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Increased age at injury
Dikmen et al. (2001)
True of all injury severities.
Premorbid psychiatric illness
Kashluba et al. (2008); Lange et al. (2007)
Development of psychiatric illness after injury (e.g.,
depression, posttraumatic stress disorder)
Dikmen et al. (2004); Gfeller et al. (1994); Jorge and Starkstein (2005); Mooney et al. (2005); Rapoport et al. (2006)
Fairly consistent association between Axis I diagnosis
and increased levels of postconcussive symptoms and other outcome
Belanger et al. (2005); Binder and Rohling (1996); Feinstein et al. (2001); Paniak et al. (2002)
Not a universal finding. Association should not be misinterpreted
Beaumont et al. (2009); McKee et al. (2009); Rimel et al. (1981)
Evidence is somewhat indirect and tentative—comes
from both sports injury literature and early emergency department populations
(Rimel et al. 1981). See Institute of Medicine (2009)
Selected polymorphic alleles (e.g., ANKK1,
McAllister (2005, 2008; Chapter
3, Genetic Factors, this volume)
Several large ongoing studies should shed further light
Abnormal acute neuroimaging
Iverson (2006); Kashluba et al. (2008); Williams et al. (1990)
"Complicated mild TBI" has outcomes
more similar to moderate TBI.
Expectation of poor outcome
Mittenberg et al. (1992); Whittaker et al. (2007)
Expectation of poor outcome or severity of complications associated
with poor recovery.
Extracranial injuries and high initial symptom load
Stulemeijer et al. (2008)
Extracranial injuries may prolong need for treatment
and delay return to work but not necessarily increase "postconcussive symptoms" (Stulemeijer et al. 2006).
Note. TBI = traumatic
General symptom inventories generally elevated in minor
TBI. Mixed symptom picture.
Depression scales generally elevated after TBI (Busch and Alpern 1998; Dikmen et al. 2004; Jorge and Starkstein 2005) for review; Pagulayan et al. 2008; Schoenhuber and Gentilini 1988).
Mobayed and Dinan (1990) found 20% of
sample met DSM-III criteria.
Federoff et al. (1992) and Jorge et al. (1993a, 1993b, 1994; Jorge and Robinson 2002) found 25%–30% of
their 66 patients depressed at 1 month and 1 year. Overall, almost
50% depression of some form in first year. Similar to Fann et al. (1995).
Depression associated with poorer social and functional
Increased risk of depression and suicide associated
with TBI (Hibbard et al. 1998; Silver et al. 2001).
May occur after very mild TBI, even without loss of
consciousness (Bracken 1987; Nizamie et al. 1988; Pope et al. 1988; Riess et al. 1987; Zwil et al. 1992, 1993).
Increased relative risk of bipolar disorder (van Reekum et al. 2000).
May have increased frequency of "irritable
Relatively rare complication. Can be associated with
TBI-induced affective disorders.
In genetically vulnerable individuals, even mild TBI
associated with increased risk of psychotic disorders (Malaspina et al. 2001).
Symptoms consistent with anxiety often endorsed, but
may not be more frequent than in general population (Schoenhuber and Gentilini 1988). Generalized anxiety disorder found in
roughly 25% (Fann et al. 1995). Increased rate
of generalized anxiety disorder (van Reekum et al. 2000).
Posttraumatic stress disorder
Posttraumatic stress disorder seen in up to 20%–30% (Bryant and Harvey 1999a, 1999b; Mayou et al. 2000), higher in some military combat populations (Hoge et al. 2008; Schneiderman et al. 2008).