Children who sustained traumatic brain injuries may experience psychological effects like anxiety, phobias and depression more than a decade later, researchers say. "The study suggests that brain injury is in some way related to longer-term anxiety symptoms, while previously it was thought that brain injury only leads to short-term effects," said lead author Michelle Albicini in an email.
The anxiety may have many causes, including actual brain damage or the experience of living in an anxious family environment after the injury, said Albicini, a researcher at Monash University School of Psychological Sciences in Melbourne, Australia. Albicini's team reports in the Journal of Head Trauma Rehabilitation that children with moderately severe brain injuries and females in general were at the greatest risk for long-term psychological effects compared with boys and children who had milder brain injuries.
Traumatic brain injury (TBI) occurs when an outside force, usually a blow to the head, causes some kind of brain dysfunction, such as loss of consciousness, amnesia or damage to brain tissue that's visible on a scan. But more research is needed to fully understand the long-term psychological effects faced by people who experience TBIs during childhood, the researchers write.
To explore the question they recruited young adults who had been treated at a New Zealand hospital for a traumatic brain injury five or more years earlier, when they were younger than 18 years old. For comparison, the researchers also recruited a similar group of young adults who were treated for childhood orthopedic injuries like broken arms or legs but had no history of brain injury.
Among the participants with childhood brain injury, 65 had mild injuries involving loss of consciousness for less than 20 minutes, little or no amnesia, a hospital stay of less than 48 hours and normal brain scans. Another 61 participants had moderate to severe brain injuries involving longer hospital stays, more severe or longer lasting symptoms and skull fractures or other physical evidence of brain injury that could be seen on a scan.
The average age at injury for those with mild TBI and those with orthopedic injuries was around 10-11 years old, while the participants with more severe TBIs were younger, around 7 years old on average, when they were injured. For most in the study group, it had been at least 10 years since their injury and for some, 15 or more years had passed.
Each person met with a psychologist for diagnostic interviews to screen for various psychological disorders including generalized anxiety disorder, panic attacks, phobias and depression.
This revealed that compared to people with no brain injuries, those with any type of TBI were five times more likely to have an anxiety disorder. People with past brain injuries were also about four times more likely to suffer from panic attacks, specific phobias and depression. Those with moderate-severe brain injuries had the highest overall rates of anxiety disorders and were most likely to suffer from multiple anxiety disorders at once.
However, women were four times more likely than men to have an anxiety disorder, regardless of whether they had a brain injury, the authors note.
"These results emphasize the need to monitor children and adolescents for the development of anxiety disorders after they have a TBI," said Dr Jeffrey Max, a psychiatry professor at the University of California, San Diego, who wasn't involved in the study. It is important to keep in mind, however, that the research did not look at the patients' anxiety before their injury, making it difficult to determine if the anxiety was a complication of the injury, Max said.
"If TBI really causes an increased risk for anxiety disorder then research on this topic could help us understand the brain mechanisms and psychological mechanisms behind the development of anxiety disorders," Max said. "While in most cases people recover 100 percent from brain injury, a select few may go on to experience anxiety, depression, or other ongoing psychological effects," Albicini said. "More work needs to be done to help identify the risk factors for those people, and then how we can help them, to lessen the burden of brain injury,"
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