Association of concussion/brain injury symptoms and diagnosis with mental and social well-being in 2020 National Health Interview Survey (NHIS) children

Figures & data

Figure 1. Venn diagram showing the overlap of concussion/brain injury symptoms, check, and diagnosis in 2020 national health interview survey children ages 5–17.

Concussion/brain injury symptoms included reported vomiting, memory loss, vision loss, or loss of consciousness after a blow to the head). Check for, or diagnosis of, concussions consisted of an evaluation for a concussion by a health professional. Analyses were completed on children ages 5–17 with complete data on symptoms, check for a concussion, and concussion diagnosis (if checked).

Figure 2. Flow chart describing the selection of 2020 national health interview survey (NHIS) children included and excluded from the final analytic sample.

Table 1. Description of children ages 5–17 in the 2020 national health interview study (NHIS) with and without symptomatic head trauma or a diagnosed concussion/brain injury.

	Concussion/Brain Injury symptoms/diagnosis		No concussion/brain injury symptoms or diagnosis
	N (%)*	95% CI	N (%)*	95% CI
Age
5–9 years	1,074(21.2)	(750, 1,399)	18,929(39.6)	(17,359, 20499)
10–13 years	1,485(29.3)	(1,097, 1,874)	14,553(30.5)	(13,262, 15843)
14–17 years	2,501(49.4)	(2,081, 2,921)	14,293(29.9)	(13,102, 15485)
Male Sex	2,931(57.9)	(2,424, 3,437)	23,931(50.1)	(22,216, 25665)
Race^**
White (only)	4,090(80.8)	(3,476, 4,705)	30,867(64.6)	(28,770, 32964)
Black (only)	270(5.3)	(126, 413)	7,125(14.9)	(6,036, 8,214)
Asian (only)	85(1.7)	(19, 150)	2,263(4.7)	(1,875, 2,652)
Hispanic ethnicity	1012(20.0)	(694, 1,330)	12,387(25.9)	(10,802, 13972)
Household income^***
Below poverty line	575(11.4)	(371, 778)	6,208(13.0)	(5,292, 7,124)
Above poverty/below median	1,440(28.5)	(1,073, 1,807)	15,666 (32.8)	(14,259, 17072)
Above median	3,046(60.2)	(2,547, 3,545)	25,906(54.2)	(23,914, 27899)
Mental Health
Any level of anxiety in last year	3,476(68.6)	(2,919, 4,032)	22,316(46.9)	(20,608, 24024)
Any level of depression in last year	2,267(44.8)	(1,818, 2,716)	14,200(29.8)	(12,855, 15544)
Any difficulty making friends	852(16.8)	(560, 1,144)	4,951(10.4)	(4,287, 5,614)
Mental health medications****	905(17.9)	(658, 1,151)	4,171(8.7)	(3,566, 4,775)
Therapy/counseling for mental health****	996(19.8)	(753, 1240)	5, 558(11.6)	(4,865, 6,252)

CI- 95% confidence interval.

*All numbers shown in thousands.

**Children with race categorized responses as other, multiple different races, not ascertained, refused, or ‘don’t know’ where not included in this table.

***2020 federal poverty line assessed for a family of 4. Percentage above median family income is slightly above 50%, reflecting that current analyses only assessed households with children.

****In the past 12 months.

Table 2. Factors associated with being checked for a concussion/brain injury amongst 2020 national health interview survey children ages 5–17 with or without NHIS-reported previous symptomatic head trauma.

	Reported symptomatic head trauma		No NHIS-reported symptomatic head trauma
Variable	Odds ratio (CI)	P-value	Odds ratio (CI)	P-value
Age (per one year older)	1.13 (1.03, 1.25)	.01	1.02 (.98, 1.07)	.31
Sex (Female vs. Male)	1.18 (.57, 2.43)	.65	.51 (.36, .74)	<0.001
Race*
Black vs. White	.80 (.22, 2.94)	.74	.44 (.21, .90)	.03
Asian vs. White	.59 (.11, 3.31)	.55	.15 (.05, .44)	<0.001
Ethnicity (Hispanic vs. not Hispanic)	2.38 (.98, 5.76)	.06	.57 (.35, .95)	.03
Region
Midwest vs. Northeast	.52 (.19, 1.46)	.21	.98 (.60, 1.60)	.95
South vs. Northeast	.62 (.22, 1.77)	.37	.96 (.59, 1.54)	.85
West vs. Northeast	1.36 (.47, 3.91)	.57	1.13 (.68, 1.88)	.63
No insurance coverage	.32 (.06, 1.62)	.17	.20 (.04, .93)	.04
Parent Education (High school or less vs. College or above)	1.92 (.80, 4.61)	.14	2.02 (1.21, 3.37)	.007
Household Income
Below poverty vs. above median	.74 (.25, 2.15)	.57	1.10 (.54, 2.25)	.79
Below median/above poverty vs. above median	.82 (.28, 2.39)	.71	1.11 (.57, 2.17)	.75

Odds ratios derived from multivariable regression models including each of the above variables as covariates.

CI = 95% Confidence interval.

*Children with missing answers for race were included in the regression, but are not shown in this table.

Table 3. Association of concussion/brain injury symptoms/diagnosis with mental/social well-being in 2020 national health interview survey children ages 5–17.

	Anxiety		Depression		Difficulty Making Friends
Variable	Odds ratio (CI)	p	Odds ratio (CI)	p	Odds ratio (CI)	p
Prior concussion/brain injury symptoms/diagnosis	2.07 (1.52, 2.82)	<.001	1.60 (1.21, 2.13)	.001	1.57 (1.06, 2.33)	.03
Age (Per one year older)	1.04 (1.02, 1.07)	<.001	1.07 (1.05, 1.10)	<.001	1.03 (1.00, 1.07)	.05
Sex (Female vs. Male)	1.40 (1.19, 1.65)	<.001	1.67 (1.40, 1.99)	<.001	0.87 (.69, 1.08)	.21
Race
Black vs. White	0.41 (.31, .54)	<.001	0.48 (.35, .67)	<.001	0.81 (.51, 1.29)	.38
Asian vs. White	0.54 (.39, .74)	<.001	0.60 (.41, .87)	.007	0.53 (.28, 1.00)	.05
Ethnicity (Hispanic vs. not Hispanic)	1.65 (1.28, 2.12)	<.001	1.68 (1.30, 2.17)	<.001	0.97 (.70, 1.34)	.87
Region
Midwest vs. Northeast	1.50 (1.10, 2.06)	.01	1.30 (.91, 1.85)	.14	0.89 (.61, 1.32)	.57
South vs. Northeast	1.03 (.79, 1.34)	.84	1.07 (.78, 1.46)	.70	0.85 (.59, 1.23)	.39
West vs. Northeast	1.05 (.79, 1.40)	.73	1.20 (.86, 1.68)	.28	0.96 (.63, 1.46)	.85
Health Insurance - (not covered vs. covered)	0.59 (.40, .88)	.01	0.96 (.60, 1.53)	.85	0.66 (.33, 1.32)	.24
Parent education (high school or less vs. any college)	0.67 (.53, .84)	<.001	0.82 (.62, 1.07)	.14	0.78 (.54, 1.14)	.19
Total Family Income
Below poverty vs. above median	0.86 (.64, 1.15)	.31	1.03 (.75, 1.43)	.84	2.28 (1.55, 3.35)	<.001
Below median/above poverty vs. below poverty	0.93 (.76, 1.13)	.46	1.37 (1.11, 1.70)	.003	1.35 (.98, 1.86)	.07

Odds ratios derived from multivariable regression models including each of the above variables as covariates.

Table 4. Association of concussion/brain injury symptoms/diagnosis with high levels of mental/social distress in 2020 national health interview survey children ages 5–17.

	Anxiety		Depression		Difficulty Making Friends		Mental health therapy/counseling*		Took medication for mental health*
Variable	Odds ratio (CI)	p	Odds ratio (CI)	p	Odds ratio (CI)	p	Odds ratio (CI)	p	Odds ratio (CI)	p
Prior concussion/brain injury symptoms/diagnosis	2.44 (1.77, 3.37)	<.001	1.97 (1.13, 3.43)	.002	1.75 (.79, 3.86)	.17	1.52 (1.13, 2.04)	.006	1.69 (1.21, 2.36)	.002
Age (per one year older)	1.01 (.98, 1.04)	.60	1.03 (.98, 1.08)	.22	1.09 (1.03, 1.15)	.004	1.06 (1.03, 1.10)	<.001	1.09 (1.06, 1.13)	<.001
Sex (Female vs. Male)	1.25 (.99, 1.57)	.06	1.52 (1.05, 2.22)	.03	0.61 (.34, 1.09)	.09	1.15 (.90, 1.46)	.26	0.69 (.53, .91)	.008
Race**
Black vs. White	0.40 (.24, .68)	.001	0.56 (.25, 1.26)	.17	0.93 (.34, 2.52)	.89	0.53 (.33, .84)	.007	0.30 (.17, .54)	<.001
Asian vs. White	0.30 (.15, .58)	<.001	0.63 (.27, 1.46)	.28	0.60 (.17, 2.12)	.43	0.19 (.09, .39)	<.001	0.18 (.07, .44)	<.001
Ethnicity (Hispanic vs. Not Hispanic	1.17 (.81, 1.68)	.41	1.25 (.75, 2.09)	.40	0.89 (.45, 1.78)	.45	1.31 (.89, 1.93)	.18	1.88 (1.24, 2.84)	.003
Region
Midwest vs. Northeast	.98 (.68, 1.40)	.89	1.80 (.93, 3.49)	.08	1.55 (.73, 3.32)	.26	1.07 (.74, 1.54)	.72	1.34 (.86, 2.08)	.20
South vs. Northeast	0.74 (.55, 1.00)	.05	1.27 (.71, 2.27)	.43	0.96 (.48, 1.93)	.91	0.82 (.60, 1.13)	.23	1.15 (.78, 1.70)	.47
West vs. Northeast	0.98 (.70, 1.37)	.89	1.61 (.85, 3.09)	.14	2.02 (.90, 4.54)	.09	0.91 (.65, 1.28)	.59	0.81 (.50, 1.30)	.38
Health Insurance Coverage (Not covered vs covered)	0.38 (.20, .73)	.004	0.48 (.22, 1.02)	.06	0.53 (.13, 2.15)	.37	0.25 (.11, .56)	.001	0.48 (.21, 1.08)	.08
Parent Education (High school or less vs. any college)	0.69 (.50, .94)	.02	0.49 (.30, .78)	.003	.95 (.51, 1.76)	.87	0.93 (.66, 1.31)	.67	0.84 (.58, 1.21)	.34
Total Family Income
Below poverty vs. above median	1.35 (.91, 1.99)	.14	1.95 (1.06, 3.60)	.03	2.90 (1.31, 6.43)	.009	1.91 (1.29, 2.83)	.001	3.28 (2.16, 4.99)	<.001
Below median/above poverty vs. above median	1.22 (.93, 1.59)	.15	2.04 (1.32, 3.16)	.001	0.71 (.92, 3.15)	.09	1.46 (1.11, 1.91)	.007	1.47 (1.09, 2.00)	.01

CI-95% confidence interval.

High levels of mental/social distress evaluated in for several outcomes in separate multivariable logistic models, including: anxiety or depression weekly or daily, having a large amount of difficulty making friends or not being able to make friends at all, mental health counseling, or taking medications for emotions/concentration/behavior/mental health.

*Considered within the past 12 months.

**Children with other race or missing answers for race were included in the regression, but are not shown in this table.

Figure 3. Frequency of depressive symptoms, anxiety frequency, and level of difficulty making friends reported in 2020 national health interview survey children ages 5–17 with symptomatic head trauma, a diagnosed concussion/brain injury, or unaffected controls.

Data are shown for frequency of depressive symptoms (a), frequency of anxiety (b), and level of difficulty making friends (c). Unaffected controls included children with neither symptomatic head trauma nor a concussion diagnosis. The symptomatic head trauma and concussion/brain injury diagnosis groups were not mutually exclusive.