationships and risk factors. Results: In the first 5 years post-injury, 75.2 received a psychiatric diagnosis, commonly emerging within the first year (77.7 ). Anxiety, mood and substance-use disorders were the most common diagnostic classes, often presenting co-morbidly. Many (56.5 ) experienced a novel diagnostic class not present prior to injury. Disorder frequency ranged between 61.8 and 35.6 over time, decreasing by 27 [odds ratio (OR) 0.73, 95 confidence interval (CI) 0.65?0.83] with each year post-injury. Anxiety disorders declined significantly over time (OR 0.73, 95 CI 0.63?0.84), whilst mood and substance-use disorder rates remained stable. The strongest predictors of post-injury disorder were pre-injury disorder (OR 2.44, 95 CI 1.41?4.25) and accident-related limb injury (OR 1.78, 95 CI 1.03?3.07). Conclusions: Findings suggest the first year post-injury is a critical period for the emergence of psychiatric disorders. Disorder frequency declines thereafter, with anxiety disorders showing greater resolution than mood and substance-use disorders
Original languageEnglish
Pages (from-to)1331-1341
Number of pages11
JournalPsychological Medicine
Volume46
Issue number6
DOIs
Publication statusPublished - 1 Apr 2016

Keywords

  • Anxiety
  • depression
  • longitudinal studies
  • psychiatric disorders
  • traumatic brain injury

Cite this

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title = "A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury",
abstract = "Background: Psychiatric disorders commonly emerge during the first year following traumatic brain injury (TBI). However, it is not clear whether these disorders soon remit or persist for long periods post-injury. This study aimed to examine, prospectively: (1) the frequency, (2) patterns of co-morbidity, (3) trajectory, and (4) risk factors for psychiatric disorders during the first 5 years following TBI. Method: Participants were 161 individuals (78.3 male) with moderate (31.2 ) or severe (68.8 ) TBI. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV, administered soon after injury and 3, 6 and 12 months, and 2, 3, 4 and 5 years post-injury. Disorder frequencies and generalized estimating equations were used to identify temporal relationships and risk factors. Results: In the first 5 years post-injury, 75.2 received a psychiatric diagnosis, commonly emerging within the first year (77.7 ). Anxiety, mood and substance-use disorders were the most common diagnostic classes, often presenting co-morbidly. Many (56.5 ) experienced a novel diagnostic class not present prior to injury. Disorder frequency ranged between 61.8 and 35.6 over time, decreasing by 27 [odds ratio (OR) 0.73, 95 confidence interval (CI) 0.65?0.83] with each year post-injury. Anxiety disorders declined significantly over time (OR 0.73, 95 CI 0.63?0.84), whilst mood and substance-use disorder rates remained stable. The strongest predictors of post-injury disorder were pre-injury disorder (OR 2.44, 95 CI 1.41?4.25) and accident-related limb injury (OR 1.78, 95 CI 1.03?3.07). Conclusions: Findings suggest the first year post-injury is a critical period for the emergence of psychiatric disorders. Disorder frequency declines thereafter, with anxiety disorders showing greater resolution than mood and substance-use disorders",
keywords = "Anxiety, depression, longitudinal studies, psychiatric disorders, traumatic brain injury",
author = "Y Alway and Gould, {K. R.} and L. Johnston and D. McKenzie and J. Ponsford",
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A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury. / Alway, Y; Gould, K. R.; Johnston, L.; McKenzie, D.; Ponsford, J.

In: Psychological Medicine, Vol. 46, No. 6, 01.04.2016, p. 1331-1341.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - A prospective examination of Axis I psychiatric disorders in the first 5 years following moderate to severe traumatic brain injury

AU - Alway, Y

AU - Gould, K. R.

AU - Johnston, L.

AU - McKenzie, D.

AU - Ponsford, J.

PY - 2016/4/1

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N2 - Background: Psychiatric disorders commonly emerge during the first year following traumatic brain injury (TBI). However, it is not clear whether these disorders soon remit or persist for long periods post-injury. This study aimed to examine, prospectively: (1) the frequency, (2) patterns of co-morbidity, (3) trajectory, and (4) risk factors for psychiatric disorders during the first 5 years following TBI. Method: Participants were 161 individuals (78.3 male) with moderate (31.2 ) or severe (68.8 ) TBI. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV, administered soon after injury and 3, 6 and 12 months, and 2, 3, 4 and 5 years post-injury. Disorder frequencies and generalized estimating equations were used to identify temporal relationships and risk factors. Results: In the first 5 years post-injury, 75.2 received a psychiatric diagnosis, commonly emerging within the first year (77.7 ). Anxiety, mood and substance-use disorders were the most common diagnostic classes, often presenting co-morbidly. Many (56.5 ) experienced a novel diagnostic class not present prior to injury. Disorder frequency ranged between 61.8 and 35.6 over time, decreasing by 27 [odds ratio (OR) 0.73, 95 confidence interval (CI) 0.65?0.83] with each year post-injury. Anxiety disorders declined significantly over time (OR 0.73, 95 CI 0.63?0.84), whilst mood and substance-use disorder rates remained stable. The strongest predictors of post-injury disorder were pre-injury disorder (OR 2.44, 95 CI 1.41?4.25) and accident-related limb injury (OR 1.78, 95 CI 1.03?3.07). Conclusions: Findings suggest the first year post-injury is a critical period for the emergence of psychiatric disorders. Disorder frequency declines thereafter, with anxiety disorders showing greater resolution than mood and substance-use disorders

AB - Background: Psychiatric disorders commonly emerge during the first year following traumatic brain injury (TBI). However, it is not clear whether these disorders soon remit or persist for long periods post-injury. This study aimed to examine, prospectively: (1) the frequency, (2) patterns of co-morbidity, (3) trajectory, and (4) risk factors for psychiatric disorders during the first 5 years following TBI. Method: Participants were 161 individuals (78.3 male) with moderate (31.2 ) or severe (68.8 ) TBI. Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV, administered soon after injury and 3, 6 and 12 months, and 2, 3, 4 and 5 years post-injury. Disorder frequencies and generalized estimating equations were used to identify temporal relationships and risk factors. Results: In the first 5 years post-injury, 75.2 received a psychiatric diagnosis, commonly emerging within the first year (77.7 ). Anxiety, mood and substance-use disorders were the most common diagnostic classes, often presenting co-morbidly. Many (56.5 ) experienced a novel diagnostic class not present prior to injury. Disorder frequency ranged between 61.8 and 35.6 over time, decreasing by 27 [odds ratio (OR) 0.73, 95 confidence interval (CI) 0.65?0.83] with each year post-injury. Anxiety disorders declined significantly over time (OR 0.73, 95 CI 0.63?0.84), whilst mood and substance-use disorder rates remained stable. The strongest predictors of post-injury disorder were pre-injury disorder (OR 2.44, 95 CI 1.41?4.25) and accident-related limb injury (OR 1.78, 95 CI 1.03?3.07). Conclusions: Findings suggest the first year post-injury is a critical period for the emergence of psychiatric disorders. Disorder frequency declines thereafter, with anxiety disorders showing greater resolution than mood and substance-use disorders

KW - Anxiety

KW - depression

KW - longitudinal studies

KW - psychiatric disorders

KW - traumatic brain injury

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