Anxiety Trajectories the First 10 Years After a Traumatic Brain Injury (TBI): A TBI Model Systems Study

Dawn Neumann, Shannon B. Juengst, Charles H. Bombardier, Jacob A. Finn, Shannon R. Miles, Yue Zhang, Richard Kennedy, Amanda R. Rabinowitz, Amber Thomas, Laura E. Dreer

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Determine anxiety trajectories and predictors up to 10 years posttraumatic brain injury (TBI). Design: Prospective longitudinal, observational study. Setting: Inpatient rehabilitation centers. Participants: 2836 participants with moderate to severe TBI enrolled in the TBI Model Systems National Database who had ≥2 anxiety data collection points (N=2836). Main Outcome Measure: Generalized Anxiety Disorder-7 (GAD-7) at 1, 2, 5, and 10-year follow-ups. Results: Linear mixed models showed higher GAD-7 scores were associated with Black race (P<.001), public insurance (P<.001), pre-injury mental health treatment (P<.001), 2 additional TBIs with loss of consciousness (P=.003), violent injury (P=.047), and more years post-TBI (P=.023). An interaction between follow-up year and age was also related to GAD-7 scores (P=.006). A latent class mixed model identified 3 anxiety trajectories: low-stable (n=2195), high-increasing (n=289), and high-decreasing (n=352). The high-increasing and high-decreasing groups had mild or higher GAD-7 scores up to 10 years. Compared to the low-stable group, the high-decreasing group was more likely to be Black (OR=2.25), have public insurance (OR=2.13), have had pre-injury mental health treatment (OR=1.77), and have had 2 prior TBIs (OR=3.16). Conclusions: A substantial minority of participants had anxiety symptoms that either increased (10%) or decreased (13%) over 10 years but never decreased below mild anxiety. Risk factors of anxiety included indicators of socioeconomic disadvantage (public insurance) and racial inequities (Black race) as well as having had pre-injury mental health treatment and 2 prior TBIs. Awareness of these risk factors may lead to identifying and proactively referring susceptible individuals to mental health services.

Original languageEnglish (US)
Pages (from-to)2105-2113
Number of pages9
JournalArchives of Physical Medicine and Rehabilitation
Volume103
Issue number11
DOIs
StatePublished - Nov 2022

Bibliographical note

Funding Information:
The contents of this article were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR Grant Nos. IU 90DRTB0002, NTX 90DPTB0013, UAB 90DPTB0015, Spaulding/Harvard 90DPTB0011, Moss 90DPTB0004 University of Washington 90DPTB008). NIDILRR is a center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.

Funding Information:
The contents of this article were developed under grants from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR Grant Nos. IU 90DRTB0002, NTX 90DPTB0013, UAB 90DPTB0015, Spaulding/Harvard 90DPTB0011, Moss 90DPTB0004 University of Washington 90DPTB008). NIDILRR is a center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government. Dr Finn's contributions to this article are the result of work supported with resources and the use of facilities at the Minneapolis VA Health Care System, as well as the VA Polytrauma Rehabilitation Center Traumatic Brain Injury Model System, a funded collaboration between the Department of Veterans Affairs and the Department of HHS. The views, opinion, and/or findings contained in this article are those of the authors and should not be construed as an official position, policy, or decision of the US Department of Veterans Affairs or any other federal agency unless so designated by other official documentation.

Publisher Copyright:
© 2022 American Congress of Rehabilitation Medicine

Keywords

  • Affect
  • Anxiety
  • Brain Injuries
  • Mental health
  • Rehabilitation

PubMed: MeSH publication types

  • Observational Study
  • Journal Article
  • Research Support, U.S. Gov't, Non-P.H.S.

Fingerprint

Dive into the research topics of 'Anxiety Trajectories the First 10 Years After a Traumatic Brain Injury (TBI): A TBI Model Systems Study'. Together they form a unique fingerprint.

Cite this