Diagnosing Major Depression Following Moderate to Severe Traumatic Brain Injury – Evidence-based Recommendations for Clinicians

While major depression (MD) is the most common psychiatric disorder following traumatic brain injury (TBI), diagnosing MD can be challenging due to cognitive, emotional and somatic symptoms that overlap with TBI and other psychiatric disorders. Current evidence suggests that the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) works well in the TBI population. The presence of ‘organic’ TBI sequelae that overlap with DSM-IV MD criteria do not appear to lead to false-positive MD diagnoses. Rumination, self-criticism and guilt may best differentiate depressed from non-depressed persons following TBI. Anxiety, aggression, sleep problems, alcohol use, lower income levels, poor social functioning and negative thinking are primary risk factors for the development of MD following TBI. Current evidence suggests that the Patient Health Questionnaire-9 is the best self-report scale option for depression screening after TBI. Apathy, anxiety, dysregulation and emotional lability require careful clinical consideration when making a differential diagnosis of MD in persons with TBI. Research indicates that asking specific questions about depressed mood, loss of interest or pleasure and psychosocial functioning yields the most accurate diagnosis. Practical recommendations are provided on how clinicians can improve MD diagnostic accuracy.