A Meta-Analysis of the Inclusion of Depression, Anxiety, and Posttraumatic Stress Disorder Assessment and Treatment in Traumatic Brain Injury Management

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Jay R. Greiner


Traumatic brain injury (TBI) incidence rates are increasing among the U.S. population and represent substantial acute and chronic care costs. A confounding factor in TBI treatment is the incidence rates of concomitant mental health disorders including depression, anxiety, and posttraumatic stress disorder (PTSD). Clinical data establish that the prevalence of any of these 3 diagnoses complicates the treatment of TBI regardless of whether the diagnosis was pre-existing or occurred because of the TBI, such that prognosis and recovery are negatively impacted. Despite this evidence, psychological assessment is not a first line step in the approach to TBI. The purpose of this research was to assess the prevalence of psychological screening among TBI patients for depression, anxiety, and PTSD to enable conclusions about the current standard of care in TBI management. Meta-analysis of peer reviewed journals on TBI management was used to determine if there was considerable evidence to support that depression, anxiety, and PTSD were being addressed as the standard of care in TBI management. Mean analysis of literature search results established that there was not considerable evidence to support a conclusion that depression, anxiety, and PTSD assessment were standard of care in TBI management. Among the recommendations resulting from this finding were for additional studies on TBI points of care to determine how mental health is currently being managed among TBI patients, and for a change in current TBI treatment protocols to incorporate mental health assessment as part of overall TBI management. If these, and the remaining recommendations, were implemented, it was affirmed that these would have a positive social impact resulting in improved patient outcomes, decreased healthcare costs, and better healthcare delivery for TBI patients.

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