TABLE 8.4 Psychologic Outcomes—Personality 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 diagnosed TBI in 1993 enrolled in health plan for at least 1 year before injury, 3 to 1 match with health plan controls; followed up to 3 years after enrollment in study

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, psychiatric-service use in year before TBI, 1–12 mo, 13–24 mo, 25–36 mo after injury

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 TBI reference date, comorbid injuries

Possible misclassification of diagnoses; lack of precision in measurement of TBI exposure





Control group is general HMO population, not injury population



TBI associated with higher risk of adjustment reaction in year after TBI: mild, 7.2%; moderate to severe, 7.4%; controls, 4.6%






Had preinjury data

TBI associated with higher risk of psychotic disorder in year after TBI: mild, 3.0%; moderate to severe, 13.0%; controls, 1.9%

Ommaya et al., 1996

Retrospective cohort

2,243 TBI military hospital patients from discharge records for all military hospitals vs

TBI severity determined with ICD-9 to compute AIS and ISS; mild

Post-TBI discharge from active-duty service for: behavioral reasons, criminal

Behavioral: mild TBI, OR, 1.8 (95% CI, 1.4–2.2); moderate TBI,

Stratified by whether injuries arose from fights

Alcohol use not considered




Normal orthopedic controls

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