Suicidality, Bullying and Other Conduct and Mental Health Correlates of Traumatic Brain Injury in Adolescents

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.

Risk of suicide after a concussion

“…[78][79][80] Past studies have suggested that a concussion can cause lasting defi cits through changes in physiology (e.g., disrupted serotonin pathways), mood (e.g., posttraumatic stress disorder) or behaviour (e.g., disinhibition with impulsivity). [81][82][83][84] Cognitive dissonance could also lead patients and clinicians to attribute injuries after weekend recreation to misadventure, whereas injuries following weekday occupation might be attributed to the employer. [85][86][87] With hindsight, a difference in activity restriction or cognitive dissonance might arise if the injury event was self-initiated.…”

Associations between a History of Traumatic Brain Injuries and Current Cigarette Smoking, Substance Use, and Elevated Psychological Distress in a Population Sample of Canadian Adults

“…Similar questions assessing TBI have been previously validated. 10,11,18,20 Whereas respondents were normal adults, able to participate in regular adult activities, we cannot rule out the possibility of cognitive impairments affecting responses of TBI-injured adults. Of relevance here, we found that TBI adults were no more likely than non-TBI adults to assess questionnaire difficulty as ''difficult'' (10 …”

“…[4][5][6] Over the past 15 years, the incidence of TBI has increased rapidly in the industrialized world, especially among youth. [7][8][9][10][11][12][13][14] In 1991, it was estimated that 1.7 million people experienced TBI in the United States. 1 By 2009, the Centers for Disease Control and Prevention (CDC) stated that TBI has become a ''silent epidemic,'' reporting an estimated 2.4 million TBI injuries captured through emergency department records, hospitalizations, or deaths in the United States, with children, adolescents, and older adults being the most likely age groups to sustain a TBI.…”

“…9,14 These reports point to the need for more population-based research on TBI that aims to understand its mechanisms, and its physical, behavioral, cognitive, and emotional correlates, as we begin to develop effective prevention as well as care and rehabilitation strategies. 8,16 Research indicates that the number of sports-related TBIs among adolescents has increased significantly in recent years (as high as almost 60% between 2001 and 2009) in the United States, rendering surveillance of TBI in youth and adult populations in North America, 10,11,12,17 as well as other developed countries, 9,14 a health priority.…”

“…18 Two recent Canadian populationbased studies of adolescents grades 7 through 12 found that 1 in 5 youth reported a TBI in their lifetime and that their history of TBI was significantly related to past-year drug and substance use, mental health issues, as well as poorer current grades in school. 10,11 The data we report here are unique in expanding on recent adolescent population-based studies 10,11 by examining province-wide data pertaining to adults from the same geographical location that were surveyed the same year (2011). This study describes not only current estimates of adult TBI from a jurisdiction without such previous data, but also investigates a range of substance types.…”