Psychological Medicine

Original Articles

Increased risk of schizophrenia following traumatic brain injury: a 5-year follow-up study in Taiwan

Yi-Hua Chena1, Wen-Ta Chiua2 c2, Shu-Fen Chua2 and Herng-Ching Lina3 c1

a1 School of Public Health, Taipei Medical University, Taipei, Taiwan

a2 Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan

a3 School of Health Care Administration, Taipei Medical University, Taipei, Taiwan

Abstract

Background Whether traumatic brain injury (TBI) is an independent risk factor for the subsequent development of schizophrenia has evoked considerable controversy. No evidence has been previously reported from Asia. This study estimated the risk of schizophrenia during a 5-year period following hospital admission for TBI relative to a comparison group of non-TBI patients during the same period in Taiwan.

Method Two datasets were linked: the Traumatic Brain Injury Registry and the Taiwan National Health Insurance Research Dataset. A total of 3495 patients hospitalized with a diagnosis of TBI from 2001 to 2002 were included, together with 17 475 non-TBI patients as the comparison group, matched on sex, age, and year of TBI hospitalization. Each individual was followed for 5 years to identify any later diagnosis of schizophrenia. Cox proportional hazard regressions were performed for analysis.

Results During the 5-year follow-up period, patients who had suffered TBI were independently associated with a 1.99-fold (95% confidence interval 1.28–3.08) increased risk of subsequent schizophrenia, after adjusting for monthly income and residential geographical location. The severity and type of TBI was not associated with the subsequent development of schizophrenia.

Conclusions Our findings add important evidence from Asia and suggest a potential link between TBI and schizophrenia. Our study suggests that clinicians and family members should be alert to possible neuropsychiatric conditions following TBI.

(Received June 01 2010)

(Revised August 05 2010)

(Accepted August 16 2010)

(Online publication September 22 2010)

Correspondence

c1 Address for correspondence: H.-C. Lin, Ph.D., School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan. (Email: henry@tmu.edu.tw) [H.-C. Lin]

c2 (Email: wtchiu@tmu.edu.tw) [W.-T. Chiu]

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