Adolescent Mental Health Risk post-mild Traumatic Brain Injury: Examination of Diagnostic codes in Electronic Health Records

This study aimed to understand the frequency and association of post-mild traumatic brain injury (mTBI) mental health (MH) diagnoses, examining the prevalence and risk factors. Retrospective matched cohort study using Electronic Health Record (EHR) data SETTING: Tertiary children's medical center PARTICIPANTS: Patients aged 11 to 17 from 2010 to 2024 were identified as mTBI cases, typically developing (TD), or orthopedic injury (OI) using diagnostic codes and Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS). Cohort included 18755 cases of mTBI and 1:2 matched adolescents from OI and TD groups (n=93775, Mean age=14.9; SD=4, 44% F, 77% White). Not applicable. MH diagnosis codes categorized using the Clinical Classifications Software Refined categorization. mTBI had a mean age of injury of 14.4 years (SD=3.3). The mTBI group had an increased risk of any MH diagnosis at 3 (OR(CI)=1.151(1.067-1.241)), 6 (OR(CI)=1.525 (1.421-1.637)), 9 (OR(CI)=1.855 (1.733-1.986)), and 12 months (OR(CI)=2.165 (2.026-2.313)) compared to the TD group at 3 months. Females, higher socio-economic disadvantage, or a prior MH diagnosis were found to have a higher risk of a MH diagnosis in all three groups. Small-town/rural or micropolitan residents were found to have a higher risk of a MH diagnosis post-mTBI, but not in OI or TD. ADHD emerged as the most common condition; however, anxiety and trauma or stress-related disorders also continued to increase over time. MH diagnoses appear to be diagnosed at higher rates in adolescents after mTBI, increasing over the first 12 months. Factors such as sex, social disadvantage, history of MH disorders, and population density conferred higher risk. The results highlight the need for screening and early intervention with those at elevated risk.