Risk factors for development of long-term mood and anxiety disorder after pediatric traumatic brain injury: a population-based, birth cohort analysis

ABSTRACT

Objectives

The objective of this study was to identify characteristics associated with an increased risk of anxiety and mood disorder prior to 25 years of age, in children who sustained a traumatic brain injury (TBI) prior to age 10.

Methods

This population-based study identified 562 TBI cases from a 1976–1982 birth cohort in Olmsted County, Minnesota. TBI cases were manually confirmed and classified by injury severity. Separate Cox proportional hazards regression models were fit to estimate the association of TBI and secondary non-TBI related characteristics with the risk of a subsequent clinically determined anxiety or mood disorder. Multivariable-adjusted population attributable risk (PAR) estimates were calculated for TBI characteristics.

Results

Older age at initial TBI and extracranial injury at time of initial TBI were significantly associated with an increased risk of anxiety (adjusted HR [95% CI]: 1.33 [1.16, 1.52] per 1-year increase and 2.41 [1.26, 4.59]), respectively. Older age at initial TBI was significantly associated with an increased risk of a mood disorder (adjusted HR 1.17 [1.08–1.27]).

Conclusion

In individuals sustaining a TBI prior to age 10, age at injury greater than 5 years old was the largest contributor to development of a mood or anxiety disorder.

KEYWORDS:

• Brain injuries
• traumatic
• psychiatry and psychology
• brain diseases
• depressive disorders
• anxiety disorders
• bipolar disorder

Acknowledgments

This study used the resources of the Rochester Epidemiology Project (REP) medical records-linkage system, which is supported by the National Institute on Aging (NIA; AG 058738), by the Mayo Clinic Research Committee, and by fees paid annually by REP users. The content of this article is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health (NIH) or the Mayo Clinic.

Abbreviation

ADHD	=	Attention Deficit Hyperactivity Disorder
aHR	=	adjusted hazard ratio
H-ICDA	=	Hospital Adaptation of the International Classification of Diseases, Eighth
Revision	=
ICD-9	=	International Classification of Diseases, Ninth Revision
IQR	=	interquartile range
LD	=	learning disabilities
PAR	=	Population attributable risk
REP	=	Rochester Epidemiology Project
TBI	=	traumatic brain injury

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors contributions

Dr Esterov had full access to all data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis.

Concept and design: Dr Esterov, Dr Brown, Dr Wi, Dr McCall, Ms Amy Weaver, Dr Witkowski

Acquisition, analysis, or interpretation of data: Dr Esterov, Dr Brown, Dr Wi, Dr McCall, Ms Amy Weaver, Dr Witkowski

Drafting of the manuscript: Dr Esterov, Dr Brown, Dr Wi, Dr McCall, Ms Amy Weaver, Dr Witkowski

Critical revision of the manuscript for important intellectual content: Dr Esterov, Dr Brown, Dr Wi, Dr McCall, Ms Amy Weaver, Dr Witkowski

Statistical analysis: Ms Amy Weaver

Final approval of the version to be published: Dr Esterov, Dr Brown, Dr Wi, Dr McCall, Ms Amy Weaver, Dr Witkowski

Agreement to be accountable for all aspects of the work in ensuring that questions related

to the accuracy or integrity of any part of the work are appropriately investigated and

resolved: Dr Esterov, Dr Brown, Dr Wi, Dr McCall, Ms Amy Weaver, Dr Witkowski

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website

Additional information

Funding

This publication was supported by CTSA Grant Number UL1 TR002377 from the National Center for Advancing Translational Science (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.