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American Indian, concussion, DSM-IV, head injury, Native American, prevalence, psychiatric, traumatic brain injury



  1. Nelson, Lonnie A. PhD
  2. Rhoades, Dorothy A. MD, MPH
  3. Noonan, Carolyn MS
  4. Manson, Spero M. PhD


Objectives: Describes prevalence of traumatic brain injury (TBI) and associated neuropsychiatric problems among two American Indian (AI) communities.


Design: Analysis of cross-sectional epidemiological data.


Setting: A Southwest (SW) and 2 Northern Plains (NP) AI reservations.


Participants: AI tribal members (N = 2687; 394 with history of TBI and 2293 noninjured comparisons) aged 15 to 54.


Outcome measures: Mood or anxiety disorders present more than 1 year after injury.


Results: Prevalences were high (>20% in males; >10% in females) in these populations. Associations between TBI and disorders meeting Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition criteria were strong in the SW community (adjusted odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.5-3.8), less so in the NP community (adjusted OR = 1.4; 95% CI = 0.9-2.2).


Conclusions: TBI is prevalent among AIs and is associated with increased OR of neuropsychiatric difficulties. This association may vary between tribes, though no interaction effect was found. AIs with TBI may require more thorough psychiatric screening to promote healthier outcomes.