Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Turner Institute for Brain and Mental Health, Monash University, School of Psychological Sciences, Melbourne, Victoria, Australia.
J Neurotrauma. 2024 Jul;41(13-14):e1639-e1648. doi: 10.1089/neu.2023.0116. Epub 2024 May 9.
Children often experience mental health difficulties after a concussion. Yet, the extent to which a concussion precipitates or exacerbates mental health difficulties remains unclear. This study aimed to examine psychological predictors of mental health difficulties after pediatric concussion. Children (5 to <18 years of age, = 11.7, = 3.3) with concussion were recruited in a single-site longitudinal prospective cohort study conducted at a tertiary children's hospital ( = 115, 73.9% male). The primary outcomes included internalizing (anxious, depressed, withdrawn behaviors), externalizing (risk-taking, aggression, attention difficulties), and total mental health problems, as measured by the Child Behavior Checklist at 2 weeks (acute) and 3 months (post-acute) after concussion. Predictors included parents' retrospective reports of premorbid concussive symptoms (Post-Concussion Symptom Inventory; PCSI), the child and their family's psychiatric history, child-rated perfectionism (Adaptive-Maladaptive Perfectionism Scale), and child-rated resilience (Youth Resilience Measure). Higher premorbid PCSI ratings consistently predicted acute and post-acute mental health difficulties. This relationship was significantly moderated by child psychiatric history. Furthermore, pre-injury learning difficulties, child psychiatric diagnoses, family psychiatric history, lower resilience, previous concussions, female sex, and older age at injury were associated with greater mental health difficulties after concussion. Pre-injury factors accounted for 23.4-39.9% of acute mental health outcomes, and 32.3-37.8% of post-acute mental health outcomes. When acute mental health was factored into the model, a total of 47.0-68.8% of variance was explained by the model. Overall, in this sample of children, several pre-injury demographic and psychological factors were observed to predict mental health difficulties after a concussion. These findings need to be validated in future research involving larger, multi-site studies that include a broader cohort of children after concussion.
儿童在脑震荡后常常会出现心理健康问题。然而，脑震荡是否会引发或加重心理健康问题仍不清楚。本研究旨在探讨儿童脑震荡后心理健康问题的心理预测因素。在一家三级儿童医院进行的单站点前瞻性队列研究中招募了患有脑震荡的儿童（5 岁至<18 岁，n=115，73.9%为男性）。主要结局包括内部问题（焦虑、抑郁、退缩行为）、外部问题（冒险、攻击、注意力困难）和总心理健康问题，采用儿童行为检查表在脑震荡后 2 周（急性期）和 3 个月（亚急性期）进行评估。预测因素包括父母对先前脑震荡症状的回顾性报告（Post-Concussion Symptom Inventory，PCSI）、儿童及其家庭的精神病史、儿童自评完美主义（Adaptive-Maladaptive Perfectionism Scale）和儿童自评韧性（Youth Resilience Measure）。较高的前震性 PCSI 评分始终预测急性和亚急性心理健康问题。这种关系受到儿童精神病史的显著调节。此外，受伤前的学习困难、儿童精神科诊断、家庭精神病史、较低的韧性、先前的脑震荡、女性性别和受伤时年龄较大与脑震荡后更大的心理健康问题相关。受伤前的因素占急性心理健康结果的 23.4-39.9%，亚急性心理健康结果的 32.3-37.8%。当将急性心理健康纳入模型时，该模型共解释了 47.0-68.8%的方差。总体而言，在本研究的儿童样本中，观察到几个受伤前的人口统计学和心理因素可预测脑震荡后的心理健康问题。这些发现需要在未来的研究中得到验证，该研究涉及更大的、多站点的研究，包括更广泛的脑震荡后儿童队列。
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