Relationship between depression and psychosocial functioning after traumatic brain injury

Objective: To examine the relationship between depression and psychosocial functioning up to 5 years after traumatic brain injury (TBI). Design: Longitudinal cohort study with 2 assessments completed. Setting: Community. Participants: Individuals (N = 188) with TBI living in the community. Interventions: Not applicable. Main Outcome Measures: Structured Clinical Interview for Depression, self-reports of depression severity, functional symptoms, quality of life (QOL), unmet important needs, and psychosocial functioning. Results: Based on observed depression patterns at initial and repeat assessment, 4 subgroups were created: no depression, resolved depression, late-onset depression, and chronic depression. Groups were equivalent in terms of demographic and injury-related factors but differed significantly in perceived psychosocial functioning. The no-depression group reported fewer depressive symptoms and higher levels of psychosocial functioning, whereas the chronic-depression group reported the poorest psychosocial functioning, with a further decline in QOL at reassessment. Although the resolved-depression and late-onset-depression groups reported similar psychosocial functioning at initial assessment, psychosocial functioning had improved for the resolved-depression group and declined for the late-onset-depression group at reassessment. Pre- and post-psychiatric diagnoses were common in all groups, with pre-TBI diagnosis of depression not predictive of post-TBI depression. Conclusions: Findings highlight the need for broad-based assessments and timely interventions for both mood and psychosocial challenges after TBI.