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Pediatric traumatic brain injury as a risk factor for psychosis and psychotic symptoms: a systematic review and meta-analysis
Abstract
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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“A comprehensive meta-analysis including 8 studies and over 150,000 pTBI patients yielded findings consistent with our study, indicating a association between pTBI and psychotic syndromes, with an odds ratio (OR) of 1.80 (CI: 1.11–2.95).”
From Pediatric traumatic brain injury and later psychotic syndromes in Finland (2025) · cites this paper as [3]
In the citing paper
“The association between pTBI and psychotic syndrome is a relatively unexplored area [3, 4].”
From Pediatric traumatic brain injury and later psychotic syndromes in Finland (2025) · cites this paper as [3]
In the citing paper
“and bipolar disorder (IRR = 1.3) specifically [3, 4]”
From Pediatric traumatic brain injury and later psychotic syndromes in Finland (2025) · cites this paper as [3]
In the citing paper
“pTBI is linked to an increased risk of post-traumatic psychotic syndromes overall (HR = 1.8)”
From Pediatric traumatic brain injury and later psychotic syndromes in Finland (2025) · cites this paper as [3]
In the citing paper
“as well as schizophrenia (incidence rate ratio [IRR] = 1.3)”
From Pediatric traumatic brain injury and later psychotic syndromes in Finland (2025) · cites this paper as [3]
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Cited by
Pediatric traumatic brain injury and later psychotic syndromes in Finland
Laaksonen, J., Ponkilainen, V., Möttönen, J., Mattila, V. M., & Kuitunen, I. (2025) · European Journal of Pediatrics · doi:10.1007/s00431-025-06224-3 · Cited by 4
Metadata
- Authors
- Yau, K.-C., Revill, G., Blackman, G., Shaikh, M., & Bell, V.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2023-09-29
- Volume
- 54
- Issue
- 1
- Pages
- 32-40
- ISSN
- 0033-2917
- 1469-8978
- Cited by
- 13
- References
- 10
- Language
- en
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- Yau, K.-C., Revill, G., Blackman, G., Shaikh, M., & Bell, V. (2024). Pediatric traumatic brain injury as a risk factor for psychosis and psychotic symptoms: a systematic review and meta-analysis. Psychological Medicine. https://doi.org/10.1017/s0033291723002878
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