Predictors and Functional Outcomes Associated with Longitudinal Trajectories of Anxiety and Depression From 2 to 36+ Months After Moderate to Severe Traumatic Brain Injury.

This study investigated longitudinal trajectories of anxiety and depressive symptoms following moderate-severe traumatic brain injury (TBI), predictors of the trajectories, and associations with 1-year return to productivity. One hundred forty-eight patients with moderate-severe TBI were assessed at 2, 5, 12, and 36+ months post-injury on the Beck Anxiety Inventory and Beck Depression Inventory. Clinical interviews obtained information about demographics, injury characteristics, and 1-year return to productivity. Latent growth mixture modeling identified trajectories of anxiety and depression across time. The three-step method identified predictors of trajectories, and chi square analyses determined associations between trajectories and 1-year return to productivity. Analyses revealed that 4-class models of anxiety and depression best fit the data. Most individuals had stable minimal (66.8%) or low (18.2%) levels of anxiety over time. Two other subsets of individuals were classified by anxiety that worsened rapidly (6.5%) or improved in the first year but worsened by 3 years post-injury (8.6%). Similarly for the depression trajectories, most individuals had stable minimal (70%) or low (10.3%) levels of depression over time. Others had depression that worsened rapidly (11.6%) or was delayed, with onset 1-year post-injury (8.1%). Predictors of worsening anxiety and depression included younger age, lower education, and male gender. Those with worsening anxiety or depression were less likely to return to productivity by 1-year post-injury. There is a significant burden of anxiety (15%) and depression (20%) in the 3 years after moderate-severe TBI. Future research targeting at-risk patients may help to improve quality of life and functional recovery.