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Published on: November 21, 2013
Pediatric traumatic brain injury as a risk factor for psychosis and psychotic symptoms: a systematic review and
King-Chi Yau1, Grace Revill1, Graham Blackman2,3
1Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Insights
Pediatric traumatic brain injury (pTBI) is linked to a higher risk of psychosis. This meta-analysis provides evidence for this association, highlighting pTBI as a potential developmental risk factor for psychosis. Further research is needed for long-term reliability.
Area of Science:
- Neuroscience
- Psychiatry
- Epidemiology
Background:
- Psychosis is a severe psychiatric disorder with significant disabling effects.
- Pediatric traumatic brain injury (pTBI) is a suspected developmental risk factor for psychosis.
- The association between pTBI and psychosis has not been previously assessed meta-analytically.
Approach:
- A systematic review and meta-analysis was conducted to evaluate the link between pTBI and subsequent psychotic disorders or symptoms.
- A random-effects model was employed to calculate the pooled odds ratio (OR) and 95% confidence interval (CI).
- Subgroup, meta-regression, and sensitivity analyses were performed to assess the robustness and characteristics of the association.
Key Points:
- The meta-analysis included eight studies with a pooled sample size of 479,686.
- A pooled OR of 1.80 (95% CI 1.11-2.95) indicated a positive association between pTBI and psychosis outcomes.
- Both diagnosed psychotic disorders and subthreshold symptoms were significantly associated with pTBI.
Conclusions:
- Cautious meta-analytic evidence suggests a positive association between pediatric traumatic brain injury and the future development of psychosis.
- The findings underscore the importance of considering pTBI as a potential risk factor in the developmental trajectory of psychosis.
- Additional research is crucial to confirm the long-term reliability and clinical implications of this association.
Background:
Psychosis is one of the most disabling psychiatric disorders. Pediatric traumatic brain injury (pTBI) has been cited as a developmental risk factor for psychosis, however this association has never been assessed meta-analytically.
Methods:
A systematic review and meta-analysis of the association between pTBI and subsequent psychotic disorders/symptoms was performed. The study was pre-registered (CRD42022360772) adopting a random-effects model to estimate meta-analytic odds ratio (OR) and 95% confidence interval (CI) using the Paule-Mandel estimator. Subgroup (study location, study design, psychotic disorder v. subthreshold symptoms, assessment type, and adult v. adolescent onset) and meta-regression (quality of evidence) analyses were also performed. The robustness of findings was assessed through sensitivity analyses. The meta-analysis is available online as a computational notebook with an open dataset.
Results:
We identified 10 relevant studies and eight were included in the meta-analysis. Based on a pooled sample size of 479686, the pooled OR for the association between pTBI and psychosis outcomes was 1.80 (95% CI 1.11-2.95). There were no subgroup effects and no outliers. Both psychotic disorder and subthreshold symptoms were associated with pTBI. The overall association remained robust after removal of low-quality studies, however the OR reduced to 1.43 (95% CI 1.04-1.98). A leave-one-out sensitivity analysis showed the association was robust to removal of all but one study which changed the estimate to marginally non-significant.
Conclusions:
We report cautious meta-analytic evidence for a positive association between pTBI and future psychosis. New evidence will be key in determining long-term reliability of this finding.
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