The evolution of posttraumatic stress disorder following moderate to severe traumatic brain injury.

Abstract

Increasing evidence indicates that posttraumatic stress disorder (PTSD) may develop following traumatic brain injury (TBI), despite most patients having no conscious memory of their accident. This prospective study examined the frequency, timing of onset, symptom profile, and trajectory of PTSD and its psychiatric comorbidities during the first four years following moderate to severe TBI. Participants were 85 individuals (78.8% male) with moderate or severe TBI recruited following admission to acute rehabilitation between 2005 and 2010. Using the Structured Clinical Interview for DSM-IV Disorders (SCID-I), participants were evaluated for pre- and post injury PTSD soon after injury and reassessed at 6 and 12 months, 2, 3, and 4 years post injury. Over the first four years post injury 17.6% developed injury-related PTSD, none of whom had PTSD prior to injury. PTSD onset peaked between 6- and 12-months post injury. The majority of PTSD cases (66.7%) had a delayed-onset, which for a third was preceded by subsyndromal symptoms in the first six months post injury. PTSD frequency increased over the first year post injury, remained stable during the second year and gradually declined thereafter. The majority with PTSD experienced a chronic symptom course and all developed one or more comorbid psychiatric disorder, with mood, other anxiety and substance-use disorders being the most common. Despite event-related amnesia, posttraumatic stress symptoms, including vivid re-experiencing phenomena, may develop following moderate to severe TBI. Onset is typically delayed and symptoms may persist for several years post injury.