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Post-Traumatic Stress Disorder After Traumatic Brain Injury—A Systematic Review and Meta-Analysis

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Abstract

Objective

To estimate the relative frequency and relative risk of post-traumatic stress disorder (PTSD) attributed to traumatic brain injury (TBI).

Data Sources

PubMed and Embase were searched from database inception until January 26, 2019.

Study Selection

Two independent investigators screened titles, abstracts, and full texts. We selected studies that included subjects presenting with TBI, and where the number of subjects with TBI and PTSD could be extrapolated. There were no restrictions on study design.

Data Extraction and Synthesis

Data were extracted by two independent investigators and results were pooled using random-effects meta-analysis.

Results

In civilian populations, relative frequency of PTSD following TBI was 12.2% after 3 months (CI-95 (7.6 to 16.8%) I2 = 83.1%), 16.3% after 6 months (CI-95 (10.2 to 22.4%), I2 = 88.4%), 18.6% after 12 months (CI-95 (10.2 to 26.9%), I2 = 91.5%), and 11.0% after 24 months (CI-95 (0.0 to 25.8%), I2 = 92.0%). Relative risk was 1.67 after 3 months (CI-95 (1.17 to 2.38), P = 0.011, I2 = 49%), 1.36 after 6 months (CI-95 (0.81 to 2.30), P = 0.189, I2 = 34%), and 1.70 after 12 months (CI-95 (1.16–2.50), P = 0.014, I2 = 89%). In military populations, the relative frequency of associated PTSD was 48.2% (CI-95 (44.3 to 52.1%), I2 = 100%) with a relative risk of 2.33 (CI-95 (2.00 to 2.72), P < 0.0001, I2 = 99.9%).

Conclusions and Relevance

TBI is a risk factor for PTSD in clinic-based civilian populations. There are insufficient data to assess the relative frequency or relative risk of PTSD in moderate to severe TBI. Due to significant between-study heterogeneity, the findings of our study should be interpreted with caution.

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Acknowledgments

We would like to express our gratitude to Caroline Augusta Richelsen for helping with editing the manuscript.

Author information

Author notes

  1. Henrik W. Schytz and Sait Ashina are co-senior authors

Authors and Affiliations

  1. Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Afrim Iljazi, Håkan Ashina, Haidar Muhsen Al-Khazali, Messoud Ashina & Henrik W. Schytz

  2. BIDMC Comprehensive Headache Center, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Afrim Iljazi & Sait Ashina

  3. Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA

    Richard B. Lipton

  4. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Sait Ashina

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Contributions

SA, HWS, and HA initiated the study. AI, HA, HWS, and SA contributed to the study design. AI and HMK carried out the search and data extraction. AI, RBL, and SA contributed to statistical analysis. All authors contributed to interpreting the results. AI and HA wrote the first draft of the manuscript while CAR, HMK, MS, RBL, HWS, and SA contributed significantly with wording and approving the final manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no other individuals meeting the criteria have been omitted.

Corresponding author

Correspondence to Sait Ashina.

Ethics declarations

Competing interests

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: Afrim Iljazi, Hakan Ashina, and Haidar Muhsen Al-Khazali have no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. Richard B. Lipton is the Edwin S. Lowe Professor of Neurology at the Albert Einstein College of Medicine in New York. He receives research support from the NIH: 2PO1 AG003949 (Multiple Principal Investigator), 5U10 NS077308 (Principal Investigator), RO1 NS082432 (Investigator), 1RF1 AG057531 (Site Principal Investigator), RF1 AG054548 (Investigator), 1RO1 AG048642 (Investigator), R56 AG057548 (Investigator), K23 NS09610 (Mentor), K23AG049466 (Mentor), and 1K01AG054700 (Mentor). He also receives support from the Migraine Research Foundation and the National Headache Foundation. He serves on the editorial board of Neurology, senior advisor to Headache, and associate editor to Cephalalgia. He has reviewed for the NIA and NINDS; holds stock options in eNeura Therapeutics and Biohaven Holdings; and serves as consultant, advisory board member, or has received honoraria from the American Academy of Neurology, Alder, Allergan, American Headache Society, Amgen, Autonomic Technologies, Avanir, Biohaven, Biovision, Boston Scientific, Dr Reddy’s, Electrocore, Eli Lilly, eNeura Therapeutics, GlaxoSmithKline, Merck, Pernix, Pfizer, Supernus, Teva, Trigemina, Vector, and Vedanta. He receives royalties from Wolff’s Headache, 7th and 8th Edition, Oxford Press University, 2009, Wiley and Informa. Messoud Ashina is a consultant, speaker, or scientific adviser for Alder, Allergan, Amgen, Eli Lilly, Novartis, and Teva. Henrik Winther Schytz has received consultant fees from Teva, Novartis, and BalancAir and received grants from Novartis. Sait Ashina has received consulting fees from Novartis, Amgen, Allergan, Elly Lilly, Supernus, Satsuma, Percept Promius, and Theranica.

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Iljazi, A., Ashina, H., Al-Khazali, H.M. et al. Post-Traumatic Stress Disorder After Traumatic Brain Injury—A Systematic Review and Meta-Analysis. Neurol Sci 41, 2737–2746 (2020). https://doi.org/10.1007/s10072-020-04458-7

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