Article

OBJECTIVE: To develop, based on previous research, and evaluate a model for
depression after traumatic brain injury (TBI). DESIGN: Cross-sectional structural
equation modeling (SEM) of data from consecutively recruited patients. SETTING:
Acute hospital and inpatient rehabilitation units. PARTICIPANTS: Adult patients
(N=158) after hospital admission for moderate to severe TBI. INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURES: External appraisal of ability in participants
was measured by the Mayo-Portland Adaptability Inventory (MPAI-4) Ability Index
completed by a TBI clinical nurse specialist. Patient self-appraisal of post-TBI
ability and depression were measured by the Awareness Questionnaire and Beck
Depression Inventory-II. Functional outcome 1 year after injury was assessed with
the MPAI-4 Participation Index. RESULTS: Successive SEM resulted in a
parsimonious model with excellent fit. Consistent with prior research, a
moderately strong association between self-appraisal of post-TBI ability and
depression was found. Injury severity, as measured by the duration of
posttraumatic amnesia (PTA), was not significantly associated with post-TBI
depression. The 1-year functional outcome was associated with depression and TBI
severity. CONCLUSIONS: The strong association between self-appraisal of post-TBI
ability and depression is consistent with the cognitive-behavioral model of
depression and recommends consideration and further study of cognitive-behavioral
therapy for post-TBI depression. The lack of association between TBI severity and
depression may represent the indirect and proxy nature of current measures of TBI
severity such as PTA. Emerging neuroimaging techniques (eg, diffusion tensor
imaging, magnetic resonance imaging spectroscopy) may provide the more direct
measures of disruption of brain function after TBI that are needed to advance
this line of research.
CI - Copyright 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS