The moderating effects of sex and age on the association between traumatic brain injury and harmful psychological correlates among adolescents

PLoS One. 2014 Sep 30;9(9):e108167. doi: 10.1371/journal.pone.0108167. eCollection 2014.


Background: Although it is well established that sex is a risk factor in acquiring a traumatic brain injury (TBI) among adolescents, it has not been established whether it also moderates the influence of other TBI psychological health correlates.

Methods and findings: Data were derived from a 2011 population-based cross-sectional school survey, which included 9,288 Ontario 7th-12th graders who completed anonymous self-administered questionnaires in classrooms. Response rate was 62%. Preliminary analyses found no evidence of nonresponse bias in the reporting of TBI. TBI was defined as a hit or blow to the head that resulted in a 5 minutes loss of consciousness or at least one overnight hospitalization due to symptoms associated with it. Reports of lifetime TBI were more common among males than females (23.1%, 95% CI: 20.5, 25.8 vs. 17.1%, 95% CI: 14.7, 19.8). Thirteen correlates were examined and included cigarette smoking, elevated psychological distress, suicide ideation, bully victimization (at school, as well as cyber bullying), bullying others, cannabis use, cannabis dependence and drug use problems, physical injuries, daily smoking, drinking alcohol, binge drinking, use of cannabis, and poor academic performance. Among the outcomes examined, sex moderated the relationship between lifetime TBI and cigarette smoking. In addition, sex and age jointly moderated the relationship between lifetime TBI and daily smoking, alcohol use and physical injuries. Late adolescent males who reported lifetime TBI, relative to females, displayed elevated daily smoking and injuries, whereas their females counterparts displayed elevated past year drinking. Possible bias related to self-report procedures and the preclusion of causal inferences due to the cross-sectional nature of the data are limitations of this study.

Conclusions: TBI differences in outcomes need to be assessed for potential moderating effects of sex and age. Results have important implications for more tailored injury prevention efforts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age Factors
  • Alcohol Drinking / adverse effects
  • Alcohol Drinking / psychology*
  • Brain Injuries / epidemiology
  • Brain Injuries / etiology
  • Brain Injuries / psychology*
  • Bullying / psychology*
  • Crime Victims / psychology*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Marijuana Abuse / complications
  • Ontario / epidemiology
  • Risk Factors
  • Schools
  • Self Report
  • Sex Factors
  • Smoking / adverse effects
  • Smoking / psychology*
  • Students / psychology*
  • Suicidal Ideation
  • Surveys and Questionnaires