Relative risk of mental health diagnoses following mild traumatic brain injury

Title : Relative risk of mental health diagnoses following mild traumatic brain injury

Abstract:

Introduction: Traumatic brain injury (TBI) affects an estimated 27 to 69 million people worldwide annually^1,2 with the majority of cases being classified as mild.³ Mild TBI (mTBI) is caused by blunt trauma or acceleration or deceleration forces to the head or body with resulting alterations in consciousness or mental status.^3,4 Previous literature established a link between mTBI and mood-related disturbances,^5,6,7,8,9 with anxiety/mood disruption now recognized as a subtype of mTBI symptomology.¹⁰ Depressive symptoms, suicidal ideation, and suicide attempts have been found to be higher in adolescents with mTBI compared to those without.^8,9,11 However, little is known about the impact of mTBI on mental health disorders in adult populations. We aim to investigate the relationship between having a mTBI diagnosis and subsequent mental health disorder diagnoses in the adult population.

Methods: This retrospective cohort study compared two groups of matched adult patients, 1) individuals diagnosed with mTBI and 2) individuals not diagnosed with mTBI (control), to determine the risk of having a mental health diagnosis within 5 years of injury. Data were collected from a large integrated healthcare system between 2009 and 2022.

Results: The study included 33,779 patients with diagnosed mTBI and 66,996 matched controls. The average age of the two study groups was approximately 39 years. The median follow-up time was 3.68 years. The Kaplan Meier five-year cumulative incidence rates of having a mental health diagnosis of the mTBI and control groups were 26.8% and 17.5%, respectively. Cox proportional regression with discrete time intervals was used to examine the association between mTBI and having a mental health diagnosis. Controlling for demographics and comorbidities, the mTBI group had an 80% increase in the risk of having a mental health diagnosis in the first-year post-injury compared to the control group. The mTBI group also had increased risks of having a mental health diagnosis in follow-up years 2-5, albeit at decreasing rates of 54%, 36%, 25%, and 12%, respectively.

Conclusion: The risk of mental health diagnosis is significantly higher following mTBI with the highest risk at follow-up year 1 and the lowest risk at follow-up year 5. While the decrease in risk throughout the follow up period is promising, clinicians should be aware of possible mental health disorders following mTBI to ensure early intervention and minimize negative long-term outcomes. Further research is needed to determine appropriate interventions for mental health diagnoses in the sub-acute and chronic period following mTBI. 

Audience Take Away Notes:

• The risk of mental health diagnosis is significantly higher following a diagnosed mTBI in the adult population
• Clinicians should be aware of possible mental health disorders following a mTBI. Earlier diagnosis of mental health disorders can allow for timely intervention and aid in holistic rehabilitation following injury
• Further research is needed to determine appropriate screening protocols and interventions for mental health disorders following mTBI

Biography:

Jordan Cornwell graduated from Dartmouth College in 2019 with a BA in Psychology and Anthropology. At Dartmouth College, she worked in the Haxby and Hill Labs on fMRI and mild traumatic brain injury (mTBI) studies, respectively. She then joined the Stanford Brain Performance Center from 2019-2021 to conduct sports-related mTBI diagnosis, symptomology, and rehabilitation research. She began medical school in 2021 at Kaiser Permanente Bernard J. Tyson School of Medicine and has continued her passion for traumatic brain injury research.