PTSD Risk Highest in First Months After Traumatic Brain Injury


MARCO ISLAND, FLA. — Posttraumatic stress disorder is not uncommon after moderate-to-severe traumatic brain injury, Jesse R. Fann, M.D., said at the annual meeting of the Academy of Psychosomatic Medicine.

Many people experience anxiety after moderate-to-severe traumatic brain injury. Because both brain injury and dissociation from posttraumatic stress disorder (PTSD) can impair declarative memory, the true occurrence of PTSD remains controversial, noted Dr. Fann, director of the psychiatry and psychology consultation service at the Seattle Cancer Care Alliance.

In a 6-month prospective follow-up study, the researchers assessed 124 patients admitted to Harborview Medical Center in Seattle following traumatic brain injury to determine the incidence of PTSD, the risk factors, and how PTSD symptoms manifest in this population.

Researchers did monthly assessments with the PTSD Checklist- Civilian Version, the Patient Health Questionnaire, and the Self-Reported Health Status (SF-1) instruments. The first month had the highest incidence of PTSD, about 13%. “A lot of the PTSD may not be prolonged, lasting 1–3 months,” he said.

Patients with lower levels of education and those injured in an assault were significantly more likely to meet criteria for the disorder. Participants who met PTSD criteria most commonly reported feeling sad when recalling aspects of the event and feeling cut off from others, jumpy, hypervigilant, and irritable. Sleep disturbances were common.

The investigators looked at PTSD symptom clusters and found arousal symptoms present in 23% of assessments over the 6 months. They also found intrusive symptoms in 20%, and avoidance and numbing in 8%.

“There is a significant overlap of other comorbid psychiatric disorders, such as anxiety and depression, that can present a diagnostic challenge,” Dr. Fann said. “There is also overlap of PTSD and traumatic brain injury symptoms.”

The researchers also assessed patients for major depressive disorder, panic disorder, and other anxiety disorders. PTSD was significantly associated with current major depression, any other anxiety disorder, a blood alcohol level greater than 0.08, and a psychiatric history, according to a univariate analysis. A logistic regression analysis showed that people with a history of PTSD reported significantly increased functional impairment compared with those without PTSD. There also was a trend toward poorer self-reported health status among participants with PTSD.

The study was funded by NIH's National Center for Medical Rehabilitation Research.

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