Depression Symptoms and Suicidal Ideation Trajectories Among Asian Americans and Pacific Islanders Over the 10 years After TBI: A Model Systems Study

OBJECTIVE: This study examined 1) longitudinal trajectories of depression and suicidal ideation (SI) trajectories over the first 10 years after traumatic brain injury (TBI) in a sample of Asian American and Pacific Islander (AAPI) individuals; 2) demographic and injury-related predictors of these trajectories; and 3) time-varying depression symptoms as predictors of SI. SETTING: Participants who completed inpatient rehabilitation at a TBI Model Systems (TBIMS) center. PARTICIPANTS: Three hundred seven AAPI participants with moderate-to-severe TBI. DESIGN: Multisite, longitudinal observational cohort study. MAIN MEASURES: Patient Health Questionnaire (PHQ-9) completed at least once for any follow-up time point (ie, 1, 2, 5, or 10 years after TBI), demographic variables, functional characteristics, and injury characteristics. Depression was assessed using PHQ-8 total score, and SI was assessed from the PHQ-9 item 9 score. RESULTS: Rates of clinically significant depression symptoms ranged from 10.1% to 20.6% over 10 years across the 4 time points. Depression symptom trajectories remained flat over time. Higher education was associated with lower overall depression trajectories, whereas a prior history of mental health treatment and violent cause of injury were associated with higher depression trajectories. SI trajectories also remained stable, with higher overall levels observed among participants who were unmarried at injury, were employed at injury, and had a lifetime history of suicide attempts. Higher depression symptoms-both within individuals over time and between individuals-were associated with higher SI. CONCLUSION: The findings reinforce the importance of detection, long-term monitoring, and targeted support through culturally responsive mental health services for AAPI individuals with TBI.