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Traumatic brain injury associated with long-term psychosocial outcomes

August 23, 2016

Traumatic brain injury (TBI) during youth is associated with elevated risks of impaired adult functioning, according to a longitudinal study published in PLOS Medicine. The study, conducted by Seena Fazel of the University of Oxford, United Kingdom, and colleagues, demonstrates that children and adolescents experiencing even milder forms of TBI (including concussion) may have reduced longevity and significant psychosocial problems in adulthood.

TBI constitutes the leading cause of morbidity and mortality in individuals under the age of 45 y globally. However, research on the long-term health of people with TBI has commonly addressed more severe injuries and medical diagnoses. To uncover broader risks associated with TBI, Fazel and colleagues compared premature mortality and long-term psychosocial outcomes between the roughly 100,000 people born in Sweden between 1973 and 1985 who sustained at least one TBI before age 25 y, and their unaffected siblings, who were followed up until age 41. The researchers found that TBI consistently predicted later risk of premature mortality (adjusted relative risk 1.40 [95% confidence interval 1.16; 1.68]), psychiatric inpatient admission (1.57 [1.47; 1.67]), psychiatric outpatient visits (1.31 [1.26; 1.37]), disability pension (1.49 [1.38; 1.60]), welfare recipiency (1.19 [1.14; 1.23]), and low educational attainment (1.28 [1.23; 1.33]) in the sibling-comparison analyses, and the effects were stronger for those with greater injury severity, recurrence, and older age at first injury.

The datasets used may include some misclassification, and despite the sibling-comparison design the associations may be confounded by shared factors other than TBI. Nonetheless, Fazel and colleagues' estimates are likely conservative and suggest that the public health benefits of preventing TBI include longevity and psychosocial outcomes. The authors state, "[s]ervices should consider how to routinely and systematically review these children [with TBI] on a regular basis to allow the subtle but important neurological, cognitive, and psychiatric consequences of TBI to be identified." In an accompanying Perspective, Donald Redelmeier and Sheharyar Raza discuss the study design, limitations, and theories for the mechanism by which TBI could cause adverse long-term psychosocial consequences.
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Research Article

Funding:

The study was supported by the Wellcome Trust (095806), the Swedish Council for Working Life and Social Research, the Swedish Research Council (2010-3184; 2011-2492; 2013-5867), and the National Institute of Child Health and Human Development (HD061817). DJS is supported by a National Institute for Health Research (NIHR) Professorship (NIHR-RP-011-048). HL has served as a speaker for Eli-Lilly and Shire and has received a research grant from Shire; all outside the submitted work. BMD is receiving funding from the American Foundation for Suicide Prevention and the Indiana Clinical and Translational Sciences Institute, both outside of the submitted work. The funders were not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript.

Competing Interests:

HL has served as a speaker for Eli-Lilly and Shire and has received a research grant from Shire; all outside the submitted work. BMD is receiving funding from the American Foundation for Suicide Prevention and the Indiana Clinical and Translational Sciences Institute, both outside of the submitted work. The remaining authors report no financial or any other conflicts of interest.

Citation:

Sariaslan A, Sharp DJ, D'Onofrio BM, Larsson H, Fazel S (2016) Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes. PLoS Med 13(8): e1002103. doi:10.1371/journal.pmed.1002103

Author Affiliations:

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College, London, United Kingdom
Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, United States of America
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
School of Medical Sciences, Örebro University, Örebro, Sweden

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002103

Contact:

Seena Fazel
University of Oxford
Department of Psychiatry
Warneford Hospital
Oxford, Oxfordshire OX3 7JX
UNITED KINGDOM
seena.fazel@psych.ox.ac.uk

Perspective Article

Funding:

This article was supported by a Canada Research Chair in Medical Decision Sciences, the Canadian Institutes of Health Research, and the Comprehensive Research Experience for Medical Students at the University of Toronto. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

DR is a member of the Editorial Board of PLOS Medicine.

Citation:

Redelmeier DA, Raza S (2016) Concussions and Repercussions. PLoS Med 13(8): e1002104. doi:10.1371/journal.pmed.1002104

Author Affiliations:

Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Center for Leading Injury Prevention Practice Education & Research Toronto, Ontario, Canada

IN YOUR COVERAGE PLEASE USE THIS URL TO PROVIDE ACCESS TO THE FREELY AVAILABLE PAPER: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1002104

PLOS

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