Association between traumatic brain injury and depression stratified by veteran status: Findings from the National Health Interview Survey

Globally, traumatic brain injury (TBI) is one of the major causes of morbidity and mortality, with increased incidence reported among veterans. In this study, we explored the relationship between TBI and subsequent screening of depressive symptoms, with further analysis stratified by veteran status. For this study, the National Health Interview Survey data for 2023 was used, which was conducted among 29,522 non-institutionalized U.S. adults aged 18 and older. The patient health questionnaire-2 was used to screen for depression. Self-reported incidence of lifetime TBI was documented. From a Chi-square test, a significant association was observed between TBI and depression (p<0.05), with TBI more commonly being reported among veterans compared to non-veterans. Our regression model indicated that, when adjusted for sociodemographic and health variables, TBI was associated with 1.80 times higher odds of depression among the whole sample population (adjusted odds ratio [aOR] = 1.80; 95% confidence interval [CI] 1.61 – 2.02, p<0.05). When stratified by veteran status, veterans with TBI had 2.92 times higher odds of depression (aOR = 2.92; 95% CI 2.05 – 4.14, p<0.05). Compared to the whole general population, veterans with a brain injury history have higher odds of depression, identifying them as a key group in prioritizing depression management in the United States population.
- Reddy MS. Depression: The disorder and the burden. Indian J Psychol Med. 2010;32(1):1-2. doi: 10.4103/0253-7176.70510
- Tenovuo O, Diaz-Arrastia R, Goldstein LE, Sharp DJ, Van Der Naalt J, Zasler ND. Assessing the severity of traumatic brain injury-time for a change? J Clin Med. 2021;10(1):148. doi: 10.3390/jcm10010148
- Choi Y, Kim EY, Sun J, et al. Incidence of depression after traumatic brain injury: A nationwide longitudinal study of 2.2 million adults. J Neurotrauma. 2022;39(5-6):390-397. doi: 10.1089/neu.2021.0111
- Howlett JR, Nelson LD, Stein MB. Mental health consequences of traumatic brain injury. Biol Psychiatry. 2022;91(5):413-420. doi: 10.1016/j.biopsych.2021.09.024
- Hellewell SC, Beaton CS, Welton T, Grieve SM. Characterizing the risk of depression following mild traumatic brain injury: A meta-analysis of the literature comparing chronic mTBI to non-mTBI populations. Front Neurol. 2020;11:350. doi: 10.3389/fneur.2020.00350
- Levin HS, Diaz-Arrastia RR. Diagnosis, prognosis, and clinical management of mild traumatic brain injury. Lancet Neurol. 2015;14(5):506-517. doi: 10.1016/S1474-4422(15)00002-2
- Thomas JL, Wilk JE, Riviere LA, McGurk D, Castro CA, Hoge CW. Prevalence of mental health problems and functional impairment among active component and national guard soldiers 3 and 12 months following combat in Iraq. Arch Gen Psychiatry. 2010;67(6):614-623. doi: 10.1001/archgenpsychiatry.2010.54
- Lavoie S, Sechrist S, Quach N, et al. Depression in men and women one year following traumatic brain injury (TBI): A TBI model systems study. Front Psychol. 2017;8:634. doi: 10.3389/fpsyg.2017.00634
- Scholten AC, Haagsma JA, Cnossen MC, Olff M, Van Beeck EF, Polinder S. Prevalence of and risk factors for anxiety and depressive disorders after traumatic brain injury: A systematic review. J Neurotrauma. 2016;33(22):1969-1994. doi: 10.1089/neu.2015.4252
- Qu Z, Wang Y, Guo D, et al. Identifying depression in the United States veterans using deep learning algorithms, NHANES 2005-2018. BMC Psychiatry. 2023;23(1):620. doi: 10.1186/s12888-023-05109-9
- Zivin K, Kim HM, McCarthy JF, et al. Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: Associations with patient and treatment setting characteristics. Am J Public Health. 2007;97(12):2193-2198. doi: 10.2105/AJPH.2007.115477
- Agha Z, Lofgren RP, VanRuiswyk JV, Layde PM. Are patients at veterans affairs medical centers sicker? A Comparative analysis of health status and medical resource use. Arch Intern Med. 2000;160(21):3252-3257. doi: 10.1001/archinte.160.21.3252
- Blore JD, Sim MR, Forbes AB, Creamer MC, Kelsall HL. Depression in gulf war veterans: A systematic review and meta-analysis. Psychol Med. 2015;45(8):1565-1580. doi: 10.1017/S0033291714001913
- Drag L, Renninger C, King R, Hoblyn J. Predictors of inpatient and outpatient healthcare utilization in veterans with traumatic brain injury. J Head Trauma Rehabil. 2013;28(1):39-47. doi: 10.1097/HTR.0b013e318263bb61
- Wilk JE, Thomas JL, McGurk DM, Riviere LA, Castro CA, Hoge CW. Mild traumatic brain injury (concussion) during combat: Lack of association of blast mechanism with persistent postconcussive symptoms. J Head Trauma Rehabil. 2010;25(1):9-14. doi: 10.1097/HTR.0b013e3181bd090f
- Van Den Berk-Clark C, Balan S, Shroff MV, Widner G, Price RK. The impact of hazardous alcohol use on behavioral healthcare utilization among national guard service members. Subst Use Misuse. 2016;51(5):625-636. doi: 10.3109/10826084.2015.1133644
- Richardson LP, Rockhill C, Russo JE, et al. Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics. 2010;125(5):e1097-e1103. doi: 10.1542/peds.2009-2712
- Löwe B, Kroenke K, Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005;58(2):163-171. doi: 10.1016/j.jpsychores.2004.09.006
- Moradi Y, Dowran B, Sepandi M. The global prevalence of depression, suicide ideation, and attempts in the military forces: A systematic review and meta-analysis of cross sectional studies. BMC Psychiatry. 2021;21(1):510. doi: 10.1186/s12888-021-03526-2
- Massaad E, Kiapour A. Long-term health outcomes of traumatic brain injury in veterans. JAMA Netw Open. 2024;7(2):e2354546. doi: 10.1001/jamanetworkopen.2023.54546
- McLaughlin KA. The public health impact of major depression: A call for interdisciplinary prevention efforts. Prev Sci. 2011;12:361-371. doi: 10.1007/s11121-011-0231-8
- Stewart IJ, Howard JT, Poltavskiy E, et al. Traumatic brain injury and subsequent risk of brain cancer in US veterans of the Iraq and Afghanistan wars. JAMA Netw Open. 2024;7(2):e2354588. doi: 10.1001/jamanetworkopen.2023.54588
- Popa-Velea O, Gheorghe IR, Truţescu CI, Purcărea VL. Current challenges and pitfalls in the pharmacological treatment of depression. J Med Life. 2015;8(2):181-186.
- Kovich H, Kim W, Quaste AM. Pharmacologic treatment of depression. Am Fam Physician. 2023;107(2):173-181.
- Almeida OP. Approaches to decrease the prevalence of depression in later life. Curr Opin Psychiatry. 2012;25(6):451-456. doi: 10.1097/YCO.0b013e328356bd57
- Bryan CJ, Hernandez AM. The functions of social support as protective factors for suicidal ideation in a sample of air force personnel. Suicide Life Threat Behav. 2013;43(5):562-573. doi: 10.1111/sltb.12039
- Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci. 2015;40(4):219-221. doi: 10.1503/jpn.150205
- Stroupe KT, Smith BM, Hogan TP, St. Andre JR, Pape T, Steiner ML., et al. (2013). Healthcare utilization and costs of Veterans screened and assessed for traumatic brain injury. J Rehabil Res Dev, 50(8). doi: 10.1682/JRRD.2012.06.0107
- Rao V, Lyketsos C. Neuropsychiatric sequelae of traumatic brain injury. Psychosomatics. 2000;41(2):95-103. doi: 10.1176/appi.psy.41.2.95
- Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613. doi: 10.1046/j.1525-1497.2001.016009606.x
- Schneiderman AI, Braver ER, Kang HK. Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: Persistent postconcussive symptoms and posttraumatic stress disorder. Am J Epidemiol. 2008;167(12):1446-52. doi: 10.1093/aje/kwn068
- Echelard JF. Use of telemedicine in depression care by physicians: Scoping review. JMIR Form Res. 2021;5(7):e29159. doi: 10.2196/29159
- Morland LA, Raab M, Mackintosh MA, et al. Telemedicine: A cost-reducing means of delivering psychotherapy to rural combat veterans with PTSD. Telemed J E Health, 2013;19(10):754-9. doi: 10.1089/tmj.2012.0298
- Pavlin JA, Burkom HS, Elbert Y, et al. Combining surveillance systems: Effective merging of U.S. Veteran and military health data. PLoS ONE. 2013;8:e84077. doi: 10.1371/journal.pone.0084077
- Donahue M, Bouhaddou O, Hsing N. Veterans health information exchange: Successes and challenges of nationwide interoperability. AMIA Annu Symp Proc. 2018;2018:385.
- O’Shea AMJ, Haraldsson B, Shahnazi AF, et al. A novel gap staffing metric for primary care in the veterans health administration and implications for rural and urban clinics. J Ambul Care Manage. 2023;46(1):25-33. doi: 10.1097/JAC.0000000000000429
- Fann JR, Hart T, Schomer KG. Treatment for depression after traumatic brain injury: A systematic review. J Neurotrauma. 2009;26(12):2383-2402. doi: 10.1089/neu.2009.1091
- Greene-Shortridge TM, Britt TW, Castro CA. The stigma of mental health problems in the military. Mil Med. 2007;172(2):157-161. doi: 10.7205/milmed.172.2.157
- McGuire TG, Miranda J. New evidence regarding racial and ethnic disparities in mental health: Policy implications. Health Aff (Millwood). 2008;27(2):393-403. doi: 10.1377/hlthaff.27.2.393
- Sheldrake E, Al-Hakeem H, Lam B, et al. Mental health outcomes across the lifespan in individuals with persistent post-concussion symptoms: A scoping review. Front Neurol. 2022;13:850590. doi: 10.3389/fneur.2022.850590