Depression assessment after traumatic brain injury: an empirically based classification method.

OBJECTIVES: To describe the patterns of depression in patients with traumatic brain injury (TBI), to evaluate the psychometric properties of the Neurobehavioral Functioning Inventory (NFI) Depression Scale, and to classify empirically NFI Depression Scale scores.

DESIGN: Depressive symptoms were characterized by using the NFI Depression Scale, the Beck Depression Inventory (BDI), and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Depression Scale.

SETTING: An outpatient clinic within a Traumatic Brain Injury Model Systems center.

PARTICIPANTS: A demographically diverse sample of 172 outpatients with TBI, evaluated between 1996 and 2000.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: The NFI, BDI, and MMPI-2 Depression Scale. The Cronbach alpha, analysis of variance, Pearson correlations, and canonical discriminant function analysis were used to examine the psychometric properties of the NFI Depression Scale.

RESULTS: Patients with TBI most frequently reported problems with frustration (81%), restlessness (73%), rumination (69%), boredom (66%), and sadness (66%) with the NFI Depression Scale. The percentages of patients classified as depressed with the BDI and the NFI Depression Scale were 37% and 30%, respectively. The Cronbach alpha for the NFI Depression Scale was.93, indicating a high degree of internal consistency. As hypothesized, NFI Depression Scale scores correlated highly with BDI (r=.765) and MMPI-2 Depression Scale T scores (r=.752). The NFI Depression Scale did not correlate significantly with the MMPI-2 Hypomania Scale, thus showing discriminant validity. Normal and clinically depressed BDI scores were most likely to be accurately predicted by the NFI Depression Scale, with 81% and 87% of grouped cases, respectively, correctly classified. Normal and depressed MMPI-2 Depression Scale scores were accurately predicted by the NFI Depression Scale, with 75% and 83% of grouped cases correctly classified, respectively. Patients' NFI Depression Scale scores were mapped to the corresponding BDI categories, and 3 NFI score classifications emerged: minimally depressed (13-28), borderline depressed (29-42), and clinically depressed (43-65).

CONCLUSIONS: Our study provided further evidence that screening for depression should be a standard component of TBI assessment protocols. Between 30% and 38% of patients with TBI were classified as depressed with the NFI Depression Scale and the BDI, respectively. Our findings also provided empirical evidence that the NFI Depression Scale is a useful tool for classifying postinjury depression.