The association of preceding traumatic brain injury with mental disorders, alcoholism and criminality: the Northern Finland 1966 Birth Cohort Study
Introduction
Traumatic brain injury (TBI) has been found to be associated with the development of psychiatric disorders. The prevalence of psychiatric disorders among patients with TBI varied from 18 to 63% (Max et al., 1998, Deb et al., 1999). This association has been noted in the psychiatric diagnostic groups of psychoses (McAllister, 1998) and affective disorders (Deb et al., 1999, Bowen et al., 1998, Taylor and Jung, 1998, van Reekum et al., 2000). Also, among patients who have suffered a TBI, there are notions of high proportions of personality disorders (up to 39%) (van Reekum et al., 1996) and psychiatric comorbidity, i.e. that after a TBI, up to 44% of the individuals had two or more Axis I diagnoses (Hibbard et al., 1998). There are only a few studies concerning TBI-related increases in risks for alcoholism or serious alcohol-use-related problems, although trauma-induced behavioral disturbances are evident (Hall et al., 1994, Kreutzer et al., 1995). On the contrary, alcohol use has been strongly implicated as a causal factor of TBI (Rimel et al., 1982, Kolakowsky-Hayner et al., 1999). The proportion of heavy drinkers among adults with TBI has been shown to range from 37 to 57% (Kolakowsky-Hayner et al., 1999, Kreutzer et al., 1991, Kreutzer et al., 1996).
In addition to psychiatric disorders including alcoholism, the association of TBI with juvenile delinquency as well as with adult criminality has been demonstrated in previous studies, both in selected data settings (Lewis and Shanok, 1979, Shanok and Lewis, 1981, Lewis et al., 1982, Lewis et al., 1986, Lewis et al., 1988, Rosebaum and Hoge, 1989, Joukamaa, 1991, Barnfield and Leathem, 1988, Sarapata et al., 1998) and at population level (Rantakallio et al., 1992a). In a review article on the clinical characteristics of TBI and criminal behavior, Diaz (1995) stated that the most likely features leading to future violence are severe head injury with prolonged unconsciousness, frontal lobe abnormalities and temporal lobe epilepsy.
Based on literature review, it is easy to conclude that a TBI in a person might be a causal factor for multiple psychiatric disorders and/or criminal behavior. However, so far there exist only a few prospective studies focusing on psychiatric disorders manifesting after TBI during childhood or adulthood. Another shortcoming is that the average follow-up periods after the trauma in previous studies were less than 3 years (Max et al., 1998). To the best of our knowledge, there are to date no systematic studies based on the general population with appropriate follow-up time in studying the co-existence of alcoholism with other psychiatric disorders and criminality in adulthood after TBI. We tested the hypothesis that TBI during childhood and adolescence increases the risk for developing psychiatric disorders, heavy alcohol use and criminal offences in adulthood. A large birth cohort database with 31-year prospective follow-up enabled us to study this issue at the epidemiological level.
Section snippets
Definition of the birth cohort
We made use of the large database of the 1966 Birth Cohort of Northern Finland. It is based on the unselected, genetically homogenous general population: in the two northernmost Finnish provinces, i.e. Oulu and Lapland, 96% of all women pregnant in 1966 (n=12 068) were evaluated and gave birth to 12 058 live infants. Many biological, socioeconomic and health conditions as well as living habits and family characteristics of the cohort members were collected through pre-natal stages up to the age
Results
Fig. 1 shows prevalences of childhood TBI and adjusted odds ratios, with 95% CI, of later mental disorder, heavy alcohol use and/or criminality in a male cohort member. Among males, TBI elevated the risk of developing mental disorders up to two-fold (crude OR 2.1, 95% CI 1.2–3.8) and 1.7-fold for criminal offenders (crude OR 1.7, 1.1–2.6). In a subgroup of mentally disordered males with co-existing criminality, the corresponding risk was over four-fold (crude OR 4.3, 1.3–14.5). After
Discussion
Our main finding was that traumatic brain injury (TBI) increased the risk of developing mental disorders up to two-fold. In addition, the corresponding risk was over four-fold in a subgroup of mentally disordered males with co-existing criminality. These findings are in accordance with previous findings where an association between TBI and psychiatric morbidity has been noticed (van Reekum et al., 1996, Bowen et al., 1998, Hibbard et al., 1998, Max et al., 1998, McAllister, 1998, Taylor and
Acknowledgements
This study was supported by grants from the Research Foundation of Orion Corporation and the Sigrid Juselius Foundation.
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