title: Suicidality, bullying and other conduct and mental health correlates of traumatic brain injury in adolescents.
abstract: OBJECTIVE
  Our knowledge on the adverse correlates of traumatic brain injuries (TBI), including non-hospitalized cases, among adolescents is limited to case studies. We report lifetime TBI and adverse mental health and conduct behaviours associated with TBI among adolescents from a population-based sample in Ontario.
  
  
  RESULTS
  Data were derived from 4,685 surveys administered to adolescents in grades 7 through 12 as part of the 2011 population-based cross-sectional Ontario Student Drug Use and Health Survey (OSDUHS). Lifetime TBI was defined as head injury that resulted in being unconscious for at least 5 minutes or being retained in the hospital for at least one night, and was reported by 19.5% (95%CI:17.3,21.9) of students. When holding constant sex, grade, and complex sample design, students with TBI had significantly greater odds of reporting elevated psychological distress (AOR = 1.52), attempting suicide (AOR = 3.39), seeking counselling through a crisis help-line (AOR = 2.10), and being prescribed medication for anxiety, depression, or both (AOR = 2.45). Moreover, students with TBI had higher odds of being victimized through bullying at school (AOR = 1.70), being cyber-bullied (AOR = 2.05), and being threatened with a weapon at school (AOR = 2.90), compared with students who did not report TBI. Students with TBI also had higher odds of victimizing others and engaging in numerous violent as well as nonviolent conduct behaviours.
  
  
  CONCLUSIONS
  Significant associations between TBI and adverse internalizing and externalizing behaviours were found in this large population-based study of adolescents. Those who reported lifetime TBI were at a high risk for experiencing mental and physical health harms in the past year than peers who never had a head injury. Primary physicians should be vigilant and screen for potential mental heath and behavioural harms in adolescent patients with TBI. Efforts to prevent TBI during adolescence and intervene at an early stage may reduce injuries and comorbid problems in this age group.
authors.affiliation: Division of Neurosurgery and Injury Prevention Research Office, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ilie
authors.affiliation: Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Community Health and Epidemiology and Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Mann
authors.affiliation: Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Boak
authors.affiliation: Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Adlaf
authors.affiliation: Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Hayley
authors.initials: H
authors.lastname: Hamilton
authors.affiliation: Department of Community Health and Epidemiology and Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Asbridge
authors.affiliation: Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Rehm
authors.affiliation: Division of Neurosurgery and Injury Prevention Research Office, St. Michael's Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cusimano
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology*; D058445:Bullying; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D009864:Ontario / Q000453:epidemiology; D062486:Public Health Surveillance; D013405:Suicide; D055815:Young Adult
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