TABLE 3.
Incidence and Adjusted Riska of Affective Disorders During 4 Years After mTBI Versus Comparisons
| Psychiatric Diagnoses % (n) | Study Groups | Overall | 0–12 mo | 13–24 mo | 25–36 mo | 37–48 mo |
|---|---|---|---|---|---|---|
| Any affective disorder | Comparisons | 16.9% (5656) | 5.3% (1780) | 4.3% (1370) | 4.2% (1281) | 4.2% (1225) |
| mTBI | 20.1% (3553) | 6.6% (1141) | 5.8% (936) | 5.1% (783) | 4.8% (693) | |
| P | <.0001b | <.0001b | <.0001b | <.0001b | .0098 | |
| RR (95% CI) | 1.25 (1.19–1.31) | 1.23 (1.14–1.33) | 1.34 (1.23–1.46) | 1.22 (1.11–1.33)b | 1.13 (1.03–1.25) | |
| 0–5 y old | Comparisons | 4.3% (187) | 0.6% (27) | 0.9% (38) | 1.6% (67) | 1.3% (55) |
| mTBI | 5.5% (118) | 0.8% (18) | 1.4% (29) | 1.2% (26) | 2.2% (45) | |
| P | .0393 | .3167 | .1075 | .2999 | .0093 | |
| RR (95% CI) | 1.28 (1.01–1.63) | 1.36 (0.74–2.47) | 1.50 (0.92–2.45) | 0.78 (0.50–1.24) | 1.70 (1.14–2.53) | |
| 6–9 y old | Comparisons | 12.6% (563) | 3.6% (162) | 3.3% (143) | 3.0% (125) | 3.3% (133) |
| mTBI | 14.0% (321) | 4.3% (99) | 3.3% (73) | 4.1% (86) | 3.1% (63) | |
| P | .1116 | .1722 | .9983 | .0309 | .7051 | |
| RR (95% CI) | 1.13 (0.97–1.31) | 1.19 (0.92–1.54) | 1.00 (0.75–1.33) | 1.36 (1.03–1.80) | 0.94 (0.69–1.28) | |
| 10–13 y old | Comparisons | 18.8% (1746) | 5.2% (485) | 4.7% (410) | 5.0% (421) | 5.4% (430) |
| mTBI | 23.6% (1137) | 6.7% (325) | 6.7% (300) | 6.5% (274) | 6.1% (238) | |
| P | <.0001b | .0002b | <.0001b | .0003b | .1017 | |
| RR (95% CI) | 1.34 (1.23–1.46) | 1.31 (1.14–1.52) | 1.48 (1.27–1.72) | 1.34 (1.14–1.57b | 1.15 (0.97–1.35) | |
| 14–17 y old | Comparisons | 20.7% (3160) | 7.2% (1106) | 5.5% (779) | 5.0% (668) | 4.8% (607) |
| mTBI | 24.3% (1977) | 8.6% (699) | 7.2% (534) | 5.7% (397) | 5.3% (347) | |
| P | <.0001b | .0004b | <.0001b | .0253 | .1052 | |
| RR (95% CI) | 1.23 (1.15–1.31b | 1.20 (1.08–1.32) | 1.32 (1.18–1.48) | 1.16 (1.02–1.32) | 1.12 (0.98–1.28) | |
| Depressive disorders | Comparisons | 9.7% (3450) | 2.9% (1031) | 2.5% (851) | 2.3% (781) | 2.4% (787) |
| mTBI | 11.3% (2053) | 3.4% (624) | 3.0% (533) | 2.7% (459) | 2.6% (437) | |
| P | <.0001b | .0027b | .0004b | .0145 | .1349 | |
| RR (95% CI) | 1.17 (1.10–1.24) | 1.17 (1.06–1.29) | 1.22 (1.09–1.36) | 1.16 (1.03–1.30) | 1.09 (0.97–1.23) | |
| 0–5 y old | Comparisons | 4.3% (187) | 0.6% (27) | 0.9% (38) | 1.6% (67) | 1.3% (55) |
| mTBI | 5.5% (118) | 0.8% (18) | 1.4% (29) | 1.2% (26) | 2.2% (45) | |
| P | .6936 | .3933 | .8237 | .3200 | .0835 | |
| RR (95% CI) | 1.15 (0.57–2.35) | 0.39 (0.05–3.36) | 0.83 (0.16–4.29) | 1.60 (0.63–4.07) | 1.25 (0.97–1.60) | |
| 6–9 y old | Comparisons | 12.6% (563) | 3.6% (162) | 3.3% (143) | 3.0% (125) | 3.3% (133) |
| mTBI | 14.0% (321) | 4.3% (99) | 3.3% (73) | 4.1% (86) | 3.1% (63) | |
| P | .0835 | .6015 | .7480 | .0937 | .3760 | |
| RR (95% CI) | 1.25 (0.97–1.60) | 1.16 (0.66–2.02) | 1.09 (0.64–1.86) | 1.51 (0.93–2.46) | 1.21 (0.79–1.85) | |
| 10–13 y old | Comparisons | 18.8% (1746) | 5.2% (485) | 4.7% (410) | 5.0% (421) | 5.4% (430) |
| mTBI | 23.6% (1137) | 6.7% (325) | 6.7% (300) | 6.5% (274) | 6.1% (238) | |
| P | <.0001b | .0004b | .0002b | .0353 | .2466 | |
| RR (95% CI) | 1.30 (1.18–1.44) | 1.43 (1.17–1.74) | 1.44 (1.19–1.75) | 1.22 (1.01–1.48) | 1.12 (0.93–1.35) | |
| 14–17 y old | Comparisons | 20.7% (3160) | 7.2% (1106) | 5.5% (779) | 5.0% (668) | 4.8% (607) |
| mTBI | 24.3% (1977) | 8.6% (699) | 7.2% (534) | 5.7% (397) | 5.3% (347) | |
| P | .0182 | .2007 | .0750 | .3071 | .5823 | |
| RR (95% CI) | 1.10 (1.01–1.18) | 0.108 (0.96–1.22) | 1.13 (0.99–1.30) | 1.09 (0.93–1.27) | 1.05 (0.88–1.24) | |
| Anxiety disorders | Comparisons | 11.8% (4182) | 3.4% (1216) | 2.9% (981) | 3.0% (990) | 3.1% (995) |
| mTBI | 13.2% (2392) | 3.8% (681) | 3.5% (601) | 3.3% (555) | 3.4% (555) | |
| P | <.0001b | .0589 | .0003b | .0430 | .0450 | |
| RR (95% CI) | 1.14 (1.08–1.20 | 1.10 (1.00–1.21) | 1.21 (1.09–1.34)b | 1.11 (1.00–1.24) | 1.11 (1.00–1.24) | |
| 0–5 y old | Comparisons | 2.8% (119) | 0.4% (19) | 0.7% (28) | 0.8% (35) | 0.9% (37) |
| mTBI | 3.3% (72) | 0.5% (10) | 0.8% (18) | 1.0% (21) | 1.1% (23) | |
| P | .2033 | .8584 | .5169 | .4797 | .3703 | |
| RR (95% CI) | 1.21 (0.90–1.64) | 1.07 (0.50–2.31) | 1.22 (0.67–2.24) | 1.22 (0.71–2.10) | 1.27 (0.75–2.14) | |
| 6–9 y old | Comparisons | 8.0% (371) | 2.2% (102) | 2.4% (107) | 1.9% (86) | 1.8% (76) |
| mTBI | 9.1% (213) | 2.9% (69) | 2.0% (45) | 2.5% (55) | 2.0% (44) | |
| P | .1432 | .0607 | .3025 | .1907 | .4667 | |
| RR (95% CI) | 1.14 (0.96–1.36) | 1.35 (0.99–1.84) | 0.83 (0.58–1.18) | 1.26 (0.89–1.77) | 1.15 (0.79–1.67) | |
| 10–13 y old | Comparisons | 12.2% (1202) | 3.3% (325) | 2.8% (267) | 3.2% (295) | 3.5% (315) |
| mTBI | 13.8% (689) | 3.4% (169) | 3.9% (190) | 3.5% (163) | 3.7% (167) | |
| P | .0062b | .8192 | .0003b | .2753 | .4809 | |
| RR (95% CI) | 1.15 (1.04–1.28) | 1.02 (0.84–1.23) | 1.42 (1.18–1.72) | 1.11 (0.92–1.36) | 1.07 (0.88–1.30) | |
| 14–17 y old | Comparisons | 14.9% (2490) | 4.6% (770) | 3.6% (579) | 3.7% (574) | 3.8% (567) |
| mTBI | 16.5% (1418) | 5.0% (433) | 4.3% (348) | 4.0% (316) | 4.3% (321) | |
| P | .0009b | .1357 | .0137 | .2397 | .1026 | |
| RR (95% CI) | 1.13 (1.05–1.22) | 1.10 (0.97–1.24) | 1.19 (1.03–1.36) | 1.09 (0.94–1.25) | 1.12 (0.98–1.29) | |
| Adjustment disorders | Comparisons | 6.2% (2275) | 1.9% (695) | 1.6% (555) | 1.5% (521) | 1.5% (504) |
| mTBI | 7.8% (1431) | 2.5% (469) | 2.0% (361) | 1.7% (305) | 1.7% (296) | |
| P | <.0001b | <.0001b | .0001b | .0255 | .0209 | |
| RR (95% CI) | 1.27 (1.19–1.36) | 1.35 (1.20–1.52) | 1.30 (1.14–1.49) | 1.18 (1.02–1.36) | 1.19 (1.03–1.37) | |
| 0–5 y old | Comparisons | 1.8% (79) | 0.2% (8) | 0.4% (16) | 0.8% (34) | 0.5% (21) |
| mTBI | 2.4% (52) | 0.3% (7) | 0.6% (12) | 0.4% (9) | 1.1% (24) | |
| P | .1034 | .2662 | .2702 | .0919 | .0044b | |
| RR (95% CI) | 1.34 (0.94–1.91) | 1.78 (0.64–4.92) | 1.52 (0.72–3.23) | 0.53 (0.25–1.11) | 2.35 (1.31–4.24) | |
| 6–9 y old | Comparisons | 5.8% (268) | 1.8% (82) | 1.3% (61) | 1.2% (54) | 1.6% (71) |
| mTBI | 7.4% (173) | 2.1% (49) | 1.6% (37) | 2.0% (45) | 1.9% (42) | |
| P | .0079 | .3417 | .3339 | .0109 | .3467 | |
| RR (95% CI) | 1.31 (1.07, 1.59) | 1.19 (0.83, 1.70) | 1.22 (0.81, 1.85) | 1.68 (1.13, 2.50) | 1.20 (0.82, 1.77) | |
| 10–13 y old | Comparisons | 7.2% (722) | 2.0% (204) | 1.8% (179) | 1.8% (170) | 1.8% (169) |
| mTBI | 9.6% (491) | 2.9% (147) | 2.4% (118) | 2.3% (112) | 2.4% (114) | |
| P | <.0001b | .0007b | .0177 | .0188 | .0099 | |
| RR (95% CI) | 1.39 (1.23–1.57) | 1.45 (1.17–1.80) | 1.33 (1.05–1.68) | 1.33 (1.05–1.70) | 1.37 (1.08–1.74) | |
| 14–17 y old | Comparisons | 6.9% (1206) | 2.3% (401) | 1.8% (299) | 1.6% (263) | 1.5% (243) |
| mTBI | 8.1% (715) | 3.0% (266) | 2.3% (194) | 1.7% (139) | 1.4% (116) | |
| P | .0005b | .0005b | .0060b | .6045 | .6710 | |
| RR (95% CI) | 1.19 (1.08–1.31) | 1.32 (1.13–1.55) | 1.29 (1.08–1.55) | 1.06 (0.86–1.30) | 0.95 (0.76–1.19) |
mTBI, mild traumatic brain injury; RR, relative risk.
a
Adjusted relative risk estimates were generated using generalized linear models with logit link function for fixed-interval, interval-censored data, controlled for age, sex, race/ethnicity, low-income residence, and electronic health record transition period. Bonferroni correction resulted in a significance threshold of 2-sided P < .00625.
b
Statistically significant risk ratios.