title: A Systematic Review of Psychiatric, Psychological, and Behavioural Outcomes following Mild Traumatic Brain Injury in Children and Adolescents.
abstract: Evidence regarding longer-term psychiatric, psychological, and behavioural outcomes (for example, anxiety, mood disorders, depression, and attention disorders) following mild traumatic brain injury (mTBI) in children and adolescents has not been previously synthesized.
  
  
  
  To conduct a systematic review of the available evidence examining psychiatric, psychological, and behavioural outcomes following mTBI in children and adolescents.
  
  
  
  Nine electronic databases were systematically searched from 1980 to August 2014. Studies selected met the following criteria: original data; study design was a randomized controlled trial, quasi-experimental design, cohort or historical cohort study, case-control study, or cross-sectional study; exposure included mTBI (including concussion); population included children and adolescents (<19 years) at the time of mTBI, as well as a comparison group (for example, healthy children, children with orthopaedic injuries); and included psychiatric, psychological, or behavioural outcomes (for example, anxiety, mood disorders, depression, attention disorders). Two authors independently assessed the quality and level of evidence with the Downs and Black (DB) criteria and Oxford Centre of Evidence-Based Medicine (OCEBM) model, respectively, for each manuscript.
  
  
  
  Of 9472 studies identified in the initial search, 30 were included and scored. Heterogeneity in methodology and injury definition precluded meta-analyses. The median methodological quality for all 30 studies, based on the DB criteria, was 15/33 (range 6 to 19). The highest level of evidence demonstrated by all reviewed studies was level 2b based on OCEBM criteria, with the majority (28/30 studies) classified at this level. Based on the literature included in this systematic review, psychological and psychiatric problems in children with a history of mTBI were found to be more prevalent when mTBI is associated with hospitalization, when assessment occurs earlier in the recovery period (that is, resolves over time), when there are multiple previous mTBIs, in individuals with preexisting psychiatric illness, when outcomes are based on retrospective recall, and when the comparison group is noninjured healthy children (as opposed to children with injuries not involving the head).
  
  
  
  Overall, few rigorous prospective studies have examined psychological, behavioural, and psychiatric outcomes following mTBI. In the absence of true reports of preinjury problems and when ideally comparing mild TBI to non-TBI injured controls, there is little evidence to suggest that psychological, behavioural, and/or psychiatric problems persist beyond the acute and subacute period following an mTBI in children and adolescents.
authors.affiliation: Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada caemery@ucalgary.ca.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Emery
authors.affiliation: Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Barlow
authors.affiliation: Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Brooks
authors.affiliation: Rady Children's Hospital, San Diego, California, USA Neuropsychiatric Research, Department of Psychiatry, University of California, San Diego, California, USA.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Max
authors.affiliation: Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Angela
authors.initials: A
authors.lastname: Villavicencio-Requis
authors.affiliation: Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Vithya
authors.initials: V
authors.lastname: Gnanakumar
authors.affiliation: Health Sciences Library, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Helen Lee
authors.initials: HL
authors.lastname: Robertson
authors.affiliation: Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Schneider
authors.affiliation: Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Keith Owen
authors.initials: KO
authors.lastname: Yeates
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D002648:Child; D006801:Humans; D001523:Mental Disorders / Q000209:etiology / Q000503:physiopathology / Q000523:psychology
keywords: behaviour outcomes; concussion; mild traumatic brain injury; psychiatric outcomes; psychological outcomes