Objective To examine the prevalence, severity, and correlates of depression, anxiety, and suicidal ideation in people with traumatic brain injury (TBI) assessed before and during the COVID-19 pandemic.
Design Retrospective cohort study using data collected through the Traumatic Brain Injury Model Systems (TBIMS) network at 1, 2, 5, 10, 15, 20, 25, or 30 years post TBI.
Setting United States–based TBIMS rehabilitation centers with telephone assessment of community residing participants.
Participants Adults (72.4% male; mean age, 47.2 years) who enrolled in the TBIMS National Database and completed mental health questionnaires prepandemic (January 1, 2017 to February 29, 2020; n=5000) or during pandemic (April 1, 2022 to June 30, 2021; n=2009) (N=7009).
Interventions Not applicable.
Main Outcome Measures Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaire.
Results Separate linear and logistic regressions were constructed with demographic, psychosocial, injury-related, and functional characteristics, along with a binary indicator of COVID-19 pandemic period (prepandemic vs during pandemic), as predictors of mental health outcomes. No meaningful differences in depression, anxiety, or suicidal ideation were observed before vs during the COVID-19 pandemic. Correlations between predictors and mental health outcomes were similar before and during the pandemic.
Conclusions Contrary to our predictions, the prevalence, severity, and correlates of mental health conditions were similar before and during the COVID-19 pandemic. Results may reflect generalized resilience and are consistent with the most recent findings from the general population that indicate only small, transient increases in psychological distress associated with the pandemic. While unworsened, depression, anxiety, and suicidal ideation remain prevalent and merit focused treatment and research efforts.
The COVID-19 pandemic-associated mitigation strategies created massive societal disruption in 2020. Access to routine health services, jobs and volunteering opportunities, leisure and socialization, and cultural and religious practices was limited. In addition to the pandemic, 2020 sparked a racial justice movement in the United States with protests that may have further affected individuals' mental and physical health. A survey of American adults1 found that 40% of individuals reported at least one adverse mental or behavioral health condition during the pandemic, including depression, anxiety, posttraumatic stress, or substance abuse. The pandemic and related events may have differentially impacted persons living with disabilities secondary to traumatic brain injury (TBI). At baseline, people with TBI already experience higher rates of psychological distress than others. The overall prevalence of depression is 38% in people with TBI, 3.41 times greater than in non-TBI controls.2 Clinically significant anxiety is present in 37% of people with TBI.3 Prevalence of suicidal ideation ranges from 7-10%, and past-year suicide attempts occur in 0.8-1.7% of cases. 4 Preliminary research is mixed on how the pandemic has impacted the mental health of people living with TBI. In May and June 2020, Morrow et al.5 surveyed 47 participants in the chronic phase of moderate-severe TBI and compared responses to non-injured peers. One-third said their brain injury made coping with the pandemic more difficult identifying social isolation as a key barrier to coping with it. However, the study was small, and no comparison could be made to pre-pandemic baselines for their population. In another study of 134 patients with physical disabilities related to neurological disorders,6 fewer negative psychological effects were found. These individuals seemed to manifest resilience in the face of pandemic-related social isolation. The authors questioned if this unexpected result had a dubiously reassuring origin—that people with physical disabilities were “already in lockdown.”
Symptoms of depression, anxiety, and suicidality have shown little change overall during the COVID-19 pandemic in included TBIMS enrollees. At the aggregate level, these results may be regarded positively. Contrary to expectations, we did not find changes in depression, anxiety and suicidality in this population during this time period.