Evaluating anxiety and depression symptoms in children and adolescents with prior mild traumatic brain injury: Agreement between methods and respondents

ABSTRACT

Psychological functioning can be adversely impacted after a mild traumatic brain injury (mTBI) and may be a potential target for intervention. Despite the use of symptom ratings or structured diagnostic interview to assess long-term anxiety and depression symptoms in children and adolescents post-injury, no known studies have considered the agreement between different assessment methods and between respondents. The objectives of this study were to investigate the agreement between symptom ratings and structured diagnostic interview and between children and parents’ symptom reporting. Participants (N = 33; 9–18 years old) were recruited from the Emergency Department and assessed on average 22.8 months (SD = 5.6) after their mTBI. Anxiety and depression symptoms were evaluated via subscales of a questionnaire (Behavior Assessment System for Children) and parts of a computerized structured diagnostic interview (generalized anxiety disorder and major depressive episode; Diagnostic Interview Schedule for Children – C-DISC-IV) administered individually to children and their parents. Results showed that the inter-method agreement to identify high levels of anxiety and depression was moderate to perfect in children while it was lower in parents. Although a similar percentage of participants with elevated anxiety or depression were identified by both children and parents, the agreement between youth and parents was variable, ranging from poor to good for anxiety and poor to moderate for depression. These results highlight the importance of collecting youth and parents’ reports of anxiety and depression symptoms and considering potential discrepancies between informants’ answers.

KEYWORDS:

• Pediatric
• head injury
• anxiety
• depression
• assessment

Acknowledgments

The authors would like to thank the families who participated in this research. The authors thank Angela Villavicencio and Brenda Turley for their assistance in the early stages of the project. Vickie Plourde PhD was supported by the Alberta Innovates Health Solutions (AIHS), the Alberta Children’s Hospital Research Institute (ACHRI), the Integrated Concussion Research Program (ICRP) at the University of Calgary, and the Cumming School of Medicine, University of Calgary. Brian Brooks PhD receives salary support from a Canadian Institutes for Health Research (CIHR) Embedded Clinician Researcher Salary award.

Disclosure statement

Brian Brooks receives royalties from Psychological Assessment Resources Inc. for pediatric neuropsychological tests [Child and Adolescent Memory Profile (ChAMP), Sherman & Brooks, 2015; Memory Validity Profile (MVP), Sherman & Brooks, 2015; Multidimensional Everyday Memory Ratings for Youth (MEMRY), Sherman & Brooks, 2017] and from Oxford University Press [Sherman & Brooks, 2012; Pediatric Forensic Neuropsychology]. The other coauthors have no conflicts of interest to declare. None of the authors nor their family members have financial interests in the tests mentioned in this paper.