Cognitive Performance, Depression, and Anxiety 1 Year After Traumatic Brain Injury

Objectives: To evaluate associations between depression, anxiety, and cognitive impairment among individuals with complicated mild to severe traumatic brain injury (TBI) 1 year after injury. Setting: Multiple inpatient rehabilitation units across the United States. Participants: A total of 498 adults 16 years and older who completed inpatient rehabilitation for complicated mild to severe TBI. Design: Secondary analysis of a prospective, multicenter, cross-sectional observational cohort study. Main Measures: Assessments of depression (Traumatic Brain Injury Quality of Life [TBI-QOL] Depression) and anxiety (TBI-QOL Anxiety) as well as a telephone-based brief screening measure of cognitive functioning (Brief Test of Adult Cognition by Telephone [BTACT]). Results: We found an inverse relationship between self-reported depression symptoms and the BTACT Composite score (β = -0.18, P <.01) and anxiety symptoms and the BTACT Composite score (β = -0.20, P <.01). There was no evidence this relationship varied by injury severity. Exploratory analyses showed depression and anxiety were negatively correlated with both BTACT Executive Function factor score and BTACT Memory factor score. Conclusions: Both depression and anxiety have a small but significant negative association with cognitive performance in the context of complicated mild to severe TBI. These findings highlight the importance of considering depression and anxiety when interpreting TBI-related neuropsychological impairments, even among more severe TBI.