The efficacy of a scheduled telephone intervention for ameliorating depressive symptoms during the first year after traumatic brain injury

OBJECTIVE: To determine whether an intervention designed to improve functioning after traumatic brain injury (TBI) also ameliorates depressive symptoms. DESIGN: Single-blinded, randomized controlled trial comparing a scheduled telephone intervention to usual care. PARTICIPANTS: One hundred seventy-one persons with TBI discharged from an inpatient rehabilitation unit. METHODS: The treatment group received up to 7 scheduled telephone sessions over 9 months designed to elicit current concerns, provide information, and facilitate problem solving in domains relevant to TBI recovery. OUTCOME MEASURES: Brief Symptom Inventory-Depression (BSI-D) subscale, Neurobehavioral Functioning Inventory-Depression subscale, and Mental Health Index-5 from the Short-Form-36 Health Survey. RESULTS: Baseline BSI-D subscale and outcome data were available on 126 (74%) participants. Randomization was effective except for greater severity of depressive symptoms in the usual care (control) group at baseline. Outcome analyses were adjusted for these differences. Overall, control participants developed greater depressive symptom severity from baseline to 1 year than did the treatment group. The treated group reported significantly lower depression symptom severity on all outcome measures. For those more depressed at baseline, the treated group demonstrated greater improvement in symptoms than did the controls. CONCLUSIONS: Telephone-based interventions using problem-solving and behavioral activation approaches may be effective in ameliorating depressive symptoms following TBI. Proactive telephone calls, motivational interviewing, and including significant others in the intervention may have contributed to its effectiveness.