Depression in Children Diagnosed With Brain Injury Or Concussion

Friday, October 25, 2013
Windermere Ballroom Y (Hyatt Regency Orlando, formerly the Peabody)
Matthew C. Wylie, M.D.1, Annie Gjelsvik, Ph.D.2, James G. Linakis, Ph.D., M.D.1 and Patrick Vivier, M.D., Ph.D.3, (1)Pediatric Emergency Medicine, The Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, (2)Community Health, Brown University, Providence, RI, (3)Pediatrics, Alpert School of Medicine of Brown University, Providence, RI

Purpose: Affective disorders are an important morbidity of head injury in adults but less is known about the relationship between head injury and psychological disease in children.  We sought to identify the prevalence of brain injury and depression in U.S. children, and describe their association.  

Methods: We analysed data from parental interviews regarding 81,936 children aged 0-17 years in the National Survey of Children’s Health, 2007 (NSCH).  The data was weighted to be nationally representative.  Our analytic sample was identified using respondents to the following questions: 1) “has [subject] ever been diagnosed with brain injury or concussion?”; and 2) “has [subject] ever been diagnosed with depression?”  Candidate predictors of depression were chosen by literature review and bivariate analysis.  We used logistic regression models to describe interrelationships using STATA 12 (STATACorp, College Station, TX).  Colinearity was excluded using variance inflation factor analysis and the final model was chosen by forward stepwise selection of independent variables. 

Results: We identified 2,034 children with brain injury corresponding to a national prevalence of 1.9% in 2007.  Likewise, there were 3,112 children with diagnosed depression yielding a prevalence of 3.7%.   Compared to other participants, children with brain injury had a 4.9 fold increase in odds of diagnosed depression (CI 3.6-6.6, p<0.001).  After adjustment for age, race, ethnicity, family income and structure, maternal mental health, child health, and developmental achievement, brain injury remained a significant predictor of depression (OR 2.2, CI:1.8-2.6, p<0.001). 

Conclusion: In the largest study of the association of brain injury and depression to date, we found an overall prevalence of depression in U.S. children of 3.7%.  In children diagnosed with brain injury or concussion, the prevalence of depression was 15%.  Brain injury remains significantly associated with depression in children despite adjustment for known predictors.  This study may enable better prognostication for brain-injured children and facilitate identification of those at high risk of depression.