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Ledoux AA, Webster RJ, Clarke AE, Fell DB, Knight BD, Gardner W, Cloutier P, Gray C, Tuna M, Zemek R. Risk of Mental Health Problems in Children and Youths Following Concussion. JAMA Netw Open 2022; 5:e221235. [PMID: 35254429 PMCID: PMC8902648 DOI: 10.1001/jamanetworkopen.2022.1235] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Concussion may exacerbate existing mental health issues. Little evidence exists on whether concussion is associated with the onset of new psychopathologies or long-term mental health problems. OBJECTIVE To investigate associations between concussion and risk of subsequent mental health issues, psychiatric hospitalizations, self-harm, or suicides. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study including children and youths aged 5 to 18 years with a concussion or orthopedic injury incurred between April 1, 2010, and March 31, 2020, in Ontario, Canada. Participants had no previous mental health visit in the year before the index event for cohort entry and no prior concussion or traumatic brain injury 5 years before the index visit. Data were collected from provincewide health administrative databases. Participants with concussion were included in the exposed cohort, and those with an orthopedic injury were included in the comparison cohort; these groups were matched 1:2, respectively, on age and sex. EXPOSURES Concussion or orthopedic injury. MAIN OUTCOMES AND MEASURES The primary outcome was mental health problems, such as psychopathologies and psychiatric disorders, identified from health care visits in emergency departments, hospitalizations, or primary care settings. Secondary outcomes were psychiatric hospitalizations, self-harm health care visits, and death by suicide (identified in health care or vital statistics databases). RESULTS A total of 152 321 children and youths with concussion (median [IQR] age, 13 [10-16] years; 86 423 [56.7%] male) and 296 482 children and youths with orthopedic injury (median [IQR] age, 13 [10-16] years; 171 563 [57.9%] male) were matched by age and sex. The incidence rates of any mental health problem were 11 141 per 100 000 person-years (exposed group) and 7960 per 100 000 person-years (unexposed group); with a difference of 3181 (95% CI, 3073-3291) per 100 000 person-years. The exposed group had an increased risk of developing a mental health issue (adjusted hazard ratio [aHR], 1.39; 95% CI, 1.37-1.40), self-harm (aHR, 1.49; 95% CI, 1.42-1.56), and psychiatric hospitalization (aHR, 1.47; 95% CI, 1.41-1.53) after a concussion. There was no statistically significant difference in death by suicide between exposed and unexposed groups (HR, 1.54; 95% CI, 0.90-2.61). CONCLUSIONS AND RELEVANCE Among children and youths aged 5 to 18 years, concussion was associated with an increased risk of mental health issues, psychiatric hospitalization, and self-harm compared with children and youths with an orthopedic injury.
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Affiliation(s)
- Andrée-Anne Ledoux
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Cellular Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard J. Webster
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Deshayne B. Fell
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Braden D. Knight
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
| | - William Gardner
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Paula Cloutier
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Clare Gray
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, Children’s Hospital of Eastern, Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Meltem Tuna
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Roger Zemek
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Children’s Hospital of Eastern, Ontario, University of Ottawa, Ottawa, Ontario, Canada
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Bannon SM, Kumar RG, Bogner J, O'Neil-Pirozzi TM, Spielman L, Watson EM, Dams-O'Connor K. Reinjury After Moderate to Severe TBI: Rates and Risk Factors in the NIDILRR Traumatic Brain Injury Model Systems. J Head Trauma Rehabil 2021; 36:E50-E60. [PMID: 32769829 DOI: 10.1097/htr.0000000000000586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To compare characteristics of those who do and do not sustain subsequent traumatic brain injuries (TBIs) following index TBI and to identify reinjury risk factors. DESIGN Secondary data analysis of an ongoing longitudinal cohort study. SETTING TBI Model Systems Centers. PARTICIPANTS In total, 11 353 individuals aged 16+ years. MAIN OUTCOME MEASURES Ohio State University TBI Identification Method. RESULTS In total, 7.9% of individuals reported sustaining a TBI post-index TBI. Twenty percent of reinjuries occurred within a year of the index TBI. Reinjury risk followed an approximate U-shaped distribution such that risk was higher in the first year, declined 2 to 10 years postinjury, and then increased after 10 years. A multivariable Weibull model identified predictors of reinjury: younger (<29 years) and middle-aged and older (50+ years) age at index TBI relative to middle age, pre-index TBI, pre-index alcohol and illicit drug use, incarceration history, and less severe index TBI. CONCLUSIONS A subset of individuals who receive inpatient rehabilitation for TBI are at an increased risk for reinjury, and an injury-prone phenotype may be characterized by engagement in risk behaviors. Factors associated with reinjury risk may differ for younger versus middle-aged and older adults. Findings underscore the need for empirically informed risk stratification models to identify TBI survivors at risk for reinjury.
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Affiliation(s)
- Sarah M Bannon
- Department of Psychiatry, Massachusetts General Hospital (Ms Bannon), and Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital (Dr O'Neil-Pirozzi), Harvard Medical School, Boston, Massachusetts; Department of Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York City, New York (Drs Kumar, Spielman, Watson, and Dams-O'Connor); Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus (Dr Bogner); and Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts (Dr O'Neil-Pirozzi)
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Paniccia M, Ippolito C, McFarland S, Murphy J, Reed N. Health-Related Quality of Life in Non-Concussed Children: A Normative Study to Inform Concussion Management. Dev Neurorehabil 2020; 23:534-541. [PMID: 32156189 DOI: 10.1080/17518423.2020.1736683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: There has been a shift to consider pediatric concussion recovery beyond symptom management by considering how health-related quality of life (HRQoL) affects recovery. This study investigated normative ranges of HRQoL in children and explored its relationship with common pediatric concussion variables. Methods: A cross-sectional study of 1,722 non-concussed children 8-12 years old (M = 10.52 ± 1.23 years; 1,335 males, 387 females) was conducted by secondary analysis of clinical baseline concussion data. Demographic information, concussion-like symptoms (PCSI-C), and HRQoL (KIDSCREEN-10 Index) were self-reported. Results: The most reported concussion-like symptoms were common stress symptoms and were significantly negatively correlated with HRQoL. Premorbid histories of attention deficit hyperactivity disorder, mental health challenges, headaches/migraines, and concussion significantly lowered HRQoL. The number of diagnosed concussions and PCSI-C scores were significantly negatively correlated with HRQoL. Conclusions: The normative ranges and model can indicate HRQoL levels to inform clinicians how children may respond to concussion and streamline care beyond traditional assessment models.
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Affiliation(s)
- M Paniccia
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - C Ippolito
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - S McFarland
- Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - J Murphy
- Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - N Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada
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Paniccia M, Ippolito C, McFarland S, Murphy J, Reed N. Self-efficacy in non-concussed youth: a normative study. Brain Inj 2020; 34:1532-1540. [PMID: 32910683 DOI: 10.1080/02699052.2020.1792983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE In pediatric concussion, there has been a shift to consider how pre-injury profiles, such as self-efficacy, affect the recovery trajectory. The aim of this study was to investigate normal ranges of self-efficacy (overall, academic, social, emotional) in youth and to explore its relationship with the effects of daily stressors, operationalized as concussion-like symptoms, demographic factors, pre-injury/learning related factors, and concussion history. METHODS A cross-sectional study of 1300 uninjured youth 13-18 years old (1111 males, 189 females) was conducted by secondary analysis of clinical pre-injury/baseline concussion data. Demographic information, concussion-like symptoms (Post-concussion Symptom Inventory), and self-efficacy (Self-efficacy Questionnaire for Children) were self-reported. RESULTS The most reported concussion-like symptoms were common stress symptoms and there was a strong negative relationship with self-efficacy. Males reported higher self-efficacy than females, but no age effects were observed. Pre-injury factors including learning disability, ADHD, special education, IEP, mental health challenges, history of headaches/migraines, and concussion history were associated with significantly lower overall self-efficacy. CONCLUSIONS These normative ranges and predictive model can be used to provide a benchmark of self-efficacy to indicate how youth may respond to a concussion, and to inform clinical care during recovery.
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Affiliation(s)
- M Paniccia
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - C Ippolito
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - S McFarland
- Concussion Centre, Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - J Murphy
- Concussion Centre, Early Concussion Care Program, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - N Reed
- Concussion Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto , Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto , Toronto, Canada
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Lantagne A, Peterson RL, Kirkwood MW, Taylor HG, Stancin T, Yeates KO, Wade SL. Featured Article: Interpersonal Stressors and Resources as Predictors of Adolescent Adjustment Following Traumatic Brain Injury. J Pediatr Psychol 2019; 43:703-712. [PMID: 29617953 DOI: 10.1093/jpepsy/jsy020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/08/2018] [Indexed: 11/13/2022] Open
Abstract
Objective The present study sought to examine adolescents' perceptions of their interpersonal stressors and resources across parent, sibling, friend, and school relationships, and the longitudinal associations with self-reported adjustment after traumatic brain injury (TBI) over a 12-month period. Methods We examined the main effects of stressors and resources on internalizing and externalizing symptoms in 152 adolescents who had sustained complicated mild-to-severe TBI. We also investigated the conjoint effects of stressors and resources and the moderating effects of TBI severity with stressors and resources on outcomes. Results High stressors consistently predicted worse adjustment. High resources were generally only associated with fewer internalizing symptoms. Main effects were qualified by interactions between school stressors and resources in predicting externalizing symptoms and between friend stressors and resources in predicting internalizing and externalizing symptoms. For school stressors, the effects of resources on externalizing symptoms functioned as a buffer. In comparison, the buffering effects of friend resources on internalizing and externalizing symptoms disappeared at moderate-to-high levels of friend stress. Moderating effects of TBI severity were also observed, such that as family resources increased, only adolescents with complicated mild-to-moderate TBI, but not those with severe TBI, experienced decreases in internalizing and eternalizing symptoms. Conclusion Interpersonal stressors and social support have important implications for adolescent adjustment after TBI. Adolescents with low levels of school resources, with high levels of friend stress, and who sustain severe TBI are at greatest risk for difficulties with adjustment.
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Affiliation(s)
- Ann Lantagne
- Department of Rehabilitation, Children's Hospital Colorado.,Department of Child Clinical Psychology, University of Denver
| | - Robin L Peterson
- Department of Rehabilitation, Children's Hospital Colorado.,University of Colorado School of Medicine
| | - Michael W Kirkwood
- Department of Rehabilitation, Children's Hospital Colorado.,University of Colorado School of Medicine
| | - H Gerry Taylor
- Case Western Reserve University.,Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Terry Stancin
- Case Western Reserve University.,Department of Psychiatry, MetroHealth Medical Center
| | | | - Shari L Wade
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
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Turnier LK, Modi AC. JPP Student Journal Club Commentary: Interpersonal Stressors and Resources as Predictors of Adolescent Adjustment Following Traumatic Brain Injury. J Pediatr Psychol 2018; 43:713-715. [DOI: 10.1093/jpepsy/jsy033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Luke K Turnier
- Xavier University
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center
| | - Avani C Modi
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center
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