Social impairment and depression after traumatic brain injury.

Objective: Previous studies have shown that social impairment is associated with major depression throughout the first year after traumatic brain injury (TBI). This study examined the specific social factors that were associated with post-TBI depression.

Method: A consecutive series of 65 patients with closed head injuries were cross-sectionally and longitudinally examined using a semistructured psychiatric interview, the Hamilton Depression Rating Scale, and the Social Functioning Exam during in-hospital care and at 3-, 6-, 9-, and 12-month follow-ups.

Results: Depressed subjects showed poorer social functioning at the initial evaluation, and at 6, 9, and 12 months. Measures of preinjury job dissatisfaction and fear of job loss were significantly associated with depression at the initial evaluation. Concurrent impaired close personal relationships as well as continued fear of job loss were associated with depression at 6, 9, and 12 months after TBI.

Conclusions: These findings suggest that two of the psychosocial factors associated with depression during the acute TBI period (patient's satisfaction with work and fear of job loss) are the same as those operant during the chronic period, but an additional psychosocial factor (close interpersonal relationships) is also operant during the chronic period. These findings support the need for early targeted social intervention in cases of TBI.