脑震荡后儿童和青少年心理健康问题的风险。

Risk of Mental Health Problems in Children and Youths Following Concussion.

机构信息

Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.

Department of Cellular Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada.

出版信息

JAMA Netw Open. 2022 Mar 1;5(3):e221235. doi: 10.1001/jamanetworkopen.2022.1235.

DOI:10.1001/jamanetworkopen.2022.1235

PMID:35254429

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8902648/

Abstract

IMPORTANCE

Concussion may exacerbate existing mental health issues. Little evidence exists on whether concussion is associated with the onset of new psychopathologies or long-term mental health problems.

OBJECTIVE

To investigate associations between concussion and risk of subsequent mental health issues, psychiatric hospitalizations, self-harm, or suicides.

DESIGN, SETTING, AND PARTICIPANTS: This population-based retrospective cohort study including children and youths aged 5 to 18 years with a concussion or orthopedic injury incurred between April 1, 2010, and March 31, 2020, in Ontario, Canada. Participants had no previous mental health visit in the year before the index event for cohort entry and no prior concussion or traumatic brain injury 5 years before the index visit. Data were collected from provincewide health administrative databases. Participants with concussion were included in the exposed cohort, and those with an orthopedic injury were included in the comparison cohort; these groups were matched 1:2, respectively, on age and sex.

EXPOSURES

Concussion or orthopedic injury.

MAIN OUTCOMES AND MEASURES

The primary outcome was mental health problems, such as psychopathologies and psychiatric disorders, identified from health care visits in emergency departments, hospitalizations, or primary care settings. Secondary outcomes were psychiatric hospitalizations, self-harm health care visits, and death by suicide (identified in health care or vital statistics databases).

RESULTS

A total of 152 321 children and youths with concussion (median [IQR] age, 13 [10-16] years; 86 423 [56.7%] male) and 296 482 children and youths with orthopedic injury (median [IQR] age, 13 [10-16] years; 171 563 [57.9%] male) were matched by age and sex. The incidence rates of any mental health problem were 11 141 per 100 000 person-years (exposed group) and 7960 per 100 000 person-years (unexposed group); with a difference of 3181 (95% CI, 3073-3291) per 100 000 person-years. The exposed group had an increased risk of developing a mental health issue (adjusted hazard ratio [aHR], 1.39; 95% CI, 1.37-1.40), self-harm (aHR, 1.49; 95% CI, 1.42-1.56), and psychiatric hospitalization (aHR, 1.47; 95% CI, 1.41-1.53) after a concussion. There was no statistically significant difference in death by suicide between exposed and unexposed groups (HR, 1.54; 95% CI, 0.90-2.61).

CONCLUSIONS AND RELEVANCE

Among children and youths aged 5 to 18 years, concussion was associated with an increased risk of mental health issues, psychiatric hospitalization, and self-harm compared with children and youths with an orthopedic injury.

摘要

重要性

脑震荡可能会使现有的心理健康问题恶化。几乎没有证据表明脑震荡是否与新的精神病理或长期心理健康问题的发生有关。

目的

调查脑震荡与随后出现心理健康问题、精神科住院、自残或自杀的风险之间的关联。

设计、地点和参与者：这是一项基于人群的回顾性队列研究，纳入了 2010 年 4 月 1 日至 2020 年 3 月 31 日期间安大略省 5 至 18 岁患有脑震荡或骨科损伤的儿童和青少年。在队列入组前一年，参与者没有任何先前的心理健康就诊记录，且在指数就诊前 5 年内没有先前的脑震荡或创伤性脑损伤。数据来自全省卫生行政数据库。有脑震荡的参与者被纳入暴露队列，有骨科损伤的参与者被纳入对照队列；分别按年龄和性别进行 1:2 匹配。

暴露

脑震荡或骨科损伤。

主要结果和测量

主要结局是通过急诊科、住院或初级保健机构的就诊来识别心理健康问题，如精神病理和精神障碍。次要结局是精神科住院、自残就诊和自杀死亡（在卫生或生命统计数据库中确定）。

结果

共有 152321 名患有脑震荡的儿童和青少年（中位数[IQR]年龄，13[10-16]岁；86423 名[56.7%]为男性）和 296482 名患有骨科损伤的儿童和青少年（中位数[IQR]年龄，13[10-16]岁；171563 名[57.9%]为男性）按年龄和性别进行了匹配。任何心理健康问题的发生率为每 100000 人年 11141 例（暴露组）和每 100000 人年 7960 例（未暴露组）；每 100000 人年相差 3181 例（95%CI，3073-3291）。与未暴露组相比，暴露组发生心理健康问题的风险增加（调整后的危险比[aHR]，1.39；95%CI，1.37-1.40）、自残（aHR，1.49；95%CI，1.42-1.56）和精神科住院（aHR，1.47；95%CI，1.41-1.53）。暴露组和未暴露组之间自杀死亡的差异无统计学意义（HR，1.54；95%CI，0.90-2.61）。