{
  "abstract": "Background Traumatic brain injury (TBI) is a major public health concern with significant morbidity and mortality. Mental health disorders (MHDs) are known to arise after TBI. Conversely, we assessed the relationship between pre-existing MHDs and subsequent TBI risk.Method A retrospective cohort study was conducted using Epic Cosmos, an electronic health record database representing >250 healthcare organisations and >300 million patients. Adults with/without a MHD were included (01-01-2015 to 31-12-2023). MHDs were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes (F01–F99), and the primary outcome was diagnosis of TBI, identified using Systematised Nomenclature of Medicine – Clinical Terms codes. Logistic regression models estimated odds of TBI by category.Results Data from >200 million patients, with multiple MHDs, indicated increased odds of TBI. Dementia showed the strongest association (OR=4.88), then substance use disorder (OR=3.24), mood disorders (OR=2.97), intellectual disability (OR=2.69) and any MHD (OR=3.46). Elevated risks were observed for anxiety (OR=2.38), conduct (OR=2.28), developmental (OR=2.30), psychosis (OR=2.12), behavioural (OR=2.01) and personality (OR=1.69) disorders (p<0.001 and 95% CI). Males had higher odds than females (OR=1.26). Compared with White individuals, odds were elevated for Black (OR=1.35) and American Indian/Alaska Native (AIAN; OR=1.25) individuals. Risk declined in middle age but increased after 65, peaking at ≥85 years (OR=2.62).Conclusions Pre-existing MHDs were strongly associated with increased risk of TBI. The greatest risk was dementia, but the risk was also higher among males, Black, AIAN and older individuals. This underscores the importance of psychiatric and demographic factors in TBI prevention and the need for integrated approaches addressing both mental health and injury risk to improve outcomes in vulnerable populations.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA",
        "Nova Southeastern University Dr Kiran C Patel College of Osteopathic Medicine, Clearwater, Florida, USA"
      ],
      "name": "Allie L Heineman"
    },
    {
      "affiliations": [
        "Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"
      ],
      "name": "Roman Jandarov"
    },
    {
      "affiliations": [
        "Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA",
        "University of Cincinnati James L Winkle College of Pharmacy, Cincinnati, Ohio, USA"
      ],
      "name": "Andrew M Ferguson"
    },
    {
      "affiliations": [
        "Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"
      ],
      "name": "Laura B Ngwenya"
    }
  ],
  "title": "Pre-existing mental health disorders are associated with an increased risk of traumatic brain injury",
  "uid": "11bf813c-0cfa-5c80-b2b3-cd2a41576d36"
}