Oct. 04, 2024
Pediatric traumatic brain injuries (TBIs) are associated with an estimated 500,000 emergency department visits and 18,000 hospitalizations every year. In addition to resulting cognitive and physical impairment and disability, pediatric TBIs also are associated with the development of psychiatric sequelae.
Researchers have demonstrated that TBI puts children at increased risk of psychiatric symptoms early after injury, and some have suggested that these injuries also elevate the risk of developing a mood or anxiety disorder up to several years after the initial injury.
Does the risk of developing clinically determined mood and anxiety disorders remain elevated more than five years after a childhood TBI and into adulthood? And does sex or injury severity influence this risk? Those are the questions that a team of Mayo Clinic researchers sought to answer via a population-based, birth cohort analysis. The results of this study were published in the Journal of Head Trauma Rehabilitation in 2023, with Mayo Clinic physiatrist Dmitry Esterov, D.O., M.S., serving as lead author on the publication. Dr. Esterov is the project director of the Traumatic Brain Injury Model System program at Mayo Clinic in Rochester, Minnesota.
Because TBI is a leading cause of morbidity in children, Dr. Esterov notes that there has been increased attention about the long-term effects of TBI in children. "Understanding whether TBI in this population increases the risk of long-term psychiatric disorders is important for education and clinical treatment guidelines," says Dr. Esterov.
Study design
The researchers analyzed the records of 5,518 people born from Jan. 1, 1976, through Dec. 31, 1982. From that cohort, they analyzed the records of 562 children, including 238 females (42.3%) and 324 males (57.7%), who sustained a TBI before age 10 (the TBI group). The researchers identified the study participants' date of TBI, and they classified their injury severity using the Mayo Classification System. Each participant in the TBI group was age- and sex-matched to two individuals from the same birth cohort without a history of TBI at the index date (the referent group).
Using Cox proportional hazards models, the researchers compared the risk of a subsequent clinically diagnosed mood or anxiety disorder by age 25 between the TBI group and the referent group. They also stratified the risk of mood or anxiety disorders by sex and injury severity.
Results
According to Dr. Esterov, the researchers' analysis yielded several interesting findings. "We found that an isolated TBI occurring prior to age 10 does not lead to an increased risk of depressive or anxiety disorders by age 25, when compared with an individual who did not sustain a TBI by age 10," says Dr. Esterov. "However, when we looked at birth sex specifically, we did find that females with TBI before age 10 may be at slightly higher risk for a depressive or anxiety disorder compared with females without a TBI before age 10. But further studies are needed to understand that association more."
"When patients do sustain a TBI during childhood, this does not necessarily increase their risk for depression or anxiety long term. However, there are likely important risk factors for some children to develop depression or anxiety after TBI, and this is an area of further study."
The researchers shared these data summarizing their results:
- At least 1 out of every 115 people in the TBI group was diagnosed with a mood or anxiety disorder, compared with at least 1 out of every 108 in the referent group.
- No statistically significant association existed between childhood TBI status and anxiety disorder, adjusted hazard ratio (aHR) 1.01, 95% confidence interval (CI), 0.71 to 1.43.
- No statistically significant association existed between childhood TBI status and mood disorder, aHR 1.16, 95% CI, 0.92 to 1.47.
- Females in the TBI group had a significantly increased risk of a subsequently diagnosed mood disorder (aHR 1.40, 95% CI, 1.04 to 1.89), compared with age-matched females in the referent group (aHR 1.12, 95% CI, 0.73-1.72).
Next steps
"These findings provide important guidance for patients and their families," explains Dr. Esterov. "When patients do sustain a TBI during childhood, this does not necessarily increase their risk for depression or anxiety long term. However, there are likely important risk factors for some children to develop depression or anxiety after TBI, and this is an area of further study."
For more information
Esterov D, et al. Long-term risk for mood and anxiety disorders after pediatric traumatic brain injury: A population-based, birth cohort analysis. Journal of Head Trauma Rehabilitation. 2023;38:E212.
Refer a patient to Mayo Clinic.