Objective: Mild traumatic brain injury (mTBI) is associated with depressed mood acutely post-injury, but there is little evidence regarding long-term depression. The aim of this study was to determine the odds ratio (OR) of depression chronically following mTBI. Methods: We searched Medline (PubMed), ProQuest, and Web of Science from date of database creation to January 23, 2019, for eligible studies examining depression at least 6 months post-injury in adult subjects with mTBI of any etiology, including civilians and military. Three authors independently reviewed titles and abstracts for study eligibility. Data were extracted and collated by two investigators. Risk of bias was assessed with the SIGN methodology. Study data were pooled using random-effects meta-analysis. The primary exposure was mTBI, and the primary outcome was depression. Secondary exploratory variables were time of assessment, age at injury, age at assessment, sex, and etiology. Results: We included 47 cross-sectional studies (n = 25,103 mTBI and 29,982 control), 26 cohort studies (n = 70,119 mTBI, 262,034 control), four prospective observational studies (n = 1,058 mTBI and 733 control), two prospective longitudinal studies (n = 119 mTBI, 81 control), two case-control studies (n = 56 mTBI, 56 control), and one randomized controlled trial (n = 252 mTBI, 3,214 control). mTBI was associated with a 3.29-fold increased risk of depression (OR 3.29, 95% CI 2.68-4.03, I 2 = 96%). The OR for depression did not change when subjects were assessed at 6-12 months (OR 2.43, 1.45-4.07), years 1-2 (OR 4.12, 2.10-8.07); 2-10 (OR 3.28, 2.42-4.46), or 10+ (OR 3.42, 1.51-7.77). Similar risk of depression was sustained across different age at injury (<25: OR 2.26, 1.82-2.81; 25-35: OR 4.67, 3.06-7.14; >35: OR 2.69, 1.42-5.10) and different age at assessment (<40 years: OR 3.14, 2.48-3.99; >40 years: OR 4.57, 2.54-8.24). Female sex had a non-significant increase in OR (OR 19.97, 2.39-166.93) compared to male (OR 3.0, 2.33-3.86). mTBI etiology had no impact on depression. Conclusions: Those experiencing mTBI are more than three times more likely to experience depression compared to those without a history of mTBI, and this risk remains decades beyond the mTBI event. Future longitudinal studies are needed to identify and mitigate this risk.

中文翻译：

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表征轻度颅脑外伤后抑郁的风险：对慢性mTBI与非mTBI人群进行比较的文献的荟萃分析。

目的：轻度创伤性脑损伤（mTBI）与急性损伤后情绪低落有关，但关于长期抑郁的证据很少。这项研究的目的是确定mTBI后慢性抑郁的优势比（OR）。方法：自数据库创建之日起至2019年1月23日，我们对Medline（PubMed），ProQuest和Web of Science进行了搜索，以寻找合格的研究，以研究任何病因性mTBI的成年受试者受伤后至少6个月的抑郁症，包括平民和军事。三位作者独立审查了标题和摘要以获取研究资格。两名研究人员提取并整理了数据。使用SIGN方法评估偏倚风险。使用随机效应荟萃分析汇总研究数据。主要暴露是mTBI，主要结果是抑郁。次要探索性变量是评估时间，受伤年龄，评估年龄，性别和病因。结果：我们纳入了47项横断面研究（n = 25,103 mTBI和29,982例对照），26项队列研究（n = 70,119 mTBI，262,034例对照），四项前瞻性观察性研究（n = 1,058 mTBI和733例对照），两项前瞻性纵向研究（n = 119 mTBI，81例对照），两项病例对照研究（n = 56 mTBI，56例对照）和一项随机对照试验（n = 252 mTBI，3,214例对照）。mTBI与抑郁风险增加3.29倍相关（OR 3.29，95％CI 2.68-4.03，I 2 = 96％）。当在6-12个月（OR 2.43，1.45-4.07），1-2年（OR 4.12，2.10-8.07）评估受试者时，抑郁症的OR不变。2-10（OR 3.28，2.42-4.46）或10+（OR 3.42，1.51-7.77）。在不同的受伤年龄（<25：OR 2.26，1.82-2.81; 25-35：OR 4.67，3.06-7.14;> 35：OR 2.69，1.42-5.10）和评估时的不同年龄（<< 40年：或3.14、2.48-3.99；> 40年：或4.57、2.54-8.24）。与男性（OR 3.0，2.33-3.86）相比，女性性别OR的显着增加（OR 19.97，2.39-166.93）。mTBI病因对抑郁没有影响。结论：患有mTBI的人比没有mTBI病史的人患抑郁症的可能性高三倍以上，而且这种风险仍然比mTBI事件高出数十年。需要未来的纵向研究来识别和减轻这种风险。40年：或4.57、2.54-8.24）。与男性（OR 3.0，2.33-3.86）相比，女性性别OR的显着增加（OR 19.97，2.39-166.93）。mTBI病因对抑郁没有影响。结论：患有mTBI的人比没有mTBI病史的人患抑郁症的可能性高三倍以上，而且这种风险仍然比mTBI事件高出数十年。需要未来的纵向研究来识别和减轻这种风险。40年：或4.57、2.54-8.24）。与男性（OR 3.0，2.33-3.86）相比，女性性别OR的显着增加（OR 19.97，2.39-166.93）。mTBI病因对抑郁没有影响。结论：与没有mTBI病史的人相比，经历mTBI的人患抑郁症的可能性高三倍以上，而且这种风险仍然比mTBI事件高出数十年。需要未来的纵向研究来识别和减轻这种风险。