Incidence and Predictors of Neuropsychiatric manifestations following a Traumatic Brain Injury in Referral Hospitals in Dodoma, Tanzania: a protocol of a prospective longitudinal observational study

Abstract

ABSTRACTIntroductionTraumatic Brain Injury (TBI) is any injury to the brain resulting from an external force leading to complications. TBI affects 27-69 million yearly, with high incidence in Africa and LMICs, and is attributed to motor traffic accidents. Within three to six months following moderate-to-severe TBI, the relative risk of any psychiatric disorder is significantly higher than in the general population. Post-TBI neuropsychiatric disorders include; depression with a prevalence of over 50%, apathy up to 72%, Post-traumatic stress disorder (26%), anxiety (9%), manic symptoms (5 - 9%) and psychosis (3 to 8%).This study aims to determine the incidence and predictors of post-TBI neuropsychiatric manifestations among patients admitted at Referral hospitals in Dodoma.Methods and analysisThis is a prospective longitudinal observational study in which patients admitted after moderate to severe TBI will be recruited after obtaining informed consent. Patients will be followed for six months; the diagnostic MINI International Neuropsychiatric Interview (M.I.N.I) tool will assess psychiatric disorders, and severity and progression of symptoms will be assessed using PHQ-9 for depressive symptoms, GAD7 for anxiety symptoms, PCL-5 for Post-traumatic Stress Disorders (PTSD), MoCA for cognitive assessment, AES for apathy and YMRS for manic symptoms at one, three and six months. The analysis will use logistic regression to determine the association between predictors and neuropsychiatric outcomes.Ethics and disseminationThe ethical clearance has been secured from the institutional Research Review committee and ethical committee of the University of Dodoma with the reference number MA.84/261/12. The respective authorities provided permission to conduct the study within the premises of BMH and DRRH.Strength and limitationThe diagnostic tool “International Neuropsychiatric Interview (M.I.N.I),” is highly reliable and sensitive as it utilizes both DSM-5 and ICD-10 criteria, and screening tools there are used have good validity and reliability in assessing the severity progression of neuropsychiatric symptoms.The longitudinal prospective nature of the study offers a strong temporal association of the incidence, progression and associated factors of neuropsychiatric manifestations post-TBI.The study excluded patients with a known history of psychiatric diagnosis that could influence the recurrence relapse of the present illness and the existence of another new psychiatric diagnosis after TBI.