The multiple facets of brain injury in the development of neuropsychiatric sequelae: sleep, depression, anxiety, and associated physical symptoms.

Research Objectives: Acquired Brain Injury (ABI) is the leading cause of death and disability for Canadians under 40 years old. To better understand the chronic neuropsychiatric sequelae of this population, we investigated parameters of depression, anxiety, and sleep in relation to ABI subgroups. To address the pharmacotherapy knowledge gap concerning the prescription of sleep medication for ABI survivors, we explored the prescription trends of sleep medication and the association of physical symptoms based on ABI subgroups.

Design: A retrospective cohort study was completed using patient charts from one Physical Medicine and Rehabilitation ABI Clinic between November 2014 and December 2021.

Setting: The study population was taken from the ABI clinic at Providence Care Hospital, a tertiary care rehabilitation centre in Kingston, ON, Canada.

Participants: All patients seen between November 2014 and December 2021 in the ABI clinic (n= 224).

Interventions: N/A

Main Outcome Measures: Measured outcomes from the most recent clinic attendance included a self-rating scale score for depression (Patient Health Questionnaire-9, PHQ-9), anxiety (General Anxiety Disorder scale-7, GAD-7), and concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire, RPQ). Additional information was gathered including prescribed medications and self-reported physical symptoms.

Results: Severe traumatic brain injury (TBI) subgroup reported higher PHQ-9 and GAD-7 scores in comparison to mild, moderate, and non-TBI. Moderate TBI subgroup (n = 15) most frequently reported sleep complaints (60.0%) yet none were prescribed sleep medications. Mild TBI subgroup (n = 60) less frequently reported sleep complaints (41.7%) with 21.7% of the subgroup prescribed sleep medications. All ABI subgroups reported physical symptoms X² (3, n=220) =10.17, p= .0172 but between group comparisons, showed no significant difference following Bonferroni Corrections.

Conclusions: Severe TBI subgroup reported higher levels of depression and anxiety than mild, moderate, and non-TBI subgroups suggesting that increased ABI severity subgroups may benefit from psychiatric intervention. Moderate TBI subgroup was not prescribed any sleep medication but had the most sleep complaints. Sleep interventions need to be addressed across all ABI subgroups. Physical symptoms are equally prevalent across all ABI subgroups.

Author(s) Disclosures: None.