wounds but without TBI. Veterans were identified 50 years after the war on the basis of the diagnosis reported on their “F-cards” in their medical records. Of the 3,460 veterans with reported head injuries (combat and non-combat-related), 1,422 met the authors’ criteria for TBI—documented TBI in a military record; occurrence during military service; produced loss of consciousness (LOC), posttraumatic amnesia (PTA), or nondepressed skull facture; failure to penetrate the dura mater; and lack of significant cognitive impairment or neurological sequelae more than 3 months after the trauma—and 520 were included in the study. TBI was categorized as mild, moderate, or severe on the basis of the duration of LOC or PTA. Motor- vehicle crashes (26%), falls (19%), and blast concussions (17%) were the leading causes of head injuries. Among the 4,022 potential controls, 1,198 were included in the study.
A lifetime history of depression was assessed on the basis of a structured telephone interview with the veteran or his proxy; participants who responded affirmatively to any of three questions regarding mood also were given a modified version of the Diagnostic Interview Schedule for depression to decide on a DSM-IV diagnosis of major depression. The lifetime odds of major depression was significantly increased in veterans with TBI compared with controls (odds ratio [OR], 1.54, 95% CI, 1.17–2.04). Current major depression was also significantly increased in veterans with TBI (OR, 1.63, 95% CI, 1.07–2.50). The odds of lifetime depression also varied with TBI severity with ORs of 1.99 (95% CI, 1.11–3.57) for severe TBI, 1.40 (95% CI, 0.97–1.83) for moderate TBI, and 1.49 (95% CI, 0.96–2.31) for mild TBI. Alcohol abuse, myocardial infarction, and cerebrovascular accident did not appear to influence the association between TBI and lifetime risk of major depression. However, the odds did increase with age: ORs were 0.81 (95% CI, 0.45–1.43) for men aged 65–69 years old, 1.45 (95% CI, 1.07–1.97) for men 70–74 years old, 2.61 (95% CI, 1.58–4.30) for men 75–79 years old, and 5.95 (95% CI, 2.05–17.23) for men 80 years old and older. One important limitation of this study was the failure to specifically ascertain the presence of major depression before TBI.
Jorge et al. (2004) assessed the presence of comorbid psychiatric disorders in 91 consecutive patients with closed TBI and a comparison group of 27 patients with multiple trauma but without evidence of central nervous system injury who were admitted at injury to two Iowa medical facilities. Patients with peripheral nerve injuries or spinal-cord injuries were excluded. All included patients were assessed at 3, 6, and 12 months after injury. A modified version of the Present State Examination and the Structured Clinical Interview for DSM-IV diagnoses were used to make a DSM-IV diagnosis of mood and anxiety disorder. The severity of symptoms of depression and anxiety was assessed with the Hamilton Depression Rating Scale and the Hamilton Anxiety Scale; aggressive behavior was assessed with the Overt Aggression Scale. Neuroimaging was done with computed tomography scans or magnetic resonance imaging, and a neuropsychologic assessment was conducted at 3 months. Of the 91 TBI patients, 47 (51.6%) developed a mood disorder in the 12 months after their injury, 30 (33%) of whom had major depressive disorder. There was no significant between-group difference with respect to prior history of depression or anxiety disorders. Mood disorder was statistically significantly more common in the TBI group than in the comparison group during the first year after injury (51.6% vs 22.2%, p = 0.006). Of the patients who met DSM-IV criteria for mood disorder, 30 of the TBI patients presented with major depression compared with controls (p = 0.008).
The authors compared the 30 TBI patients who had major depressive disorder with the 44 TBI patients who did not develop any mood disorder in the 12 months after injury. Of the 30 TBI patients with major depression, 23 (76.7%) also met the criteria for an anxiety disorder compared