Division of Neurosurgery and Injury Prevention Research Office, St. Michael's Hospital, Toronto, Ontario, Canada.
Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Community Health and Epidemiology and Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
PLoS One. 2014 Apr 15;9(4):e94936. doi: 10.1371/journal.pone.0094936. eCollection 2014.
Our knowledge on the adverse correlates of traumatic brain injuries (TBI), including non-hospitalized cases, among adolescents is limited to case studies. We report lifetime TBI and adverse mental health and conduct behaviours associated with TBI among adolescents from a population-based sample in Ontario.
Data were derived from 4,685 surveys administered to adolescents in grades 7 through 12 as part of the 2011 population-based cross-sectional Ontario Student Drug Use and Health Survey (OSDUHS). Lifetime TBI was defined as head injury that resulted in being unconscious for at least 5 minutes or being retained in the hospital for at least one night, and was reported by 19.5% (95%CI:17.3,21.9) of students. When holding constant sex, grade, and complex sample design, students with TBI had significantly greater odds of reporting elevated psychological distress (AOR = 1.52), attempting suicide (AOR = 3.39), seeking counselling through a crisis help-line (AOR = 2.10), and being prescribed medication for anxiety, depression, or both (AOR = 2.45). Moreover, students with TBI had higher odds of being victimized through bullying at school (AOR = 1.70), being cyber-bullied (AOR = 2.05), and being threatened with a weapon at school (AOR = 2.90), compared with students who did not report TBI. Students with TBI also had higher odds of victimizing others and engaging in numerous violent as well as nonviolent conduct behaviours.
Significant associations between TBI and adverse internalizing and externalizing behaviours were found in this large population-based study of adolescents. Those who reported lifetime TBI were at a high risk for experiencing mental and physical health harms in the past year than peers who never had a head injury. Primary physicians should be vigilant and screen for potential mental heath and behavioural harms in adolescent patients with TBI. Efforts to prevent TBI during adolescence and intervene at an early stage may reduce injuries and comorbid problems in this age group.
我们对于创伤性脑损伤（TBI）不良后果的认识，包括非住院病例，仅限于病例研究。我们报告了安大略省基于人群样本中青少年的终生 TBI 以及与 TBI 相关的不良心理健康和行为。
数据来自于 2011 年基于人群的横断面安大略省学生毒品使用和健康调查（OSDUHS）中对 7 至 12 年级青少年进行的 4685 次调查。终生 TBI 的定义为头部受伤导致昏迷至少 5 分钟或在医院至少留院一晚，有 19.5%（95%CI：17.3，21.9）的学生报告了 TBI。在固定性别、年级和复杂样本设计的情况下，患有 TBI 的学生报告出现心理困扰（AOR=1.52）、自杀未遂（AOR=3.39）、通过危机热线寻求咨询（AOR=2.10）以及因焦虑、抑郁或两者都开处方药的可能性显著更高（AOR=2.45）。此外，与未报告 TBI 的学生相比，TBI 患者在学校遭受欺凌（AOR=1.70）、网络欺凌（AOR=2.05）和在学校受到武器威胁（AOR=2.90）的可能性更高。TBI 患者也更有可能伤害他人，并参与多种暴力和非暴力行为。
在这项针对青少年的大型基于人群的研究中，TBI 与不良的内化和外化行为之间存在显著关联。那些报告有终生 TBI 的人在过去一年中经历心理健康和身体伤害的风险比从未头部受伤的同龄人高。初级医生应保持警惕，并对 TBI 青少年患者进行潜在心理健康和行为伤害的筛查。在青少年时期预防 TBI 并及早干预可能会减少该年龄段的伤害和合并问题。
