Family Resilience and Mental and Physical Health Sequelae of Pediatric TBI in Youths

Importance: Traumatic brain injury (TBI) in children and adolescents is associated with mental and physical health sequelae, including elevated risks of anxiety, depression, persistent headaches, and chronic physical pain. However, factors that may be associated with the risk of these adverse outcomes and with improved recovery remain underexplored. Objective: To examine associations between medically diagnosed TBI and mental (anxiety and depression) and physical (frequent headaches and chronic pain) health outcomes among US children and adolescents aged 6 to 17 years and to evaluate whether these associations vary by level of family resilience. Design, Setting, and Participants: This cross-sectional study used data from the 2022 and 2023 National Survey of Children's Health (NSCH), a nationally representative survey conducted by the US Census Bureau and sponsored by the Health Resources and Services Administration Maternal and Child Health Bureau. The NSCH collects caregiver-reported data on child and adolescent health, family context, and social determinants across all 50 US states and the District of Columbia. This study included children and adolescents aged 6 to 17 years whose parents reported medically diagnosed TBI and a comparison group without medically diagnosed TBI. Children and adolescents with comorbidities were excluded. Survey weights accounted for complex sampling to generate nationally representative estimates. Data analysis was done from June 1 to November 13, 2025. Exposures: Medically diagnosed TBI. Main Outcomes and Measures: Current status and severity of medically diagnosed anxiety, depression, frequent or severe headaches (including migraine headaches), and chronic physical pain. Moderators included adverse childhood experiences, child and adolescent flourishing, and family resilience. Results: Among 33 572 participants, 1195 individuals (3.5%; 47.0% [95% CI, 41.2%-52.9%] female; 46.5% [95% CI, 41.0%-52.0%] aged 15-17 years) had a history of medically diagnosed TBI and 32 377 individuals (96.4%; 54.0% [95% CI, 52.9%-55.1%] female; 51.7% [95% CI, 50.6%-52.8%] aged 6-11 years) had no TBI. Children and adolescents with TBI had a significantly higher prevalence of poor health than those without TBI (eg, current anxiety: 12.9% [95% CI, 9.3%-16.5%] vs 4.7% [95% CI, 4.3%-5.0%]; adjusted prevalence ratio, 1.83 [95% CI, 1.38-2.43]). They had increased odds of current anxiety (adjusted odds ratio [aOR], 1.87 [95% CI, 1.31-2.67]), depression (aOR, 1.98 [95% CI, 1.13-3.47]), frequent headaches (aOR, 7.76 [95% CI, 2.71-22.20]), and chronic pain (aOR, 3.99 [95% CI, 1.81-8.77]). Interaction analyses showed evidence of effect modification on the multiplicative (OR) scale for depression, with higher odds observed at moderate (aOR, 5.64 [95% CI, 1.13-28.20]; P = .04) and low (aOR, 6.41 [95% CI, 1.24-33.20]; P = .03) resilience levels compared with the reference group (no TBI × high resilience). Conclusions and Relevance: In this study, family resilience was associated with variation in the association between TBI and depression. These findings support further investigation of family-focused rehabilitation approaches in prospective studies.