(068) Assessing the benefits of specialty Concussion Clinic after mild traumatic brain injury and improving linkage to follow-up

Abstract: Background

Half of patients with Traumatic Brain Injury (TBI) report some neuropsychiatric disorder, with depression being the most common psychiatric sequelae at 25-50% of all patients with a TBI (Blennow, 2016). Maladaptive coping strategies confer a higher risk of post-TBI depression, suggesting an adjustment-based model of depression after TBI and highlighting the importance of early intervention and psychotherapy (Roy, 2018). Pharmacologic treatment for depression after TBI remains controversial, namely the efficacy of selective serotonin reuptake inhibitors (SSRIs) (Narapeddy, 2020; Kreitzer, 2019).

Barriers to such treatment abound, which may explain why social determinants such as unemployment, poverty, substance abuse around the time of injury also increase risk for developing depression after TBI (Hart 2014). Many patients with a TBI are lost to follow up, especially without ubiquitous screening for psychiatric disorders after a TBI.



Methods

Study design: a de-identified case series of patients seen in the Concussion Clinic following a first-time mild TBI to track identification and treatment of depression. This is part of a larger chart review of all adult patients presenting to the San Francisco General Hospital (SFGH) Emergency Department (ED) with a first-time mild TBI from 2019 to 2021. Our aims include 1) quantifying the impact of follow-up care with the SFGH Concussion Clinic on risk of depression after TBI in the year following injury; and 2) evaluating current interventions for depression after TBI, as well as barriers to treatment, and how specialty programs like the Concussion Clinic addresses these.



Ethics: This study was approved by the Institutional Review Board at the University of California, San Francisco.



Results

We expect to have meaningful data in September ahead of the meeting in November 2022.



Discussion/Implications

Our goal is to assess how the Concussion Clinic improves detection and early treatment of depression after TBI, with special attention to the barriers affecting follow-up care. This study will inform improvements in screening and care for depression after TBI for the unique patient population of SFGH and TBI survivors broadly.



References

Blennow, K. et al. Traumatic brain injuries. Nature Reviews Disease Primers 2016 2:1 2, 1–19 (2016).

Hart, T. et al. Early Trajectory of Psychiatric Symptoms after Traumatic Brain Injury: Relationship to Patient and Injury Characteristics. Journal of Neurotrauma 31, 610 (2014).

Kreitzer, N. et al. The Effect of Antidepressants on Depression After Traumatic Brain Injury: A Meta-analysis. The Journal of head trauma rehabilitation 34, E47–E54 (2019).

Narapareddy, B. R. et al. Treatment of Depression After Traumatic Brain Injury: A Systematic Review Focused on Pharmacological and Neuromodulatory Interventions. Psychosomatics 61, 481–497 (2020).

Roy, D., Koliatsos, V., Vaishnavi, S., Han, D. & Rao, V. Risk Factors for New Onset Depression After First-Time Traumatic Brain Injury. Psychosomatics 59, 47 (2018).