A new study, published today in JAMA Network Open, reveals that schoolage children and adolescents with medically diagnosed traumatic brain injury (TBI) have significantly higher rates of anxiety/depression, and strong family support and resilience helps alleviate some of it.
Researchers at the Center for Injury Research and Policy of the Abigail Wexner Research Institute at Nationwide Children's Hospital, The Ohio State University, and University of Washington analyzed associations between medically diagnosed TBI and mental (anxiety and depression) and physical (frequent headaches and chronic pain) health outcomes among U.S. children and teens aged 6-17 years and evaluated whether these associations varied by level of family resilience. They found that children and teens with TBI had a significantly higher prevalence of poor health than those without TBI, along with increased odds of current anxiety, frequent headaches and chronic pain.
"Our study shows that the impact of traumatic brain injury in children often extends well beyond the initial injury," said Henry Xiang, MD, MPH, PhD, MBA , principal investigator in the Center for Injury Research and Policy and senior author of the study. "Children who experience TBI face increased risks of mental health challenges such as anxiety and depression, highlighting the importance of routine mental health screening and long-term follow-up care."
The study also found that family resilience was associated with decreased odds of depression after TBI. Family resilience describes how families respond to stress, communicate effectively, and mobilize collective strengths when facing crisis or major family events. "One of the most encouraging findings from our research is that family resilience appears to play an important role in a TBI patient's recovery," said Xiang. "Children recovering from traumatic brain injury who grow up in supportive families may have lower risks of long-term mental health problems. Strengthening family support systems and resilience may be an important pathway to improving TBI patients' long-term outcomes."
These findings underscore the importance of strategies families can use to build resilience during recovery.
"Recovery following brain injury in children is about so much more than the child themselves – recovery happens in many contexts with many people, with home and primary caregivers being some of the most important," said Christine Koterba, PhD, ABPP , pediatric neuropsychologist at Nationwide Children's, who was not involved in this study. "I see how recovery actually happens outside the brain, in environments where children spend their time surrounded by the steady caregivers in their lives. This study opens the door for future research focused on caregiver resilience."
This cross-sectional study used data from the 2022 and 2023 National Survey of Children's Health (NSCH), a nationally representative, cross-sectional survey conducted by the U.S. Census Bureau and sponsored by the Health Resources and Services Administration Maternal and Child Health Bureau. The NSCH collects caregiver-reported data on health and well-being, health care access, family environments, and social determinants of health for children and adolescents aged 0 to 17 years across all 50 states and the District of Columbia.
The Center for Injury Research and Policy (CIRP) of the Abigail Wexner Research Institute at Nationwide Children's Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research at its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment, and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy, and advances in clinical care. For related injury prevention materials or to learn more about CIRP, visit www.injurycenter.org . Follow CIRP on Instagram @CIRPatNCH .
About The Abigail Wexner Research Institute at Nationwide Children's Hospital
Named to the Top 10 Honor Roll on U.S. News & World Report's 2025-26 list of "Best Children's Hospitals," Nationwide Children's Hospital is one of America's largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child. Integrated clinical and research programs are part of what allows Nationwide Children's to advance its unique model of care. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children's faculty train the next generation of pediatricians, scientists and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children's Hospital is one of the Top 10 National Institutes of Healthfunded free-standing pediatric research facilities in the U.S., supporting basic, clinical, translational, behavioral and population health research. The AWRI is comprised of multidisciplinary Centers of Emphasis paired with advanced infrastructure supporting capabilities such as technology commercialization for discoveries; gene- and cell-based therapies; and genome sequencing and analysis. More information is available at NationwideChildrens.org/Research .
