Anxiety Trajectories the First 10 Years After a Traumatic Brain Injury (TBI): A TBI Model Systems Study

Objective: Determine anxiety trajectories and predictors up to 10 years posttraumatic brain injury (TBI).Design: Prospective longitudinal, observational study.Setting: Inpatient rehabilitation centers.Participants: 2836 participants with moderate to severe TBI enrolled in the TBI Model Systems National Database who had >= 2 anxiety data col-lection points (N=2836).Main Outcome Measure: Generalized Anxiety Disorder-7 (GAD-7) at 1, 2, 5, and 10-year follow-ups.Results: Linear mixed models showed higher GAD-7 scores were associated with Black race (P<.001), public insurance (P<.001), pre -injury mental health treatment (P<.001), 2 additional TBIs with loss of consciousness (P=.003), violent injury (P=.047), and more years post-TBI (P=.023). An interaction between follow-up year and age was also related to GAD-7 scores (P=.006). A latent class mixed model identified 3 anxiety trajectories: low-stable (n=2195), high-increasing (n=289), and high-decreasing (n=352). The high-increasing and high -decreasing groups had mild or higher GAD-7 scores up to 10 years. Compared to the low-stable group, the high-decreasing group was more likely to be Black (OR=2.25), have public insurance (OR=2.13), have had pre-injury mental health treatment (OR=1.77), and have had 2 prior TBIs (OR=3.16).