The association between female sex and depression following traumatic brain injury: A systematic review and meta-analysis

While women tend to experience more severe psychiatric and neurobehavioral symptoms following traumatic brain injury (TBI), the connection between sex and post-TBI depression remains poorly understood. To explore the potential association between sex and post-TBI depression, we conducted a systematic review and meta-analysis, including studies with participants who had no prior diagnosis of depression. Thirteen studies met the criteria for inclusion, collectively investigating a cohort of 449,471 individuals with TBI. The median age of the subjects was 49.9 years (≥7 years old). All participants were observed across a spectrum of TBI severities, encompassing mild, moderate, and severe cases. A pooled analysis of 449,471 subjects, revealed a statistically significant difference in the risk of developing post-TBI depression between male and female patients, with females at a significantly higher risk compared to males (RR = 1.4 [95 % CI, 1.29–1.52], P <.0001; I2 = 90.8 %, P <.0001). This significance also appeared in mild TBI/concussion cases (RR = 1.44 [95% CI, 1.36−1.52], P <.0001; I2 = 0%, P =.9), and in depression after a longer period (≥ 24 months) following the TBI (RR = 1.6 [95% CI, 1.59−1.66], P <.0001; I2 = 0%, P = 1). These findings identify TBI as a consistent risk factor for depression, regardless of its severity or type.