Citation

Hart T, Fann JR, Chervoneva I, Juengst SB, Rosenthal JA, Krellman JW, Dreer LE, Kroenke K. Arch. Phys. Med. Rehabil. 2015; 97(5): 701-707.

Affiliation

VA HSR&D Center for Health Information and Communication, Department of Medicine, Indiana University, and Regenstrief Institute, Inc. Indianapolis, IN.

Copyright

(Copyright © 2015, Elsevier Publishing)

DOI

10.1016/j.apmr.2015.08.436

PMID

26707456

Abstract

OBJECTIVE: To determine at 1 year post moderate to severe traumatic brain injury (1) the rate of clinically significant anxiety; (2) rates of specific symptoms of anxiety; (3) risk factors for anxiety; and (4) associations of anxiety with other 1-year outcomes including participation and quality of life.

DESIGN: Prospective longitudinal observational study. SETTING: Inpatient rehabilitation centers, with data capture at injury and 1-year followup. PARTICIPANTS: 1838 persons with moderate to severe traumatic brain injury who were enrolled in the Traumatic Brain Injury Model Systems database. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Generalized Anxiety Disorder-7 item scale, Patient Health Questionnaire-9 item scale of depression, FIM, Participation Assessment with Recombined Tools-Objective, Satisfaction with Life Scale.

RESULTS: Clinically significant anxiety was reported by 21% of participants. Of these, more than 80% reported interference with daily activities, with most common symptoms being excessive worry and irritability. A common pattern was comorbid anxiety and depression, with smaller proportions reporting either disorder alone. Anxiety had large effect sizes with respect to life satisfaction and cognitive disability, and medium to small effects relative to societal participation and self-care. Middle age, African-American race, lower socio-economic status, preinjury mental health treatment, and at least 1 traumatic brain injury prior to the index injury were all risk factors for later anxiety.

CONCLUSIONS: Anxiety should be screened, fully evaluated, and treated after moderate/ severe TBI. Worry and irritability might be treated with pharmacologic agents or with relatively simple behavioral interventions, which should be further researched in this population.

Language: en