Concussions associated with increased risk children developing behavioral and affective disorders
By Ella Gullickson. This article was initially published in the 3/7/24 edition of our Concussion Update newsletter; please consider subscribing.
The Journal of the American Academy of Pediatrics published a study that found a significant correlation between children who sustain mild traumatic brain injuries (mTBIs/concussions) and risk of developing affective disorders (anxiety, depression, OCD, or adjustment disorders) and behavioral disorders (ADHD or Conduct Disorder) within four years post-injury. While the study broke down the risks by age group and time from injury, participants’ overall risk of developing affective disorders and behavioral disorders over the four years was 25% and 18% higher, respectively, than children who hadn’t sustained a concussion. Children 10-to-13 years old were at the highest risk for developing an affective disorder after an mTBI over the four years.
The importance of this study is evident when considering that 42% of patients with mTBI diagnoses in Kaiser Permanente Northern California (the site of the study) were under 18 years old. With so many children suffering the effects of mTBI and our increasing understanding of mTBI as a risk factor for affective and behavioral disorders, it is vital that doctors are aware of the need for regular screening for mental health disorders “in children who sustain a mild mTBI over at least 2 years post-injury,” according to lead author Delmonico. This awareness is especially critical, as the COVID-19 pandemic may be aggravating the upsurge in depression, anxiety, and other behavioral health issues in children.
The study included more than two million children (aged 17 and under) evaluated at emergency rooms, urgent care clinics, and outpatient clinics between 2000 and 2014. The researchers utilized an observational matched cohort design, using electronic health records (EHRs) within the Kaiser Permanente Northern California (KPNC) integrated healthcare system, to create an mTBI and a no mTBI cohort matched on sex, age, race/ethnicity, and date of injury. Delmonico et al. found that overall, the mTBI group was 25% more likely to develop an Affective Disorder, with the highest risk of diagnosis (34%) occurring during the second year after injury.
As stated above, children with mTBIs 10 to 13 years old were at the highest risk for developing an affective disorder over the four years, with an increased risk of 34%. Children with mTBIs 14 to 17 years old were next highest at 23%. Overall, the risk for behavioral disorders in mTBI subjects was 18% over the four years. In the second and fourth years after injury, children in the mTBI cohort were at a 37% increased risk of developing a behavioral or affective disorder.
One limitation of the study was that 43% of the study’s initial participants were excluded due to factors such as a lapse in insurance coverage, meaning that findings might be biased because they potentially underestimate how behavioral disorders may be reflected in uninsured children. Another limitation was the lack of inclusion of children outside the KNPC healthcare system. Also, the study did not investigate the impact of multiple mTBIs.
