Risk of mood, anxiety, and substance use disorders following adolescent traumatic brain injury: a retrospective cohort study.

Abstract

Objective: The aim of this study was to determine whether adolescent traumatic brain injury (TBI) is associated with long-term risk of depression, anxiety, suicide ideation, suicide attempt, and substance use disorders, and whether these risks differ by sex and injury severity.

Methods: This retrospective cohort study used electronic health record data from January 1, 2000, to January 1, 2019, with a 5-year follow-up period. Data were obtained from the TriNetX platform, which aggregates deidentified information from 60 US healthcare organizations across all 50 states. A total of 262,262 adolescents aged 10-18 years diagnosed with mild or moderate to severe TBI were included. Cohorts were stratified by sex and TBI severity and matched to controls without TBI by race, socioeconomic factors, and prior psychiatric or head injury diagnoses. Exposures were defined by ICD-10 codes for TBI severity, and outcomes included incidence of depression, anxiety, alcohol dependence, nicotine dependence, suicide ideation, and suicide attempt within 5 years of TBI diagnosis.

Results: Among 262,262 adolescents with TBI (154,149 male and 108,113 female), mild TBI was associated with increased risk of depression, anxiety, suicide ideation, suicide attempt, alcohol dependence, and nicotine dependence in both males and females compared with matched controls. Females with mild TBI had a higher risk of mood disorders and suicidality, whereas males had higher risk of substance use. Moderate to severe TBI was not associated with higher risk for these disorders compared with mild TBI.

Conclusions: Adolescent TBI, regardless of severity, was associated with increased risk of psychiatric disorders and substance use, with females showing greater vulnerability to mood disorders and suicidality.