OBJECTIVES To examine heterogeneity in the temporal patterns of depression and participation over the first two years post-TBI. DESIGN Observational prospective longitudinal study. SETTING Inpatient rehabilitation centers, with 1- and 2-year follow-up conducted primarily by telephone. PARTICIPANTS Persons with TBI (N=2307) enrolled in the Traumatic Brain Injury Model Systems database, followed at 1 and 2 years postinjury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Patient Health Questionnaire-9 (PHQ9) and Participation Assessment with Recombined Tools-Objective (PART-O) RESULTS: Using latent class modeling we examined heterogeneity in the longitudinal relationship between PHQ9 and PART-O. The identified 6 classes were most distinct in terms of 1) level of PHQ9 score and 2) association between the year 1 PART-O score and year 2 PHQ9 score. For most participants, PART-O at year 1 predicted PHQ9 at year 2 more than the reverse. However, there was a subgroup of participants that demonstrated the reverse pattern, PHQ9 predicting later PAR-O, who were on average, older and in the "other" employment category. CONCLUSIONS Results suggest that links between participation and depression are stronger for some people living with TBI than for others, and that variation in the temporal sequencing of these two constructs is associated with demographic characteristics. These findings illustrate the value in accounting for population heterogeneity when evaluating temporal among outcome domains.

中文翻译：

---

创伤性脑损伤后抑郁和参与时间顺序的异质性

目的 检验 TBI 后头两年抑郁和参与的时间模式的异质性。设计 观察性前瞻性纵向研究。设置住院康复中心，主要通过电话进行 1 年和 2 年的随访。参与者 患有 TBI 的人 (N=2307) 加入了创伤性脑损伤模型系统数据库，并在受伤后 1 年和 2 年进行了随访。干预 不适用。主要结果测量患者健康问卷 9 (PHQ9) 和使用重组工具目标的参与评估 (PART-O) 结果：我们使用潜在类别模型检查了 PHQ9 和 PART-O 之间纵向关系的异质性。确定的 6 个班级在 1) PHQ9 分数水平和 2) 第 1 年 PART-O 分数和第 2 年 PHQ9 分数之间的关联方面最为不同。对于大多数参与者来说，第 1 年的 PART-O 预测第 2 年的 PHQ9 多于相反的预测。然而，有一部分参与者表现出相反的模式，PHQ9 预测后期 PAR-O，他们平均年龄更大，属于“其他”就业类别。结论 结果表明，对于某些 TBI 患者而言，参与和抑郁之间的联系比其他人更强，并且这两种结构的时间顺序变化与人口统计学特征相关。这些发现说明了在评估结果域之间的时间时考虑人口异质性的价值。PHQ9 预测后来的 PAR-O，他们平均年龄更大，属于“其他”就业类别。结论 结果表明，对于某些 TBI 患者而言，参与和抑郁之间的联系比其他人更强，并且这两种结构的时间顺序变化与人口统计学特征相关。这些发现说明了在评估结果域之间的时间时考虑人口异质性的价值。PHQ9 预测后来的 PAR-O，他们平均年龄更大，属于“其他”就业类别。结论 结果表明，对于某些 TBI 患者而言，参与和抑郁之间的联系比其他人更强，并且这两种结构的时间顺序变化与人口统计学特征相关。这些发现说明了在评估结果域之间的时间时考虑人口异质性的价值。