Brain injury and adverse outcomes: a contemporary review of the evidence

Pediatric traumatic brain injury as a risk factor for psychosis and psychotic symptoms: a systematic review and meta-analysis

BACKGROUND

Psychosis is one of the most disabling psychiatric disorders. Pediatric traumatic brain injury (pTBI) has been cited as a developmental risk factor for psychosis, however this association has never been assessed meta-analytically.

METHODS

A systematic review and meta-analysis of the association between pTBI and subsequent psychotic disorders/symptoms was performed. The study was pre-registered (CRD42022360772) adopting a random-effects model to estimate meta-analytic odds ratio (OR) and 95% confidence interval (CI) using the Paule-Mandel estimator. Subgroup (study location, study design, psychotic disorder v. subthreshold symptoms, assessment type, and adult v. adolescent onset) and meta-regression (quality of evidence) analyses were also performed. The robustness of findings was assessed through sensitivity analyses. The meta-analysis is available online as a computational notebook with an open dataset.

RESULTS

We identified 10 relevant studies and eight were included in the meta-analysis. Based on a pooled sample size of 479686, the pooled OR for the association between pTBI and psychosis outcomes was 1.80 (95% CI 1.11-2.95). There were no subgroup effects and no outliers. Both psychotic disorder and subthreshold symptoms were associated with pTBI. The overall association remained robust after removal of low-quality studies, however the OR reduced to 1.43 (95% CI 1.04-1.98). A leave-one-out sensitivity analysis showed the association was robust to removal of all but one study which changed the estimate to marginally non-significant.

CONCLUSIONS

We report cautious meta-analytic evidence for a positive association between pTBI and future psychosis. New evidence will be key in determining long-term reliability of this finding.

A Systematic Review of Cognitive Functioning After Traumatic Brain Injury in Individuals Aged 10-30 Years

Given the importance of the period of life from 10 to 30 years in terms of cognitive development and education, combined with the high incidence of traumatic brain injury (TBI) during this period, and limited consensus as to the pattern and degree of cognitive impairment post TBI during this period, we conducted a systematic review to investigate cognitive performance across a range of domains among individuals between the ages of 10 and 30 years who had sustained a TBI. We searched five databases and identified 799 unique records; 52 met our inclusion criteria. These studies reported cognitive function for intelligence, attention, memory, processing speed, and executive function. The majority of the studies reported significant effects, suggesting that TBI is associated with cognitive impairments in these domains. Nine of the studies used physiological tests (EEG and fMRI), the outcomes of which supported behaviorally demonstrated cognitive deficits. In the studies we reviewed, individuals aged 10-30 years who had experienced a TBI performed worse than healthy controls on cognitive function measures-specifically for attention, memory, processing speed, and executive function. In the studies that subjected the individuals with TBI to EEG and fMRI, atypical activation in associated brain regions was demonstrated while the individuals were undergoing cognitive tasks. However, caution should be taken when interpreting the overall results due to the high risk of bias across the majority of the studies. The broader implications of reduced cognitive performance after TBI across this age range are yet to be fully understood.

Mild Traumatic Brain Injury and Psychopathology in Adolescence: Evidence From the Project on Human Development in Chicago Neighborhoods

PURPOSE

Emerging scientific evidence and media accounts document an association between mild traumatic brain injury (mTBI) and deleterious mental health outcomes in adulthood. This study focuses on exploring the relationship between mTBI and increased risk for psychopathology in a sample of adolescent youth.

METHODS

Longitudinal data from adolescent youth aged 10-18 years (n = 1,827) from the Project on Human Development in Chicago Neighborhoods are analyzed. Multivariate negative binomial regression models are calculated to examine the relationship between mTBI and aggressive behavior, anxiety/depression, attention problems, somatic symptoms, and delinquency.

RESULTS

Participants with a mTBI were significantly more likely to demonstrate an increase in symptoms of aggressive behavior, anxiety/depression, and delinquency while controlling for several confounders and prior levels of psychopathology.

CONCLUSIONS

Our results suggest that mTBI is an important environmental risk factor for increases in psychopathology during adolescence. Health professionals should begin to consider screening children for mTBI to better address the influence of this type of victimization experience on the emergence of symptoms for internalizing and externalizing problems during adolescence.