| 소속 |
Seoul National University Hospital, Department of Rehabilitation Medicine1, National Traffic Injury Rehabilitation Hospital, National Traffic Injury Rehabilitation Research Institute2, Seoul National University Hospital, Department of Psychiatry3, Workers’ Compensation and Welfare Incheon Hospital, Department of Rehabilitation Medicine4 |
| 저자 |
Yoonjeong Choi 1,2*, Han-Kyoul Kim 1,2, Ye Seol Lee 1,2, Byung-Mo Oh 1,2, Hye Yoon Park 3†, Ja-Ho Leigh 1,4† |
Background: Traumatic brain injuries (TBIs) can have long-term psychiatric consequences such as depression. However, awareness of the risk of depression after TBI has been low among both physicians and patients.
Objective: This study investigated the influence of TBIs on the incidence of depression using nationwide longitudinal data from a Korean population.
Methods: All data were extracted from the Korean National Health Insurance data from 2008 to 2017. We extracted data for TBI patients who had undergone TBIs from 2010 to 2017 (n=1,238,443). We also extracted data for 1:4 random controls who had never had TBIs (n=4,813,872) during the same period. All participants under the age of 20 or those who have had a history of depression were excluded from this analysis. TBI was used as a time-varying exposure, and a time-dependent Cox regression model was adopted to analyze the risk of depression after TBI. To adjust for confounding factors, age, sex, insurance premium, region of residence, insurance type, past psychiatric diseases (dementia, amnestic disorder, alcohol related disorders), and past metabolic diseases (hypertension, diabetes, and dyslipidemia) were adjusted. Subgroup analysis was performed according to sex (male and female), age group (20-30-year-olds, 40-50-year-olds, and 60 year-olds and older), and severity of TBI (mild and severe TBI).
Results: The incidence of depression in the TBI patients was 20.65 per 1,000 person-years, and 16.77 per 1,000 person-years in the control group. The risk of depression was higher in the TBI group (hazard ratio=1.63; 95% CI=1.62-1.64) than in the control group. After stratification by age and sex, we observed effect modification. The risk of depression after TBI was highest in the younger age group. In the younger age group (20-30-year-olds), the risk of depression was higher in women. In contrast, in the middle-aged group (40-50-year-olds), the risk of depression was higher in men. In the older age group (60-year-olds and older), no effect modification was found by sex. After stratification by severity, the severe TBI group showed a higher risk of depression than that of the mild TBI group.
Conclusion: In this large longitudinal study, TBIs were significantly associated with an increased risk of subsequent depression. The risk of depression after a TBI was higher in the younger age group and in the severe TBI group. This result suggests that fast and proper treatment is needed to prevent depression after TBIs. Therefore, physicians need to pay attention to mental health care for TBI patients as well as physical health care.
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