Am J Psychiatry. 2014 Apr;171(4):463-9. doi: 10.1176/appi.ajp.2013.13020190.
Studies investigating the relationship between head injury and subsequent psychiatric disorders often suffer from methodological weaknesses and show conflicting results. The authors investigated the incidence of severe psychiatric disorders following hospital contact for head injury.
The authors used linkable Danish nationwide population-based registers to investigate the incidence of schizophrenia spectrum disorders, unipolar depression, bipolar disorder, and organic mental disorders in 113,906 persons who had suffered head injuries. Data were analyzed by survival analysis and adjusted for gender, age, calendar year, presence of a psychiatric family history, epilepsy, infections, autoimmune diseases, and fractures not involving the skull or spine.
Head injury was associated with a higher risk of schizophrenia (incidence rate ratio [IRR]=1.65, 95% CI=1.55-1.75), depression (IRR=1.59 95% CI=1.53-1.65), bipolar disorder (IRR=1.28, 95% CI=1.10-1.48), and organic mental disorders (IRR=4.39, 95% CI=3.86-4.99). This effect was larger than that of fractures not involving the skull or spine for schizophrenia, depression, and organic mental disorders, which suggests that the results were not merely due to accident proneness. Head injury between ages 11 and 15 years was the strongest predictor for subsequent development of schizophrenia, depression, and bipolar disorder. The added risk of mental illness following head injury did not differ between individuals with and without a psychiatric family history.
This is the largest study to date investigating head injury and subsequent mental illness. The authors demonstrated an increase in risk for all psychiatric outcomes after head injury. The effect did not seem to be solely due to accident proneness, and the added risk was not more pronounced in persons with a psychiatric family history.
研究头部损伤与随后发生的精神障碍之间关系的研究往往存在方法学上的弱点，并得出相互矛盾的结果。作者调查了因头部损伤而住院后严重精神障碍的发生率。
作者使用可链接的丹麦全国基于人群的登记处，调查了 113906 名头部损伤患者发生精神分裂症谱系障碍、单相抑郁、双相障碍和器质性精神障碍的发病率。通过生存分析进行数据分析，并调整了性别、年龄、日历年份、是否存在精神科家族史、癫痫、感染、自身免疫性疾病以及不涉及颅骨或脊柱的骨折等因素。
头部损伤与精神分裂症（发病率比 [IRR] = 1.65，95%CI = 1.55-1.75）、抑郁（IRR = 1.59，95%CI = 1.53-1.65）、双相障碍（IRR = 1.28，95%CI = 1.10-1.48）和器质性精神障碍（IRR = 4.39，95%CI = 3.86-4.99）的风险增加相关。这一效应大于颅骨或脊柱无骨折的精神分裂症、抑郁和器质性精神障碍，这表明结果不仅仅是由于易发生事故。11 至 15 岁之间的头部损伤是随后发生精神分裂症、抑郁和双相障碍的最强预测因素。头部损伤后发生精神疾病的风险增加在有无精神科家族史的个体之间没有差异。
这是迄今为止最大的研究头部损伤与随后发生的精神疾病的研究。作者证明了头部损伤后所有精神障碍的风险增加。这种影响似乎不仅仅是由于易发生事故，而且在有精神科家族史的个体中，风险增加并不明显。
