Henry Xiang, MD, PhD, links pediatric TBI to mental health risks

In this discussion, Henry Xiang, MD, PhD, MPH, MBA, director of research for the Center for Injury Research and Policy at Nationwide Children’s Hospital, addresses key clinical and research considerations related to pediatric traumatic brain injury (TBI), particularly its long-term physical and mental health consequences.

He emphasizes that children with a history of TBI face significantly increased risks of persistent headaches, chronic pain, anxiety, and depression, outcomes that are often underrecognized in routine care. A central recommendation is the importance of thorough clinical history-taking. When children present with ongoing headaches or chronic pain, clinicians should actively inquire about prior TBIs.

Establishing this connection is critical for accurately attributing symptoms to earlier injury and guiding appropriate management strategies. Without this linkage, persistent physical sequelae may be overlooked or misattributed, delaying effective treatment.

Xiang also discusses the study’s exclusion of children with neurodevelopmental or psychiatric comorbidities, noting that while this approach allowed for clearer analysis, it does not fully reflect real-world pediatric populations. He outlines plans for future research that will include these children in a more complex 4-group comparison model to examine outcomes among children with and without TBI, with and without comorbidities. The hypothesis is that children with both TBI and comorbid conditions will experience even greater risks of adverse outcomes, including depression, anxiety, and chronic pain, because of additive or interacting effects.

Regarding mental health screening, Xiang underscores the value of integrating established tools into routine pediatric care following TBI. While specific instruments are not detailed, he highlights that many health care settings already have screening protocols in place for anxiety and depression. He also stresses the role of caregivers, encouraging them to remain vigilant for warning signs and to seek professional evaluation when concerns arise. Early identification is key to mitigating long-term psychological effects.

Finally, Xiang addresses the emerging role of family-focused interventions. Although no definitive, evidence-based family-centered rehabilitation model exists specifically for pediatric TBI, he notes growing interest in the concept of family resilience. His team’s research suggests that family resilience may serve a protective role, helping reduce the risk of mental health issues in affected children.

While existing digital and online interventions offer support for coping and adaptation, they do not explicitly target family resilience as a core framework. Xiang positions this work as an important first step in highlighting the need for integrated approaches that combine medical care with family-centered support systems to improve long-term outcomes after pediatric TBI.

No relevant disclosures.

Reference

Zhou Z, Sullivan L, Qian R, et al. Family resilience and mental and physical health sequelae of pediatric TBI in youths. JAMA Netw Open. 2026;9(4):e269222. doi:10.1001/jamanetworkopen.2026.9222