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Major Depression Often Follows Brain Injury
Date:5/18/2010

Patients, including many veterans, are at 8 times the risk after head trauma, study finds

TUESDAY, May 18 (HealthDay News) -- People who are hospitalized for a traumatic brain injury face an almost eight-fold higher risk of also suffering major depression.

That's the finding of a team led by Charles H. Bombardier, professor of rehabilitation medicine at the University of Washington School of Medicine in Seattle and first author of a study published in the May 19 issue of the Journal of the American Medical Association.

Bombardier spoke Tuesday at a special JAMA teleconference, held to present findings from a number of studies focused on mental health.

Other studies in the same issue of the journal describe a treatment method for anxiety disorders that may provide help in primary-care settings, and a Detroit depression-care program that has dramatically reduced the number of suicides among patients at one hospital.

According to Bombardier, some 6 million people in the United States are living with a traumatic brain injury (TBI) and have significant disability as a result. Major causes of traumatic brain injury include vehicle accidents, blunt injuries to the head and penetrating wounds such as gun shots. It is also a "signature injury" among soldiers serving in Afghanistan and Iraq, the study stated.

In this study of 559 patients with traumatic brain injury, more than half (53.1 percent) also endured major depressive disorder at some point during the study follow-up.

In terms of risk factors, patients with major depression at the time of their injury or before their injury, as well as those who were younger and those who reported alcohol dependence, were most likely to suffer depression after head trauma. Those who were diagnosed with major depression were also more likely to have anxiety disorders, the researchers found.

Unfortunately, there seems to be a troubling shortfall when it comes to depression care -- only 44 percent of traumatic brain injury patients with depression had been treated with medications or counseling for their depression, significantly affecting their quality of life, the study found.

"Often the depression appeared in the first three months but the risk persisted for one year and probably beyond," Bombardier said. "We need to improve recognition of major depression after traumatic brain injury and identify individuals at risk early on."

A second study in the journal found that a strategy that gave patients with anxiety disorders a choice of medication, cognitive behavioral therapy or both, along with professional monitoring in a primary-care setting, had better results than "usual care."

Approximately 1,000 patients participated in the study, which compared usual care or with a program called Coordinated Anxiety Learning and Management (CALM).

CALM also incorporated "non-expert" professionals to help doctors with treatment.

Volunteers in the CALM group, who suffered from panic disorder, generalized anxiety disorder, social anxiety disorder and/or post traumatic stress disorder (PTSD), reported greater alleviation of symptoms and better life functioning.

If reimbursement issues are worked out, the model could become an alternative to the current referral system, the study authors stated.

"This addresses one of the major public health problems in this country, which is that although we do have some fairly effective though not ideal treatments, very, very few people end up having access to them," said lead author Dr. Peter Roy-Byrne, professor of psychiatry and behavioral sciences at the University of Washington School of Medicine in Seattle. "We need to move available treatments from controlled research settings into real-world practice settings that have much greater variability in patients' characteristics and skill levels of physicians. The majority of people with anxiety and depression are seen in primary-care and not mental health settings."

A third study found that an individualized program to treat depressed patients reduced to zero the number of suicides at Henry Ford Health System in Detroit, with not one depressed patient committing suicide over a two-and-a-half-year time span.

"The encouraging results of the initiative suggest that this care model can be highly effective for achieving and sustaining breakthrough quality improvement in mental health care," Dr. C. Edward Coffey, Henry Ford's vice president Behavioral Health Services, said in a news release.

More information

There's more on a range of mental health topics at the U.S. National Institute of Mental Health.



SOURCES: May 18, 2010, news conference with Peter Roy-Byrne, M.D., professor of psychiatry and behavioral sciences, University of Washington School of Medicine, Seattle, and Charles H. Bombardier, Ph.D., professor of rehabilitation medicine, University of Washington School of Medicine, Seattle; May 19, 2010, Journal of the American Medical Association, May 18, 2010, news release, Henry Ford Health System, Detroit


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