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Head Injury in Early Adulthood and the Lifetime Risk of Depression
Tracey Holsinger, MD;
David C. Steffens, MD;
Caroline Phillips, MS;
Michael J. Helms, MS;
Richard J. Havlik, MD, MPH;
John C. S. Breitner, MD, MPH;
Jack M. Guralnik, MD, PhD;
Brenda L. Plassman, PhD
Arch Gen Psychiatry. 2002;59:17-22.
Background Depressive symptoms are common and can be debilitating in the months
after head injury. Head injury can also have long-term cognitive effects,
but little is known about the long-term risk of depression associated with
head injury. We investigated the lifetime rates of depressive illness 50 years
after closed head injury.
Methods Participants were male World War II veterans who served during 1944-1945
and were hospitalized at that time for a head injury, pneumonia, or laceration,
puncture, or incision wounds. We used military medical records to establish
the presence and severity of closed head injuries. Veterans with (n = 520)
and without (n = 1198) head injuries were interviewed in 1996-1997 for their
lifetime history of depressive illness. Men with dementia were excluded.
Results Veterans with head injury were more likely to report major depression
in subsequent years and were more often currently depressed. Using logistic
regression and controlling for age and education, the lifetime prevalence
of major depression in the head injured group was 18.5% vs 13.4% in those
with no head injury (odds ratio = 1.54, 95% confidence interval = 1.17-2.04).
Current major depression was detected in 11.2% of the veterans with head injuries
vs 8.5% of those without head injury (odds ratio = 1.63, 95% confidence interval
= 1.07-2.50). This increase in depression could not be explained by a history
of myocardial infarction, a history of cerebrovascular accident, or history
of alcohol abuse. The lifetime risk of depression increased with severity
of the head injury.
Conclusion The risk of depression remains elevated for decades following head injury
and seems to be highest in those who have had a severe head injury.
From the Department of Psychiatry and Behavioral Sciences (Drs Holsinger,
Steffens, Breitner, and Plassman and Mr Helms), Duke University Medical Center,
Durham, NC; the Epidemiology, Demography, and Biometry Program of the National
Institute on Aging, Bethesda, Md (Drs Havlik and Guralnik and Ms Phillips);
and the School of Hygiene and Public Health, John Hopkins University, Baltimore,
Md (Dr Breitner).
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