Research Reports - Utilization of mental health services after mild pediatric traumatic brain injury

Pediatrics. 2017 Mar;139(3). pii: e20162462. doi: 10.1542/peds.2016-2462. Epub
2017 Feb 3.

Jimenez N(1,)(2), Quistberg A(2), Vavilala MS(3,)(2,)(4), Jaffe KM(2,)(5), Rivara
FP(2,)(4,)(6).

BACKGROUND: Mild traumatic brain injury injuries (mTBIs), including concussions,
represent >2 million US pediatric emergency department visits annually. Post-mTBI
mental health symptoms are prominent and often attributed to the mTBI. This study
examined whether individuals seeking post-mTBI mental health care had previous
mental health diagnoses or a new onset of such disorders, and determined if
mental health care utilization differed by race/ethnicity.
METHODS: Retrospective cohort study, using the Medicaid Marketscan claims
national dataset (2007-2012). Utilization of mental health services 1 year before
and 1 year after mTBI was compared between children with and without mental
health diagnoses before injury. Primary outcome was receipt of post-mTBI
outpatient mental health care.
RESULTS: A total of 31 272 children 20 years or younger were included, 8577 (27%)
with mental health diagnoses before their mTBI and 22 695 without one. After
injury, children without previous mental health disorders increased mental health
services utilization; however, most (86%) postinjury mental health care was
received by children with previous mental health disorders. Having a mental
health diagnosis pre-mTBI was the most important risk factor for receiving
post-mTBI mental health care (odds ratio 7.93, 95% confidence interval
7.40-8.50). Hispanic children were less likely to receive post-mTBI mental health
care.
CONCLUSIONS: mTBI was associated with increased utilization of mental health
services but most of these services were received by children with previous
mental health disorders. Our documentation of racial/ethnic disparities in mental
health care utilization reemphasize the importance of providing individualized,
culturally, and linguistically competent care to improve outcomes after mTBI for
all children. 

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