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Am J Psychiatry 1995; 152:1493-1499
Copyright © 1995 by American Psychiatric Association
Psychiatric disorders and functional disability in outpatients with traumatic brain injuries
JR Fann, WJ Katon, JM Uomoto and PC Esselman
Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, USA.
OBJECTIVE: This study examined psychiatric sequelae of traumatic brain
injuries in outpatients and their relation to functional disability.
METHOD: Fifty consecutive outpatients with traumatic brain injuries who
came to a brain injury rehabilitation clinic for initial evaluation were
examined for DSM-III-R diagnoses with the use of the National Institute of
Mental Health Diagnostic Interview Schedule. The patients completed the
Medical Outcomes Study Health Survey to assess functional disability and a
questionnaire to assess postconcussion symptoms and self-perceptions of the
severity of their brain injuries and cognitive functioning. RESULTS:
Thirteen (26%) of the patients had current major depression, and an
additional 14 (28%) reported a first-onset major depressive episode after
the injury that had resolved. Twelve (24%) had current generalized anxiety
disorder, and four (8%) reported current substance abuse. The group with
depression and/or anxiety was significantly more impaired than the
nondepressed/nonanxious patients according to the Medical Outcomes Study
Health Survey measures of emotional role functioning, mental health, and
general health perceptions. The depressed/anxious group also rated their
injuries as significantly more severe and their cognitive functioning as
significantly worse, despite the lack of significant differences in
objective measures of severity of injury and Mini-Mental State examination
scores. The depressed patients reported significantly more postconcussion
symptoms that were increasing in severity over time. CONCLUSIONS:
Depression and anxiety are common in outpatients with traumatic brain
injuries. Patients with depression or anxiety are more functionally
disabled and perceive their injury and cognitive impairment as more severe.
Depressed patients report more increasingly severe postconcussion symptoms.
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