Psychiatric disorders after traumatic intracranial hemorrhage: the HEAD Helsinki study.

BACKGROUND: The extent of psychiatric disorders after head injury is not well recognized. We assessed the prevalence and treatment of psychiatric disorders after traumatic intracranial hemorrhage (tICH) in a 10-year follow-up. METHODS: An observational, retrospective single-center cohort of tICH patients from HEAD Helsinki (Head trauma related health care Economics, Acute care and Development of long-term outcomes in Helsinki city region) study hospitalized at Helsinki University Hospital between 01 January and 31 December 2010. We reported primary outcomes as psychiatric disorders and their subsequent treatment on secondary level psychiatric care during the follow-up period between January 2010 and December 2019. Logistic regression analysis was performed to study associations between admission clinical characteristics and primary outcomes. RESULTS: In our cohort of 385 patients (mean age 60.7 years, 66.5% male) with tICH, 66 (17.1%) had any psychiatric disorders during the follow-up period (median time 108 months, IQR 92 months), and 48 (72.1%) of them experienced new psychiatric disorders (median time to onset 29.5 months, IQR 64 months), of which 26 (54.2%) were without any psychiatric history prior to tICH. A total of 35 patients (53.0%) received secondary level psychiatric care, and 40 (60.6%) patients had initiated new psychotropics (median time to initiation 8 months, IQR 40 months). Compared to patients without psychiatric disorders, those with psychiatric disorders were younger (mean age 49.1 vs. 63.1 years, p < 0.001) and had less frequently larger (> 100 ml) intracranial hemorrhages (21.2 vs. 44.2%, p = 0.001). In multivariable analyses, younger age was independently associated with the development of any psychiatric disorders. Prior psychiatric medication and lower admission GCS score were associated with consequent psychiatric treatment. CONCLUSIONS: Every sixth patient treated in a tertiary level neurosurgical unit had psychiatric disorders diagnosed at secondary level care after tICH and over half of them received secondary level psychiatric care. Psychiatric disorders development was associated with younger age whereas prior psychiatric medication and lower admission GCS score indicated subsequent psychiatric treatment.