Jorge R, Robinson R, Crespo-Fecarro B, Arndt S. Major depression following traumatic brain injury.Arch Gen Psychiatry.2004;61(1):43-50.

Many studies have revealed an association between traumatic brain injury and future major depression. The present study involved 91 patients with closed head injury. Patients were assessed at 3, 6, and 12 months postinjury. Assessment was by 2 semistructured interviews-a modified variation of the Present State Examination and the Structured Clinical Interview for DSM-IV Diagnosis. Further tests utilized were the Hamilton Depression Rating Scale, Hamilton Anxiety Scale, and the Overt Aggression Scale. Several other scales were utilized to assess family history and psychosocial functioning. Computed tomographic scans and occasional magnetic resonance imaging were obtained. Neuropsychologic testing was performed at the 3-month visit.

A total of 47 patients (51.6%) developed a mood disorder within one year following injury as compared to 6 patients (22.2%) of a control group (27 patients with multiple trauma without central nervous system involvement). Co-existent anxiety disorders and aggressive behavior were frequent. Patients who developed major depression had a significantly higher history of mood and anxiety disorders.

History of alcohol and substance dependence and family history of mood disorders did not distinguish between patients with major depression and those without. While overall brain volume did not distinguish between these groups, the patients with major depression demonstrated decreased left frontal gray matter volume.

Future studies should attempt to identify traumatic brain injury patients at high risk for major depression and delineate therapeutic interventions.