According to a recent study, children who sustained concussions or traumatic brain injuries (TBI) may experience anxiety, phobias, and depression years later.

Lead author Michelle Albicini, a researcher at Monash University School of Psychological Sciences in Melbourne, Australia, says that the study suggests that brain injury is related to long-term anxiety symptoms. The anxiety may be caused by actual brain damage or the result of living in an anxious family environment after the injury, said Albicini.

Albicini’s team found that children with moderately severe brain injuries and females in general were at greater risk for long-term psychological effects compared with males and those children who sustained milder brain injuries.

To better understand the long-term psychological effects faced by people who sustain TBI during childhood, the researchers recruited young adults who had been treated at a hospital for TBI five or more years earlier, when they were younger than 18 years old. For comparison, the researchers also recruited a similar group of adults who were treated for childhood orthopedic injuries who had no history of brain injury.

Among the participants with childhood brain injury, 65 had mild injuries involving loss of consciousness for less than 20 minutes, little or no amnesia, a hospital stay of less than 48 hours and normal brain scans. Another 61 participants had moderate to severe brain injuries involving longer hospital stays, more severe or longer lasting symptoms and skull fractures or other physical evidence of brain injury that could be seen on a scan.

The average age at injury for study participants with mild TBI and those with orthopedic injuries was 10 to 11. The average age at injury of study of participants with more-severe TBI was 7. For most study participants, it had been at least 10 years since the injury occurred.

Each participant met with a psychologist for diagnostic interviews to screen for various psychological disorders including generalized anxiety disorder, panic attacks, phobias, and depression. The researchers found that compared to people with no brain injuries, those with any type of TBI were five times more likely to have an anxiety disorder, and four times more likely to suffer from panic attacks, specific phobias and depression. Those with moderate-severe TBIs had the highest overall rates of anxiety disorders and were most likely to suffer from multiple anxiety disorders.

Dr. Jeffrey Max, a psychiatry professor at the University of California, San Diego (who was not involved in the study), commented that the results “emphasize the need to monitor children and adolescents for the development of anxiety disorders after they have a TBI.”