Mild TBI May Exacerbate Existing Mental Health Problems in Kids

By Megan Brooks

February 06, 2017

NEW YORK (Reuters Health) - There is increased use of mental health services after mild traumatic brain injury (mTBI) in children, but mostly by children with a preexisting mental health diagnosis, a new study shows.

Mental health symptoms after mTBI are "prominent and often attributed to the TBI. It remains unclear if utilization of post-mTBI mental health care is related to development of new symptoms or previous illness," Dr. Nathalia Jimenez and colleagues from the University of Washington in Seattle note in a Pediatrics report online February 3.

To investigate, they used the Medicaid Marketscan claims dataset to assess use of mental health services one year before and one year after pediatric mTBI.

The analysis included more than 31,000 children, 8,577 with and 22,695 without a mental health diagnosis before their mTBI. The most common existing mental health diagnoses were attention-deficit/hyperactivity disorder (44%) and mood disorders (33%).

Confirming prior studies, overall utilization of mental health services increased after mTBI, the researchers report. What their study adds, they say, is the finding that most post-mTBI mental health care was received by children with previous mental health disorders (86%).

"Having a mental health diagnosis pre-mTBI was the most important risk factor for receiving post-mTBI mental health care (odds ratio 7.93, 95% confidence interval 7.40-8.50)," they write.

"Our study showed that children with prior mental health disorders increased their use of mental health services after injury, which is in agreement with prior clinical studies," Dr. Jimenez told Reuters Health by email. "However, it is important to keep in mind that the increased use of services, peaked one month after injury and returned to baseline after two months. This underscores the importance of close follow up of these patients during the first months after injury."

The study also found racial and ethnic disparities in use of mental health services post-mTBI, with Hispanic children less likely to receive post-mTBI mental health care.

"Based on this new finding," said Dr. Jimenez, "we recommend clinicians caring for minority patients, specially those with language and cultural barriers, to educate parents about possible mental and behavioral problems after mild TBI. Also we recommend to maintain a closer follow up of these children, to diagnose new mental or behavioral disorders that might be missed by parents or that parents might be reluctant to address."


Pediatrics 2017.