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Concussions increase the risk of depression in teens

Researchers at the Seattle Children’s Hospital and the Department of Pediatrics at the University of Washington, Seattle, have found that teenagers with a history of concussions are more likely to be diagnosed with depression than other teens who never suffered that type of traumatic brain injury. Their study is published in the Journal of Adolescent Health here (in press, available online Dec 16, 2013).

Pediatricians Sara Chrisman, MD, MPH, and Laura P Richardson, MD, MPH, looked at about 36,000 teens without a current concussion, ages 12 to 17 years, from the 2007-2008 National Survey of Children’s Health, a nationally representative survey conducted via random digit dialing. The survey relies on parents to report their children’s health status on several parameters, including concussion and diagnoses of depression.

“Even when controlling for age, sex, parental mental health, and socioeconomic status, history of concussion was associated with a 3.3-fold greater risk for depression diagnosis,” the study said.

Teens living below 200 percent of the poverty line suffered from depression about one and a half times more frequently than their wealthier counterparts, but the teenagers’ sex was not associated with any differences in the risk of depression. Poor or fair parental mental health, on the other hand, was correlated with a greater risk of depression, based on the large sample surveyed.

Other doctors have come to slightly different conclusions. For example, Jeffrey Max, MD, a psychiatrist who specializes in psychiatric outcomes of traumatic brain injury in children and adolescents at the University of California, San Diego, said children who have a history of concussion are more likely to develop attention-deficit/hyperactivity disorder and have difficulties controlling their moods, especially anger, rather than experience depression, the Health Behavior News Service, part of the Center for Advancing Health, reported.

The study repeats earlier independent work

By press release, from the American Academy of Pediatrics:

(Oct 25, 2013) — Adults with head injuries are known to be at high risk for depression, and yet little research had been done on the topic related to children. In the abstract, “Depression in Children Diagnosed with Brain Injury or Concussion,” presented Oct 25 at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Orlando, researchers sought to identify the prevalence of depression in children with brain injuries, including concussions, in the US.

Using data from the 2007 National Survey of Children’s Health, researchers identified more than 2,000 children with brain injuries, reflecting the national child brain injury rate of 1.9 percent in 2007; and 3,112 children with diagnosed depression, mirroring the 3.7-percent national child depression rate that year. Compared to other children, 15 percent of those with brain injuries or concussions were diagnosed as depressed—a 4.9-fold increase in the odds of diagnosed depression.

“After adjustment for known predictors of depression in children like family structure, developmental delay, and poor physical health, depression remained two times more likely in children with brain injury or concussion,” said study author Matthew C Wylie, MD, author of the abstract.

The study, the largest to look at an association between brain injury and depression in children and adolescents, “may enable better prognostication for brain-injured children and facilitate identification of those at high risk of depression,” Dr Wylie said.

What this means

Whether it’s 3.3 times or 4.9 times more likely that kids who have a history of concussions will suffer from depression isn’t really a discrepancy—or the point of us writing this article. The take-home lesson here is that “clinicians should screen for depression in their adolescent patients with concussion,” the Chrisman study concluded.

In addition, teachers and counselors may find this information useful and should be on an increased lookout for signs and symptoms of depression in their students who have suffered traumatic brain injury, since one seems to be associated with the other.

Note: This research has been accepted for publication in a peer-reviewed journal, but it is not intended to offer any medical advice.

Paul Katula is the executive editor of the Voxitatis Research Foundation, which publishes this blog. For more information, see the About page.

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