Anxiety and Posttraumatic Stress Disorder Among Medicare Beneficiaries After Traumatic Brain Injury

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Abstract

Objective:

To estimate rates of anxiety and posttraumatic stress disorder (PTSD) diagnoses after traumatic brain injury (TBI) among Medicare beneficiaries, quantify the increase in rates relative to the pre-TBI period, and identify risk factors for diagnosis of anxiety and PTSD.

Participants:

A total of 96 881 Medicare beneficiaries hospitalized with TBI between June 1, 2006 and May 31, 2010.

Design:

Retrospective cohort study.

Measures:

Diagnosis of anxiety (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 300.0x) and/or PTSD (ICD-9-CM code 309.81).

Results:

After TBI, 16 519 (17%) beneficiaries were diagnosed with anxiety and 269 (0.3%) were diagnosed with PTSD. Rates of anxiety and PTSD diagnoses were highest in the first 5 months post-TBI and decreased over time. Pre-TBI diagnosis of anxiety disorder was significantly associated with post-TBI anxiety (risk ratio, 3.55; 95% confidence interval, 3.42–3.68) and pre-TBI diagnosis of PTSD was significantly associated with post-TBI PTSD (risk ratio 70.09; 95% confidence interval 56.29–111.12).

Conclusion:

This study highlights the increased risk of anxiety and PTSD after TBI. Routine screening for anxiety and PTSD, especially during the first 5 months after TBI, may help clinicians identify these important and treatable conditions, especially among patients with a history of psychiatric illness.

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