Anxiety and depression are higher in children with brain injuries, study shows

A new study, published today jama network opn, shows that school-age children and adolescents with clinically diagnosed traumatic brain injury (TBI) have significantly higher rates of anxiety/depression, and that strong family support and resiliency helps mitigate some of this.

Researchers from the Center for Injury Research and Policy at Nationwide Children’s Hospital, Ohio State University, and the Abigail Wexner Research Institute at the University of Washington analyzed the associations between clinically diagnosed TBI and mental (anxiety and depression) and physical (persistent headaches and chronic pain) health outcomes among U.S. children and adolescents aged 6–17 years, and assessed whether these associations varied according to the level of family resiliency. They found that children and adolescents with TBI had a higher prevalence of poor health than children without TBI, as well as an increased likelihood of current anxiety, frequent headaches, and chronic pain.

Our study shows that the impact of traumatic brain injury in children often goes far beyond the initial injury. “Children who experience TBI are at increased risk for mental health challenges such as anxiety and depression, which highlights the importance of regular mental health screenings and long-term follow-up care.”

Henry Jiang, MD, MPH, PhD, MBA, principal investigator at the Center for Injury Research and Policy and senior author of the study

The study also found that family resiliency was associated with lower odds of depression after TBI. Family resilience describes how families respond to stress, communicate effectively, and mobilize collective strength when faced with crises or major family events. “One of the most encouraging findings from our research is that family resiliency plays an important role in TBI patient recovery,” Jiang said. “Children recovering from traumatic brain injury who grow up in supportive families may have a reduced risk of long-term mental health problems. Strengthening family support systems and resilience may be an important path to improving long-term outcomes for TBI patients.”

These findings underscore the importance of strategies that families can use to build resiliency during recovery.

“Recovery after brain injury in children is about much more than the child itself – recovery occurs in many contexts with many people, with the home and primary caregivers being the most important,” said Christine Kotarba, PhD, ABPP, a pediatric neuropsychologist at Nationwide Children’s, who was not involved in the study. “I see how recovery actually happens outside the brain, in an environment where children spend their time among the stable caregivers in their lives. This study opens the door to future research focused on the resiliency of caregivers.”

This cross-sectional study used data from the 2022 and 2023 National Survey of Children’s Health (NSCH), a nationally representative, cross-sectional survey conducted by the U.S. Census Bureau and sponsored by the Health Resources and Services Administration Maternal and Child Health Bureau. The NSCH collects caregiver-reported data on the health and well-being, health care access, family environment, and social determinants of health of children and adolescents ages 0 to 17 years in all 50 states and the District of Columbia.