TY - JOUR
T1 - Post-traumatic epilepsy associations with mental health outcomes in the first two years after moderate to severe TBI
T2 - A TBI Model Systems analysis
AU - Juengst, Shannon B.
AU - Wagner, Amy K.
AU - Ritter, Anne C.
AU - Szaflarski, Jerzy P.
AU - Walker, William C.
AU - Zafonte, Ross D.
AU - Brown, Allen W.
AU - Hammond, Flora M.
AU - Pugh, Mary Jo
AU - Shea, Timothy
AU - Krellman, Jason W.
AU - Bushnik, Tamara
AU - Arenth, Patricia M.
N1 - Funding Information:
This work was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research [Grants numbers 90DP0041 (SBJ, AKW, ACR, PMA), 90DP0038 (JWK), 90DP0036 (FH), 90DP0033 (WCW), 90DP0039 (RDZ)]; the Polytrauma Rehabilitation Center Traumatic Brain Injury Model System (MJP). The Polytrauma Rehabilitation Center TBI Model System is a funded collaboration between the Department of Veterans Affairs (VA) and NIDILRR. NIDILRR is a Center within the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS). The contents of this manuscript do not necessarily represent the policy of the VA, NIDILRR, ACL, or HHS, and endorsement of this content by the Federal Government should not be assumed.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/8
Y1 - 2017/8
N2 - Purpose Research suggests that there are reciprocal relationships between mental health (MH) disorders and epilepsy risk. However, MH relationships to post-traumatic epilepsy (PTE) have not been explored. Thus, the objective of this study was to assess associations between PTE and frequency of depression and/or anxiety in a cohort of individuals with moderate-to-severe TBI who received acute inpatient rehabilitation. Methods Multivariate regression models were developed using a recent (2010–2012) cohort (n = 867 unique participants) from the TBI Model Systems (TBIMS) National Database, a time frame during which self-reported seizures, depression [Patient Health Questionnaire (PHQ)-9], and anxiety [Generalized Anxiety Disorder (GAD-7)] follow-up measures were concurrently collected at year-1 and year-2 after injury. Results PTE did not significantly contribute to depression status in either the year-1 or year-2 cohort, nor did it contribute significantly to anxiety status in the year-1 cohort, after controlling for other known depression and anxiety predictors. However, those with PTE in year-2 had 3.34 times the odds (p = .002) of having clinically significant anxiety, even after accounting for other relevant predictors. In this model, participants who self-identified as Black were also more likely to report clinical symptoms of anxiety than those who identified as White. PTE was the only significant predictor of comorbid depression and anxiety at year-2 (Odds Ratio 2.71; p = 0.049). Conclusions Our data suggest that PTE is associated with MH outcomes 2 years after TBI, findings whose significance may reflect reciprocal, biological, psychological, and/or experiential factors contributing to and resulting from both PTE and MH status post-TBI. Future work should consider temporal and reciprocal relationships between PTE and MH as well as if/how treatment of each condition influences biosusceptibility to the other condition.
AB - Purpose Research suggests that there are reciprocal relationships between mental health (MH) disorders and epilepsy risk. However, MH relationships to post-traumatic epilepsy (PTE) have not been explored. Thus, the objective of this study was to assess associations between PTE and frequency of depression and/or anxiety in a cohort of individuals with moderate-to-severe TBI who received acute inpatient rehabilitation. Methods Multivariate regression models were developed using a recent (2010–2012) cohort (n = 867 unique participants) from the TBI Model Systems (TBIMS) National Database, a time frame during which self-reported seizures, depression [Patient Health Questionnaire (PHQ)-9], and anxiety [Generalized Anxiety Disorder (GAD-7)] follow-up measures were concurrently collected at year-1 and year-2 after injury. Results PTE did not significantly contribute to depression status in either the year-1 or year-2 cohort, nor did it contribute significantly to anxiety status in the year-1 cohort, after controlling for other known depression and anxiety predictors. However, those with PTE in year-2 had 3.34 times the odds (p = .002) of having clinically significant anxiety, even after accounting for other relevant predictors. In this model, participants who self-identified as Black were also more likely to report clinical symptoms of anxiety than those who identified as White. PTE was the only significant predictor of comorbid depression and anxiety at year-2 (Odds Ratio 2.71; p = 0.049). Conclusions Our data suggest that PTE is associated with MH outcomes 2 years after TBI, findings whose significance may reflect reciprocal, biological, psychological, and/or experiential factors contributing to and resulting from both PTE and MH status post-TBI. Future work should consider temporal and reciprocal relationships between PTE and MH as well as if/how treatment of each condition influences biosusceptibility to the other condition.
KW - Anxiety
KW - Depression
KW - Mental health disorders
KW - Post-traumatic epilepsy
KW - Traumatic brain injury
KW - Traumatic brain injury model system
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U2 - 10.1016/j.yebeh.2017.06.001
DO - 10.1016/j.yebeh.2017.06.001
M3 - Article
C2 - 28658654
AN - SCOPUS:85021143104
SN - 1525-5050
VL - 73
SP - 240
EP - 246
JO - Epilepsy and Behavior
JF - Epilepsy and Behavior
ER -