The Association of Adverse Childhood Experiences with Long-term Mood and Anxiety Disorders After Childhood Traumatic Brain Injury: A Population-based Case-Control Study

Objective To assess the association between ACEs and the development of psychiatric disorders by age 25 among individuals who sustained TBI prior to age 10. Design Population-based case-control study. Setting Olmsted County, Minnesota. Participants 566 individuals (N=566) who sustained a TBI prior to age 10 were identified and classified using a validated TBI classification system. Among these individuals, cases with a subsequent mood or anxiety disorder prior to age 25 were identified through clinical diagnostic codes and manual record review. For each case, a 1:1 matched control was randomly selected from individuals with a pediatric TBI who did not have a mood/anxiety disorder prior to the matched case's mood/anxiety disorder. Interventions Not applicable Main Outcome Measures Development of a mood/anxiety disorder. Results Among the 114 matched pairs of individuals with a TBI prior to age 10, a subsequent mood/anxiety diagnosis was significantly associated with a history of 10 of 14 ACE categories and with having an ACE score ≥1 (odds ratio 5.17; 95% confidence interval 2.78-9.59). Conclusions This is the first population-based study to the authors’ knowledge showing that among children who sustained a TBI prior to age 10, those who experienced ACEs are at increased risk of developing a mood or anxiety disorder.