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Articles   |    
Head Injury as Risk Factor for Psychiatric Disorders: A Nationwide Register-Based Follow-Up Study of 113,906 Persons With Head Injury
Sonja Orlovska, M.D.; Michael Skaarup Pedersen, M.Sc.; Michael Eriksen Benros, M.D., Ph.D.; Preben Bo Mortensen, Dr.Med.Sc.; Esben Agerbo, Dr.Med.Sc.; Merete Nordentoft, Dr.Med.Sc.
Am J Psychiatry 2014;171:463-469. doi:10.1176/appi.ajp.2013.13020190
View Author and Article Information

The authors report no financial relationships with commercial interests.

Supported by a grant from the Stanley Medical Research Institute and an unrestricted grant from the Lundbeck Foundation.

From the Mental Health Center Copenhagen, Faculty of Health Sciences, Copenhagen University, Denmark; the National Center for Register-Based Research, Aarhus University, Denmark; the Lundbeck Foundation Initiative for Psychiatric Research (iPSYCH), Denmark; and the Center for Integrated Register-Based Research at Aarhus University (CIRRAU), Denmark.

Presented in part as a poster at the Third Biennial Schizophrenia International Research Conference, Florence, Italy, April 14–18, 2012.

Address correspondence to Dr. Orlovska (sonjaorlovska@gmail.com).

Copyright © 2014 by the American Psychiatric Association

Received February 12, 2013; Revised June 30, 2013; Revised September 30, 2013; Accepted October 10, 2013.

Abstract

Objective  Studies investigating the relationship between head injury and subsequent psychiatric disorders often suffer from methodological weaknesses and show conflicting results. The authors investigated the incidence of severe psychiatric disorders following hospital contact for head injury.

Method  The authors used linkable Danish nationwide population-based registers to investigate the incidence of schizophrenia spectrum disorders, unipolar depression, bipolar disorder, and organic mental disorders in 113,906 persons who had suffered head injuries. Data were analyzed by survival analysis and adjusted for gender, age, calendar year, presence of a psychiatric family history, epilepsy, infections, autoimmune diseases, and fractures not involving the skull or spine.

Results  Head injury was associated with a higher risk of schizophrenia (incidence rate ratio [IRR]=1.65, 95% CI=1.55–1.75), depression (IRR=1.59 95% CI=1.53–1.65), bipolar disorder (IRR=1.28, 95% CI=1.10–1.48), and organic mental disorders (IRR=4.39, 95% CI=3.86–4.99). This effect was larger than that of fractures not involving the skull or spine for schizophrenia, depression, and organic mental disorders, which suggests that the results were not merely due to accident proneness. Head injury between ages 11 and 15 years was the strongest predictor for subsequent development of schizophrenia, depression, and bipolar disorder. The added risk of mental illness following head injury did not differ between individuals with and without a psychiatric family history.

Conclusions  This is the largest study to date investigating head injury and subsequent mental illness. The authors demonstrated an increase in risk for all psychiatric outcomes after head injury. The effect did not seem to be solely due to accident proneness, and the added risk was not more pronounced in persons with a psychiatric family history.

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FIGURE 1. Risk of Psychiatric Disorders Associated With Hospital Contact for Head Injury and Fractures Not Involving the Skull or Spinea

a Adjusted for gender, age, and calendar year. Error bars indicate 95% confidence interval.

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TABLE 1.Risk of Psychiatric Disorders Associated With Hospital Contact for Head Injurya
Table Footer Note

a IRR=incidence rate ratio; adjusted for gender, age, and calendar year.

Table Footer Note

b Further adjusted for fractures not involving the skull or spine, a family history of psychiatric disorders, epilepsy, and infections.

Table Footer Note

c Because of low case numbers, IRRs were adjusted only in the basic model.

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TABLE 2.Risk of Psychiatric Disorders, by Time Since Hospital Contact for Head Injurya
Table Footer Note

a IRR=incidence rate ratio; adjusted for gender, age, and calendar year.

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TABLE 3.Risk of Psychiatric Disorders, by Age at Hospital Contact for Head Injurya
Table Footer Note

a IRR=incidence rate ratio; adjusted for gender, age, and calendar year.

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TABLE 4.Risk of Psychiatric Disorders Associated With Head Injury in Persons With and Without a Family History of Psychiatric Disorders, a Hospital Contact for Infection, and Autoimmune Diseasea
Table Footer Note

a IRR=incidence rate ratio; adjusted for gender, age, and calendar year.

Table Footer Note

b The main effect of a psychiatric family history, infections, and autoimmune disease is not included.

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For which psychiatric outcome was the effect of fractures not involving the skull or spine significantly greater than the effect of head injury?
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Head injury at what age was shown to be most predictive of subsequent psychiatric disorder development?
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