Suicidality, bullying and other conduct and mental health correlates of traumatic brain injury in adolescents.

Gabriela Ilie,Hayley Hamilton,Robert E Mann,Mark Asbridge,Michael D Cusimano,Angela Boak,Edward M Adlaf,Jürgen Rehm,Linda Chao

doi:10.1371/journal.pone.0094936

Abstract

ObjectiveOur knowledge on the adverse correlates of traumatic brain injuries (TBI), including non-hospitalized cases, among adolescents is limited to case studies. We report lifetime TBI and adverse mental health and conduct behaviours associated with TBI among adolescents from a population-based sample in Ontario.Method and FindingsData were derived from 4,685 surveys administered to adolescents in grades 7 through 12 as part of the 2011 population-based cross-sectional Ontario Student Drug Use and Health Survey (OSDUHS). Lifetime TBI was defined as head injury that resulted in being unconscious for at least 5 minutes or being retained in the hospital for at least one night, and was reported by 19.5% (95%CI:17.3,21.9) of students. When holding constant sex, grade, and complex sample design, students with TBI had significantly greater odds of reporting elevated psychological distress (AOR = 1.52), attempting suicide (AOR = 3.39), seeking counselling through a crisis help-line (AOR = 2.10), and being prescribed medication for anxiety, depression, or both (AOR = 2.45). Moreover, students with TBI had higher odds of being victimized through bullying at school (AOR = 1.70), being cyber-bullied (AOR = 2.05), and being threatened with a weapon at school (AOR = 2.90), compared with students who did not report TBI. Students with TBI also had higher odds of victimizing others and engaging in numerous violent as well as nonviolent conduct behaviours.ConclusionsSignificant associations between TBI and adverse internalizing and externalizing behaviours were found in this large population-based study of adolescents. Those who reported lifetime TBI were at a high risk for experiencing mental and physical health harms in the past year than peers who never had a head injury. Primary physicians should be vigilant and screen for potential mental heath and behavioural harms in adolescent patients with TBI. Efforts to prevent TBI during adolescence and intervene at an early stage may reduce injuries and comorbid problems in this age group.

Highlights

In North America, more than half a million youth under the age of 18 experience a Traumatic Brain Injury (TBI) that requires hospital-based care each year [1,2,3,4]
Significant associations between TBI and adverse internalizing and externalizing behaviours were found in this large population-based study of adolescents. Those who reported lifetime TBI were at a high risk for experiencing mental and physical health harms in the past year than peers who never had a head injury
Every year in the United States direct and indirect medical expenses related to TBI are estimated around $77 billion with a similar burden observed in Canada and other similar countries [9]

Summary

Introduction

In North America, more than half a million youth under the age of 18 experience a Traumatic Brain Injury (TBI) that requires hospital-based care each year [1,2,3,4]. Studies with clinical samples show impairments associated with TBI that include short- and long-term burdens related to cognitive, emotional and social functioning [1,4,5,6,7,8]. Every year in the United States direct (e.g., medical care and rehabilitation) and indirect (e.g., low productivity and loss of work) medical expenses related to TBI are estimated around $77 billion with a similar burden observed in Canada and other similar countries [9]. There is growing evidence that people who have had one or more TBIs are at greater risk of future TBIs, and evidence that multiple brain injuries can result in lasting cognitive impairment, substance use, mental health and physical health harms [6,7,10,11,12,13,14,15]

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