November 07, 2025
2 min read
Key takeaways:
- The study also examined how social determinants of health impact TBI outcomes.
- Lower SDI linked to increased risk for sleep disorders, higher SDI linked to lower likelihood of anxiety, PTSD and dementia.
Black patients had a greater likelihood for psychotic and headache disorders after traumatic brain injury than white patients, with social determinants of health also playing a role, according to data published in JAMA Network Open.
“This study fills a gap by leveraging a large, diverse cohort to quantify post-traumatic brain injury (TBI) neuropsychiatric outcomes and explicitly account for selection bias and social determinants — areas that have been underexamined in prior TBI research,” Tim B. Bigdeli, PhD, assistant professor of psychiatry and behavioral sciences at the State University of New York Downstate Health Sciences University, told Healio.
Data were derived from Calixte RME, et al. JAMA Neurol. 2025;doi:10.1001/jamanetworkopen.2025.39313.
Beyond its effect on those who played contact sports with repetitive head contact, TBI remains a crucial public health concern, Bigdeli and colleagues wrote. Prior research has established disparities in post-TBI neuropsychiatric diagnoses (NPDs) across Black and white populations.
The researchers aimed to assess incidence of NPDs following TBI in the U.S. and to examine how socioeconomic factors are associated with population-level differences.
Their retrospective cohort study culled data from the All of Us Research Program, version 7, including available electronic health record data, and included 8,714 individuals (mean age, 49 years, 54.5% women, 25.2% Black) enrolled between May 2018 and July 2022.
All eligible individuals had a previously established TBI diagnosis based on diagnostic codes and at least one EHR, along with additional criteria from the CDC, the U.S. Department of Defense and clinical expertise.
Age of TBI was determined by the index date of the injury, while severity of TBI was measured by the Abbreviated Injury Score (AIS) with serious injury marked as a score of three and higher and less serious injury less than three.
The study’s primary outcome was incident NPDs following TBI grouped into 10 diagnostic clusters (schizophrenia and other psychiatric disorders; any mood disorders; PTSD; sleep disorders; substance use disorders; suicide attempt or ideation; dementia; headache disorders and seizure disorders.
Social determinants of neuropsychiatric health were expressed via the social deprivation index (SDI), while risk was expressed in adjusted hazard ratios with 95% confidence intervals.
Results showed white participants had a lower adjusted risk for schizophrenia or other psychotic disorders (aHR = 0.49; 95% CI: 0.35-0.69), PTSD, (aHR = 0.67; 95% CI: 0.52-0.86), substance use disorders (aHR = 0.51; 95% CI: 0.42-0.62) and headache disorders (aHR = 0.78; 95% CI: 0.67-0.91) compared with Black individuals.
The researchers reported that higher SDI was associated with an increased risk for schizophrenia and other psychotic disorders (HR = 12.64; 95% CI: 4.51-35.46) and substance use disorders (HR = 9.7; 95% CI: 5.27-17.86).
Higher SDI was additionally associated with suicidal ideation and suicide attempt, along with headache and seizure disorders. Conversely, lower SDI was associated with an increased risk for sleep disorders as well as a risk for anxiety disorders.
Data further showed that models accounting for selection bias revealed a lower adjusted likelihood of schizophrenia or other psychotic disorders and headache disorders among white participants.
Additionally, Bigdeli and colleagues found that higher social deprivation was associated with lower likelihood of mood disorders, anxiety, PTSD, dementia and headache disorders, but was associated with a higher likelihood of sleep disorders.
Data further showed that white participants were older than Black counterparts at the time of index TBI, with lower SDI observed in white vs. Black participants.
“Clinically, the observed racial disparities in risk argue for tailored post-TBI screening, follow-up and resource allocation that incorporate psychosocial modifiers of patients’ outcome trajectories,” Bigdeli said.
For more information:
Tim B. Bigdeli, PhD, can be reached at neurology@healio.com.
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