Childhood brain injury increases the risk of developing a psychiatric disorder (Research Summary)

What do we already know?

Pediatric traumatic brain injury (TBI) refers to injuries that happen prior to age 18

Globally, the incidence of pediatric TBI is 280 injuries per 100,000 people every year

In the 2 years after injury, children & youth with TBI have an increased risk of developing a psychiatric disorder

• Those with severe TBI have an even greater risk

There is little research on long-term mental health outcomes of pediatric TBI (i.e., how a TBI sustained as a child may affect someone as an adult)

What did they do?

Participants were youth ages 6-14 hospitalized for mild to severe TBI in the United States

Participants were assessed at several timepoints:

• At the initial time of injury (within 14 days of injury)
• 3, 6, 12, and 24 months post-injury
• 24 years post-injury (participants now 29-39 years old)

The study had a good attrition rate: Of the 50 participants who initially participated in the study, 45 participated in the 24-year follow-up

Novel Psychiatric Disorder (NPD) = Psychiatric disorders which developed after the initial TBI (i.e., not a reoccurrence of a past psychiatric disorder)

• Current NPD = Psychiatric disorder the person is currently experiencing
• Any NPD = Experiencing a psychiatric disorder anytime after the initial injury
• Example: Person A previously developed Major Depressive Disorder (MDD) as a teenager but is not experiencing depressive symptoms anymore. At the time of the assessment, they do meet the criteria for a diagnosis of Generalized Anxiety Disorder (GAD). In this case, MDD would be classified as Any NPD and GAD would be classified as Current NPD and Any NPD.

The initial assessment measured:

• Severity of injury
• Lifetime psychiatric disorder
• Behavioural/adaptive function
• Family psychiatric history
• Family function
• Socioeconomic status
• Pre-injury intellectual functioning

Participants completed repeat psychiatric evaluations at the follow-up assessments

At the 24-year follow-up, a control group of healthy adults (i.e., no history of TBI or neurological conditions) were recruited to make comparisons to the TBI group (i.e., compare prevalence of psychiatric disorders in those with vs. without TBI)

What did they want to know?

The researchers made several predictions:

(1) They predicted that the TBI group (vs. the healthy control group) would have higher rates of psychiatric disorders at the time of the assessment (i.e., Current NPD)

(2) They predicted that the TBI group would have higher rates of psychiatric disorders at any point in the follow-up period (i.e., Any NPD)

(3) They predicted that Current NPD would be related to some of the variables measured at the first assessment (injury severity, family functioning, etc.)

(4) They predicted that the TBI group would have a shorter time to develop Any NPD compared the control group during the follow-up period

What did they find?

Any Novel Psychiatric Disorder (NPD-A)

• 82% of people in the TBI group developed a diagnosable psychiatric disorder at some point since their initial injury as a child compared to only 58% of people in the control group
• The TBI group also had a greater number of years of NPD exposure (i.e., longer duration of experiencing a psychiatric disorder) with an average of 10.8 years (compared to 3.96 years in the control group)
• The TBI group had a steeper onset of NPD over the follow-up period (i.e., earlier development of psychiatric disorder)

Current Novel Psychiatric Disorder (NPD-C)

• 53% of people in the TBI group had a diagnosable psychiatric disorder at the 24-year follow-up compared to only 13% of people in the control group
• People in the TBI group with no lifetime pre-injury psychiatric disorder developed NPD-C (i.e., a current psychiatric disorder) at a higher rate than those in the control group with no lifetime pre-injury psychiatric disorder

Factors predicting NPD

• Pre-injury lifetime psychiatric disorder and abnormal day-of-injury CT scan predicted a current psychiatric disorder (NPD-C) at the 24-year follow-up

What does this mean?

The prevalence of psychiatric disorders is 4x higher for those who sustained a brain injury in childhood

• Sustaining a brain injury in childhood is a risk factor for mental illness as an adult
• Mental health and medical professionals should screen for history of brain injury when considering a patient’s mental health concerns

For those who sustain a pediatric TBI, there is a shorter duration to develop a psychiatric disorder and a longer duration of exposure (longer time living with psychiatric disorder)

• Other studies show earlier and longer exposure to psychiatric disorders is linked to worse functional outcomes (more trouble with every day tasks and activities)

Pre-injury psychiatric history may influence pediatric TBI outcomes in the short- and long-term

• Early and targeted interventions, as well as long-term follow-up supports, should be readily available and accessible for people who sustain a brain injury in childhood

Future research should continue to investigate long-term psychiatric outcomes of pediatric brain injury

• As well, the relationship between abnormal neuroimaging results and psychiatric outcomes should be further investigated, particularly with modern imaging techniques like diffusion tensor imaging

Source:

Arif, H., Troyer, E. A., Paulsen, J. S., Vaida, F., Wilde, E. A., Bigler, E. D., … & Max, J. E. (2021). Long-term psychiatric outcomes in adults with history of pediatric traumatic brain injury. Journal of Neurotrauma, 38(11), 1515-1525.

https://doi.org/10.1089/neu.2020.7238

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