O3287: Mental and Behavioral Health Diagnosis Trends in Adolescents 12 Months after Mild Traumatic Brain Injury and Associations with Sex and Race

Background: Mental and behavioral health (MBH) diagnoses continue to rise among adolescents, yet the impact of mild traumatic brain injury (mTBI) on the likelihood of developing these conditions post-injury remains uncertain. Thus, our objective was to assess the prevalence of MBH diagnoses in adolescents 12 months after mTBI compared to typically developing (TD) controls. Secondarily, we examined these trends in context of sex and race.

Methods: This retrospective case-control study used electronic health record data collected between 2010 and 2022 from a large tertiary care hospital system. Adolescents aged 11-17 were identified using ICD10CM codes for mTBI (cases) or non-mTBI conditions (TD controls) and had at least one additional visit over the following 12 months after the initial visit. Case-control matching was performed to account for sex, race, ethnicity, and age of visit. MBH diagnoses were categorized into standardized diagnostic groupings. Category frequencies were calculated, and comparative statistics were used to evaluate group differences and odd ratios (OR) associated with sex and race.

Results: A total of 12,856 adolescents with mTBI (Mage=13.0; SD=1.7) and 51,424 TD adolescents (Mage=13.4, SD=1.9) were identified. In both groups, 46% of adolescents identified as female, 77% identified as White, 17% as Black, 3% as multiracial, 2% as other, < 1% as Asian, and < 1% were unknown. Within twelve months of the first visit, frequencies of MBH diagnoses varied significantly (p < 0.01) between mTBI and TD controls for ADHD, trauma/stress disorders, anxiety, depression, and conduct/impulse disorders (Fig 1). Among adolescents with mTBI (Table 1), males had reduced odds compared to females for experiencing anxiety, depression, eating disorders, suicidality, and trauma/stress disorders post-mTBI, yet showed increased odds for ADHD, conduct/impulse disorders, and substance abuse. No significant differences were observed between sex and the odds of developing bipolar disorder, mood disorders, obsessive compulsive disorder (OCD), and personality disorders post-mTBI. Among racial groups, Black patients displayed decreased odds compared to White patients for developing post-mTBI anxiety, eating disorders, and OCD, while having increased odds for conduct/impulse disorders and trauma/stress disorder post-mTBI. There was no significant difference between the odds of Black versus White patients developing ADHD, bipolar disorder, depression, mood disorders, personality disorders, substance abuse, or suicidality post-mTBI.

Conclusion: After mTBI, adolescents are more likely to be diagnosed with certain MBH disorders including ADHD, trauma/stress disorders, anxiety, depression, and conduct/impulse disorders within one-year post-injury compared to normal peers. Moreover, the disparities in diagnosis trends observed across sex and race may imply systemic inequities. These findings highlight the critical need to closely monitor and implement timely interventions that can improve mental health outcomes in adolescents post-mTBI.