Traumatic brain injury associated with long-term psychosocial outcomes

TBI constitutes the leading cause of morbidity and mortality in individuals under the age of 45 y globally. However, research on the long-term health of people with TBI has commonly addressed more severe injuries and medical diagnoses. To uncover broader risks associated with TBI, Fazel and colleagues compared premature mortality and long-term psychosocial outcomes between the roughly 100,000 people born in Sweden between 1973 and 1985 who sustained at least one TBI before age 25 y, and their unaffected siblings, who were followed up until age 41. The researchers found that TBI consistently predicted later risk of premature mortality (adjusted relative risk 1.40 [95% confidence interval 1.16; 1.68]), psychiatric inpatient admission (1.57 [1.47; 1.67]), psychiatric outpatient visits (1.31 [1.26; 1.37]), disability pension (1.49 [1.38; 1.60]), welfare recipiency (1.19 [1.14; 1.23]), and low educational attainment (1.28 [1.23; 1.33]) in the sibling-comparison analyses, and the effects were stronger for those with greater injury severity, recurrence, and older age at first injury.

The datasets used may include some misclassification, and despite the sibling-comparison design the associations may be confounded by shared factors other than TBI. Nonetheless, Fazel and colleagues' estimates are likely conservative and suggest that the public health benefits of preventing TBI include longevity and psychosocial outcomes. The authors state, "[s]ervices should consider how to routinely and systematically review these children [with TBI] on a regular basis to allow the subtle but important neurological, cognitive, and psychiatric consequences of TBI to be identified." In an accompanying Perspective, Donald Redelmeier and Sheharyar Raza discuss the study design, limitations, and theories for the mechanism by which TBI could cause adverse long-term psychosocial consequences.