Novel Psychiatric Disorders Following Mild Traumatic Brain Injury (mTBI): A Retrospective Multivariable Analysis with Screening Recommendations

Introduction: Concussions are a form of mild traumatic brain injury (mTBI) that most commonly occur following blunt trauma to the head and may result in a temporary loss of consciousness. The purpose of this study was twofold: 1) to evaluate how patient demographics impact the development of novel psychiatric disorders (NPDs) following mTBI, and 2) to develop screening recommendations to identify patients with NPDs.

Methods: We used the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmissions Database (NRD) from the years 2010-2019. Patients who were readmitted within one calendar year after being admitted initially for mTBI in 2010-2019 were identified (n=206,070). Multivariable binomial regression analysis was performed to determine the relationship between patient demographics and the development of NPDs following mTBI. Diagnostic trends for NPDs were investigated using density plots.

Results: Overall, an additional 818 (0.40%) patients were reported to have novel suicidal ideation (SI), 3,866 (1.9%) patients were reported to have novel depression, 3,449 (1.7%) patients were reported to have novel anxiety, and 88 (0.043%) were reported to have novel homicidal ideation (HI) following mTBI. Lower age (OR:0.9775;95%CI:0.9805-0.9848;p < 0.0001) and reduced CCI (OR:0.9155;95%CI:0.8539-0.9774;p=0.010) may predict novel SI, and female sex (OR:0.7464;95%CI:0.6026-0.9214;p=0.0069) may be inversely related to novel SI after mTBI. Female sex (OR:1.1774;95%CI:1.0654-1.3016;p=0.0014) and Medicare/Medicaid insurance types (OR:0.9381;95%CI:0.8983-0.9797;p=0.0039) may predict novel anxiety following mTBI. Lower age (OR:0.9956;95%CI:0.9923-0.9989;p=0.0096), higher CCI (OR:1.0363;95%CI:1.0099-1.0629;p=0.0062), and Medicare/Medicaid insurance types (OR:0.9386;95%CI:0.8998-0.9789;p=0.0032) may predict novel depression. Female sex (OR:0.3271;95%CI:0.1467-0.6567;p=0.0031) and increased median income (OR:0.8829;95%CI:0.7930-0.9944;p=0.049) were inversely proportional with novel HI following mTBI. The median time-to-diagnosis of NPDs were 69.5±81.2 days for depression, 66.5±57.8 days for anxiety, 70.0±80.3 days for SI, and 66.5±57.8 days for HI.

Conclusion : Numerous patient demographic factors are significant predictors of developing NPDs following mTBI and concussion. Screening for NPDs within 3 months after mTBI may identify most patients at-risk for developing novel post-concussive psychiatric conditions.