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Psychiatric illness following traumatic brain injury in an adult health maintenance organization population.

Abstract

BACKGROUND

Psychiatric illness after traumatic brain injury (TBI) has been shown to be prevalent in hospitalized and tertiary care patient populations.

OBJECTIVE

To determine the risk of psychiatric illness after TBI in an adult health maintenance organization population.

DESIGN

Prospective cohort study.

SETTING

Large staff-model health maintenance organization.

PARTICIPANTS

Nine hundred thirty-nine health plan members diagnosed as having TBI in 1993 and enrolled in the prior year, during which no TBI was ascertained. Three health plan members per TBI-exposed subject were randomly selected as unexposed comparisons, matched for age, sex, and reference date.

MAIN OUTCOME MEASURE

Psychiatric illness in the 3 years after the TBI reference date, determined using computerized records of psychiatric diagnoses according to the International Classification of Diseases, Ninth Revision, Clinical Modification, prescriptions, and service utilization.

RESULTS

Prevalence of any psychiatric illness in the first year was 49% following moderate to severe TBI, 34% following mild TBI, and 18% in the comparison group. Among subjects without psychiatric illness in the prior year, the adjusted relative risk for any psychiatric illness in the 6 months following moderate to severe TBI was 4.0 (95% confidence interval [CI], 2.4-6.8) and following mild TBI was 2.8 (95% CI, 2.1-3.7; P<.001) compared with those without TBI. Among subjects with prior psychiatric illness, the adjusted relative risk for any psychiatric illness in the 6 months following moderate to severe TBI was 2.1 (95% CI, 1.3-3.3) and following mild TBI was 1.6 (95% CI, 1.2-2.0; P =.005). Prior psychiatric illness significantly modified the relationship between TBI and subsequent psychiatric illness (P =.04) and was a significant predictor (P<.001). Persons with mild TBI and prior psychiatric illness had evidence of persisting psychiatric illness.

CONCLUSIONS

Both moderate to severe and mild TBI are associated with an increased risk of subsequent psychiatric illness. Whereas moderate to severe TBI is associated with a higher initial risk, mild TBI may be associated with persistent psychiatric illness.

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  • Authors+Show Affiliations

    ,

    Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98105-6560, USA. fann@u.washington.edu

    , , , ,

    Source

    Archives of general psychiatry 61:1 2004 Jan pg 53-61

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Brain Injuries
    Brain Injury, Chronic
    Causality
    Cohort Studies
    Comorbidity
    Cross-Sectional Studies
    Female
    Follow-Up Studies
    Health Maintenance Organizations
    Humans
    Male
    Mental Disorders
    Middle Aged
    Neurocognitive Disorders
    Prospective Studies
    Reference Values
    Risk
    Washington

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    14706944

    Citation

    Fann, Jesse R., et al. "Psychiatric Illness Following Traumatic Brain Injury in an Adult Health Maintenance Organization Population." Archives of General Psychiatry, vol. 61, no. 1, 2004, pp. 53-61.
    Fann JR, Burington B, Leonetti A, et al. Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. Arch Gen Psychiatry. 2004;61(1):53-61.
    Fann, J. R., Burington, B., Leonetti, A., Jaffe, K., Katon, W. J., & Thompson, R. S. (2004). Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. Archives of General Psychiatry, 61(1), pp. 53-61.
    Fann JR, et al. Psychiatric Illness Following Traumatic Brain Injury in an Adult Health Maintenance Organization Population. Arch Gen Psychiatry. 2004;61(1):53-61. PubMed PMID: 14706944.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Psychiatric illness following traumatic brain injury in an adult health maintenance organization population. AU - Fann,Jesse R, AU - Burington,Bart, AU - Leonetti,Alexandra, AU - Jaffe,Kenneth, AU - Katon,Wayne J, AU - Thompson,Robert S, PY - 2004/1/7/pubmed PY - 2004/2/18/medline PY - 2004/1/7/entrez SP - 53 EP - 61 JF - Archives of general psychiatry JO - Arch. Gen. Psychiatry VL - 61 IS - 1 N2 - BACKGROUND: Psychiatric illness after traumatic brain injury (TBI) has been shown to be prevalent in hospitalized and tertiary care patient populations. OBJECTIVE: To determine the risk of psychiatric illness after TBI in an adult health maintenance organization population. DESIGN: Prospective cohort study. SETTING: Large staff-model health maintenance organization. PARTICIPANTS: Nine hundred thirty-nine health plan members diagnosed as having TBI in 1993 and enrolled in the prior year, during which no TBI was ascertained. Three health plan members per TBI-exposed subject were randomly selected as unexposed comparisons, matched for age, sex, and reference date. MAIN OUTCOME MEASURE: Psychiatric illness in the 3 years after the TBI reference date, determined using computerized records of psychiatric diagnoses according to the International Classification of Diseases, Ninth Revision, Clinical Modification, prescriptions, and service utilization. RESULTS: Prevalence of any psychiatric illness in the first year was 49% following moderate to severe TBI, 34% following mild TBI, and 18% in the comparison group. Among subjects without psychiatric illness in the prior year, the adjusted relative risk for any psychiatric illness in the 6 months following moderate to severe TBI was 4.0 (95% confidence interval [CI], 2.4-6.8) and following mild TBI was 2.8 (95% CI, 2.1-3.7; P<.001) compared with those without TBI. Among subjects with prior psychiatric illness, the adjusted relative risk for any psychiatric illness in the 6 months following moderate to severe TBI was 2.1 (95% CI, 1.3-3.3) and following mild TBI was 1.6 (95% CI, 1.2-2.0; P =.005). Prior psychiatric illness significantly modified the relationship between TBI and subsequent psychiatric illness (P =.04) and was a significant predictor (P<.001). Persons with mild TBI and prior psychiatric illness had evidence of persisting psychiatric illness. CONCLUSIONS: Both moderate to severe and mild TBI are associated with an increased risk of subsequent psychiatric illness. Whereas moderate to severe TBI is associated with a higher initial risk, mild TBI may be associated with persistent psychiatric illness. SN - 0003-990X UR - https://www.unboundmedicine.com/medline/citation/14706944/Psychiatric_illness_following_traumatic_brain_injury_in_an_adult_health_maintenance_organization_population_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=14706944.ui DB - PRIME DP - Unbound Medicine ER -