précis

• Children with brain injury, including concussions, are twice as likely to have depression as children without brain injury, according to a new study.

• This shouldn’t be surprising, as there is a proven association between brain injury and depression in adults.

• However, it is not clear whether the relationship is a causal one, since full details aren’t available in only an abstract.

• The data came from the National Survey of Children’s Health.

Children with brain injuries may be twice as likely to suffer from depression, say researchers of a new study who sought to identify the prevalence of depression in children with brain injuries, including concussions, in the United States, and describe their association. They presented the findings in a poster on October 25 at the American Academy of Pediatrics (AAP) National Conference and Exhibition in Orlando, Florida.

Of the preliminary results, researchers said they are currently working on a manuscript for submission to a peer-reviewed journal later this month. According to the abstract, “Depression in Children Diagnosed with Brain Injury or Concussion,” 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.

Researchers analyzed data from parental interviews regarding 81,936 children ages 0–17 in the National Survey of Children’s Health (NSCH). The data was weighted to be nationally representative. The analytic sample was identified using responses 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, according to the abstract.

Researchers identified more than 2,034 children with brain injuries, 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%. In children diagnosed with brain injury or concussion, the prevalence of depression was 15%.

Compared to other participants, children with brain injuries had a nearly fivefold increase in odds of diagnosed depression. After an 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.

‘No surprises’

“Given the robust association between brain injury and depression in adults, it was not too much of a surprise that an association existed in children,” said Matthew C. Wylie, M.D., affiliated with pediatric emergency medicine at the Alpert Medical School of Brown University in Providence, R.I., and lead author of the study.

Researchers said they are not sure why there hasn’t been more research on the link between head injuries and affective disease. “One reason is that the NSCH hasn’t always been around,” Wylie said. “I think the first was in 2003 and the scope of it has grown over the last few years to contain questions about brain injury in research, and this has spurred investigation of the consequences of childhood brain injury. We have conducted a similar study in a more recent iteration of NSCH and we’re currently seeking to publish this work.”

More details needed

“The details of the research need to be fleshed out in a full publication,” said Keith Yeates, Ph.D., professor of pediatrics at Ohio State University and chief of psychiatry and neuropsychiatry at Nationwide Children’s Hospital in Columbus, who was not involved in the study. Yeates acknowledged some reluctance to comment when only an abstract of the research is available. “With the kind of research they are doing, it doesn’t prove that there is a causal relationship between the two outcomes — brain injury and depression,” he said. Given the research and design of the study, it’s [not certain] whether the depression didn’t preexist before the injury,” he noted.

Yeates said that with adults, studies have revealed an increased risk for depression following a traumatic brain injury (TBI). The new study doesn’t suggest that clinical depression is as much of a risk in children as it is in adults, he said. “It’s worth stressing that while the risk [for depression] is elevated in the vast majority of brain injuries, children don’t end up with clinical depression,” said Yeates. “The same holds true for adults.” Yeates added, “The literature would support that high percentages of people with TBI end up with depression, but I don’t think that research would suggest that for the majority of adults.”

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For the poster abstract, go to https://aap.confex.com/aap/2013/webprogram/Paper22515.html