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The Neurobehavioral Functioning Inventory (NFI) Depression Scale Appears to be a Useful Tool for Classifying Depression

Categories: Cognitive Assessments - Thinking and Emotional Skills

The Question

Is the Neurobehavioral Functioning Inventory (NFI) Depression Scale a useful tool for classifying depression in individuals with traumatic brain injury?

Past Studies

Past Studies have found that individuals with traumatic brain injury can develop depression after their injuries. Depression is a real medical condition that can be treated. Depression is not a “normal part” of every day life. Individuals with depression report that they continually feel sad, irritable, tired, and uninterested in activities that they used to find enjoyable. Other common symptoms of depression include difficulty sleeping, moving the body at a much slower pace, and not being able to remember things or concentrate as easily as before the brain injury. Historically, researchers have used a variety of tests to evaluate depression. Many of these tests were developed and standardized for individuals with psychiatric diagnoses. Such tests include the Beck Depression Inventory (BDI), the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and the Diagnostic Statistical Manual for Mental Disorders, 4th Edition (DSM-IV). Recently, researchers have used the Neurobehavioral Functioning Inventory (NFI) to identify and characterize depression in individuals with traumatic brain injury. A particular scoring scale for individuals with traumatic brain injury has not been developed for the NFI.

This Study 

This study focused on determining score ranges for the Neurobehavioral Functioning Inventory (NFI) to identify and classify depression in individuals with traumatic brain injury. Participants included 172 individuals with traumatic brain injury who were treated at a TBI Model Systems’ outpatient clinic. The participants completed the BDI and the NFI. The researchers examined data collected from the participants’ medical records, health history questionnaires, and patient and family interviews. The researchers were able to formulate scoring ranges for the NFI to identify and classify depression based on comparison of the BDI and NFI results. Between 30% and 38% of the participants were classified as moderately to severely depressed with the NFI and BDI, respectively. The NFI accurately identified nearly 90% of the participants with depression and about 80% of the participants with little or no depression. The NFI appeared to be less accurate for identifying individuals with borderline levels of clinical depression. Additionally, the participants most frequently reported the following symptoms of depression with the NFI: frustration (81%), restlessness (66%), thinking about the same thing over and over again (69%), boredom (66%), and sadness (66%). This study provides further evidence that depression appears to be a common occurrence following traumatic brain injury.

Who May Be Affected By These Findings

Individuals with traumatic brain injury and their families, healthcare providers, insurers, policy makers, advocates, and researchers.

Caveats

Information about the participants’ history of depression was not available to the researchers. The researchers state that future studies should examine the extent to which a traumatic brain injury might make an individual’s predisposition to depressionworse, as well as whether depression might be a risk factor for traumatic brain injury.

Bottom Line

The Neurobehavioral Functioning Inventory (NFI) appears to be a useful tool for classifying post-injury depression. The researchers were able to formulate scores to classify degrees of depression for individuals with traumatic brain injury. The researchers advocate that screening for depression should be a standard component of traumatic brain injury exams.

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Find This Study

Seel, R.T., & Kreutzer, J.S. (2003). Depression assessment after traumatic brain injury: An empirically based classification method.Archives of Physical Medicine and Rehabilitation, 84, 1621-1628.

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