EVALUATING THE RELATIONSHIP BETWEEN DEPRESSION, COGNITIVE PERFORMANCE AND QUALITY OF LIFE FOLLOWING TRAUMATIC BRAIN INJURY WITHIN THE CONTEXT OF THE CHRONIC CARE MODEL

Depression is the most common mood disorder after traumatic brain injury (TBI). This study evaluated how the presence and/or severity of depression post-TBI affect a person's cognitive status and quality of life (QOL). Demographic variables, injury severity, and pre-morbid psychiatric histories were documented from patient interview and medical records. Persons with TBI were assessed at 6 and 12 months post-injury for posttraumatic depression using the Patient Health Questionnaire (PHQ-9). They were also evaluated for cognitive status and QOL at the same time points. Results indicate that persons with moderate/severe TBI exhibit worse cognitive status and report lower QOL post-injury than persons with no depression. Persons with mild depression report lower QOL than persons with no depression, but do not display worse cognitive functioning. The severity of posttraumatic depression, not just the presence of depression, affects a person's cognitive status and QOL after injury. TBI and posttraumatic depression are chronic conditions. The Chronic Care Model is a framework for identifying and improving care at multiple levels within the health care system including delivery system design, decision support, clinical information systems, self-management support, and within the community. The current health care delivery for persons with TBI suffering from posttraumatic depression and treated in southwestern Pennsylvania is discussed and areas for improvement within the system are identified. The public health significance of this research is important for understanding the relationship of depression, cognition and QOL after TBI and effectively targeting persons with posttraumatic depression to formulate interventions which allow for better outcome and QOL post-injury