TABLE 8.1 Psychologic Outcomes—Mood-Disorder Studies


Study Design


Type of TBI

Health Outcomes or Outcome Measures



Comments or Limitations

Fann et al., 2004

Prospective cohort

939 HMO enrollees (479 women, 460 men) with diagnosis of TBI in 1993 enrolled in health plan for at least 1 year before injury, 3 to 1 match with health-plan controls; cases, controls followed for 3 years after enrollment in study

Severity dichotomized with CDC categorization criteria into mild (803), moderate to severe (136); injury identified with ICD-9-CM categories, codes (fracture of vault base of skull; other, unqualified, multiple fractures of skull; intracranial injury)

Psychiatric illness determined with three major indicators: ICD-9-CM codes, prescriptions, use of psychiatric service year before TBI, 1–12, 13–24, 25–36 mo after injury; affective disorders included depression, anxiety

Increased rates of psychiatric illness in year after TBI (49% in moderate to severe, 34% in mild, 18% in non-TBI comparisons)

Age, sex, TBI reference date, logarithm of costs in year before reference date, comorbid injuries

Limitation: control group is general HMO population, not an injury population



TBI associated with higher risk of any psychiatric illness 6 mo after trauma in subjects with or without prior psychiatric illness







No prior psychiatric illness (p <0.001): mild TBI, RR, 2.8 (95% CI, 2.1–3.7); moderate to severe TBI, RR, 4.0 (95% CI, 2.4–6.8)








Prior psychiatric illness (p, 0.005): mild TBI, RR, 1.6 (95% CI, 1.2–2.0); moderate to severe TBI, RR, 2.1 (95% CI, 1.3–3.3)








Subjects with mild TBI showed chronic likelihood of psychiatric illness



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