2025/11/20 by Holly Elser, R.K. Magee, Sabrina Abbruzzese +5 · 1 voice
Medicine · #Stroke Rehabilitation and Recovery #Traumatic Brain Injury Research #Traumatic Brain Injury and Neurovascular Disturbances
paper · doi:10.1212/wnl.0000000000214407
openalex created_date 2025/11/20 · openalex publication_date 2025/11/20 · openalex updated_date 2026/08/01
BACKGROUND AND OBJECTIVES: Mood symptoms are recognized short-term sequelae of traumatic brain injury (TBI). Research regarding depressive symptoms among older, community-based individuals with TBI is limited. Previous studies have largely focused on short-term and intermediate-term follow-up. METHODS: The Atherosclerosis Risk in Communities study is an ongoing prospective cohort study of community-dwelling adults in the United States, initially recruited from 1987 to 1989. TBI was defined using self-reported and International Classification of Diseases diagnostic codes. Participants were sampled from centers in Maryland, Minnesota, Mississippi, and North Carolina. Depressive symptoms and antidepressant prescription(s) were assessed beginning at visit 5 (2011-2013) and were analyzed as time-varying repeated outcome measures until visit 7 (2018-2019), representing a maximum follow-up interval of 9 years. We used generalized estimating equations (GEEs) with an autoregressive working correlation structure and binomial distribution with a log link to estimate risk ratios (RRs) for the association of TBI with time-varying depressive symptoms and antidepressant prescription(s), adjusting for sociodemographic characteristics including age, race and study center, income, educational attainment, and history of military service. RESULTS: Our analysis included 6,607 individuals who attended at least 1 study visit between visits 5 and 7. The median age was 75 years (25th-75th percentiles = 72-80). More than half were female (59.0%), and 23.7% self-identified as Black. There were 2,113 participants (32.0%) with a lifetime history of TBI, most of which were classified as mild. There were 665 individuals (10.1%) who experienced depressive symptoms and 1,225 (18.5%) with antidepressant prescriptions recorded during follow-up. In fully adjusted GEE models, TBI was associated with an increased risk of depressive symptoms (RR 1.59, 95% CI 1.37-1.85) and antidepressant use (RR 1.32, 95% CI 1.20-1.45). These results persisted in analysis of subgroups defined by age, sex, race, and participant health characteristics, regardless of TBI frequency or severity. DISCUSSION: We observed a robust and persistent association of TBI with depressive symptoms and antidepressant prescriptions in this cohort of older, community-dwelling adults regardless of participant characteristics. These results suggest that universal screening for and prompt treatment of depressive symptoms in among older adults with a history of TBI is warranted.