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Traumatic Brain Injury Linked With Emotional Issues In Teens

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By Liza Baskin

Every year, more than half a million teenagers experience a serious concussion. These brain injuries often leave lasting damage, but to what extent?

A recent study found that teenagers who have had a traumatic brain injury were at a significantly increased risk of being bullied, attempting or considering suicide, having elevated psychological stress and engaging in various poor conduct behaviors such as running away from home or starting a fight at school.

The researchers believe that primary care doctors should be aware if their patients have had a traumatic brain injury and screen them for potential mental and behavioral problems.

The lead author of this study was Gabriela Ilie, PhD, from the Division of Neurosurgery and Injury Prevention Research Office at St. Michael's Hospital in Toronto, Ontario, Canada.

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The study included 4,685 public school students in 7th to 12th grade who took the Ontario Student Drug and Health Survey in 2011. The students were between 11 and 20 years old.

The researchers asked the students to report lifetime traumatic brain injury (TBI), defined as a head injury that resulted in being unconscious for at least five minutes or being hospitalized for at least one night.

Mental and emotional health was assessed through a 12-item questionnaire on depressive symptoms, anxiety and social dysfunction. Students were considered to have elevated psychological stress if they scored a 3 or higher.

The students were then asked if they had considered or attempted suicide, contacted a crisis helpline to talk to a counselor or been prescribed medication for depression, anxiety or both during the 12 months prior to the survey.

The researchers also assessed the participants' experiences of being bullied, including cyber bullying and physical and verbal bullying at school. Lastly, the researchers asked the students about their conduct behaviors in the prior 12 months.

The findings showed that 20 percent of the students reported lifetime TBI. The male students were 47 percent more likely to report TBI than the female students.

The students who experienced TBI were 52 percent more likely to have elevated psychological stress compared to the students who did not experience TBI.

The researchers found that TBI was associated with 3.39 times increased odds of attempting suicide and 1.93 times increased odds of thinking about suicide.

Compared to the students who did not have TBI, the students with TBI were 2.10 times more likely to seek out counseling from a crisis helpline and 2.45 times more likely to be prescribed medication for depression, anxiety or both.

TBI was also associated with 1.7 times increased odds of being bullied at school, 2.05 times increased odds of being cyber bullied and 2.9 times increased odds of being threatened with a weapon at school.

The students with TBI were more than twice as likely to engage in poor conduct behaviors, such as taking someone's car without permission, stealing more than $50, setting fire to something, running away from home, breaking into a locked building, hurting someone on purpose, carrying a weapon or starting a fight at school, compared to the students who did not have TBI.

"These results show that preventable brain injuries and mental health and behavioral problems among teens continue to remain a blind spot in our culture," Dr. Ilie said in a press statement. "These kids are falling through the cracks."

This study had a few limitations. First, data was self-reported. Second, the study did not include students who had been institutionalized, so the associations may be underestimated. Third, the researchers did not know if events occurred after TBI as coping mechanisms or as predisposed factors relating to TBI.

This study was published on April 15 in PLoS Medicine.