Yau, King-Chi; (2023) Exploring the association between traumatic brain injury and psychotic-like experiences in children. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

This thesis studies the relationships between exposure to paediatric traumatic brain injury (TBI) and psychosis outcomes, and is presented in three parts. Part 1 is a systematic review and meta-analysis of the association between paediatric TBI and subsequent psychotic disorders/symptoms. We identified 10 relevant studies, of which eight were included in the meta-analysis. Based on a pooled sample size of 479,686, the pooled odds ratio (OR) for the association between paediatric TBI and psychosis outcomes was found to be marginally significant. Part 1 reports cautious meta-analytic evidence for a positive association between paediatric TBI and future psychosis. Part 2 utilised the Adolescent Brain Cognitive Development (ABCD) large cohort data from children aged 9 to 10 years old at baseline (n = 11,875), with longitudinal and prospective 3-year follow-up to investigate the extent to which TBI at baseline predicted psychotic-like experiences (PLEs) in children, using multi-level logistic regression analyses. It was found that the presence of paediatric TBI at baseline was a significant predictor of the occurrence of PLEs at 36 months, with the relationship remaining robust after controlling for potential confounders. However, no significant association was found between the presence of TBI and the presence of PLEs at baseline. Additionally, no significant relationships were observed between the number of TBIs and the presence of PLEs at both baseline and 36 months, whilst the severity of TBI was only found to be significantly associated with the presence of PLEs at baseline, but not at 36 months. In conclusion, part 2 provides evidence indicating (i) a delayed occurrence of PLEs following TBI among children aged 9 to 10 years old; (ii) weak associations between TBI and PLEs; however, (iii) a persistence of post-TBI PLEs and (iv) a dose–response relationship could not be observed. Part 3 is a critical appraisal which presents considerations in relation to three broad topics, including (i) transparency, accessibility, and reproducibility of the conducted research; (ii) reasons for and likely impact of a lack of expert by experience (EbE) involvement in the research design, conduct, analysis, and interpretation; and (iii) an exploration of the relationships between paediatric TBI and mental health outcomes in children.

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