Damian McNamara

October 27, 2013

ORLANDO, Florida — Children who experience brain injury or concussion may be up to 5 times more likely to be diagnosed with depression compared with children without these injuries, according to new research.

"Our take-home message is that knowledge of this association may help parents and providers identify children at risk for depression and initiate therapy of this treatable disease," Mark Wiley, MD, from Brown University in Providence, Rhode Island, told Medscape Medical News.

The research presented here at the American Academy of Pediatrics (AAP) 2013 National Conference and Exhibition is based on a nationally representative sample of 81,936 children.

The prevalence of brain injury was 1.9% in the National Survey of Children's Health, which includes parental interviews for children from birth to age 17 years. The incidence of depression was 3.7% in the cohort, but was much higher for patients with brain injury or concussion.

Table. Depression Risk After Brain Injury or Concussion

Mental Health

Children With Brain Injury Uninjured Children

Depression (%)

15 3.5


After adjusting for known depression risk factors, including family structure, developmental delay, and poor physical health, depression remained 2 times more likely in children with brain injury or concussion, Dr. Wiley reported.

Asked by Medscape Medical News to comment on the study, Mark Halstead, MD, from Washington University in St. Louis, Missouri, said, "It has been demonstrated that a history of brain injury can result in a higher likelihood of depression."

He noted, "The only thing about this study is that lumping the 2 questions of brain injury or concussion may not be truly representative of concussion alone." In addition, depression severity might vary by brain injury severity, but that is not clear from this study, he added.

"This is a good starting point, but we also need good prospective studies following many children with concussion and other brain injuries for many years after their injury to see if this conclusion holds true," said Dr. Halstead, who is also lead author on an AAP report entitled Returning to Learning Following a Concussion, which is to be released at the meeting.

Once depression is diagnosed in this patient population, "I think that pediatrician management, at least initially, is totally appropriate," Dr. Wiley said. "If a mood disorder or affective disease is felt to be present, and the pediatrician feels that it is out of the scope of their practice to treat, then referral to a mental health specialist would be appropriate."

Dr. Wylie and Dr. Halstead report no relevant financial relationships.

American Academy of Pediatrics (AAP) 2013 National Conference and Exhibition. Abstract 19. Presented October 25, 2013.


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