Effects of Self-awareness and Cognitive Impairment on Depression Status in Adults with Traumatic Brain Injury

Research Objectives: To examine the association of self-awareness and cognitive impairments on depression after controlling for potential covariates in a sample of adults with chronic complicated mild to severe traumatic brain injury.

Design: Secondary analysis of a cohort study.

Setting: Community.

Participants: The study included a volunteer sample of sixty-five community-dwelling individuals with a history of complicated-mild-to-severe TBI. Inclusion criteria were: 1) documented history of TBI; 2) over six months post-injury; 3) living in the community; 4) older than 18 years old.

Interventions: Not applicable.

Main Outcome Measures: Depression status was measured using the Patient Health Questionnaire (PHQ9) questions and dichotomized as Current Major or Minor Depression and No Current Depression. Logistic regression models were formed using self-awareness, cognitive impairments, and their interaction as independent variables with dichotomized depression as the dependent variable.

Results: Sixty-three participants with complete data were included in the analysis. Participants were aged 18 to 83 years old (mean=45.51 + 15.90 years), were primarily men (79.37%), and 85.71% of participants had current major or minor depression. Disability was identified as a covariate based on a significant bivariate correlation with depression (r=.286, p < .05). The logistic regression revealed no significant associations of self-awareness and cognitive impairments on depression after controlling for disability, but disability was significantly associated with depression status (p < .05).

Conclusions: Cognitive impairment, self-awareness, and their interaction may not contribute to depression status in chronic TBI, but those with depression did have more disability. It is possible that more impaired cognition and self-awareness acutely after injury contribute to later disability and, subsequently, depression, but a longitudinal prospective study is required to test this hypothesis.

Author(s) Disclosures: The study was supported in part of the SHRS Dissertation Development Fund.