Children who sustain even mild traumatic brain injuries have a much higher risk of developing new behavioral health issues –such as depression or obsessive-compulsive disorder – up to four years later, according to a new study.

The study, published last week in Pediatrics, found that kids and adolescents with mild TBIs were at significantly greater risk of having new affective disorders, also known as mood disorders, that cause disruptions in emotion. Bipolar and depressive disorders fall into this category, according to the National Institutes of Health. Children and adolescents also were at much higher risk of developing behavior disorders, such as attention-deficit/hyperactivity disorder or obsessive-compulsive disorder, the study indicated.

The study included more than two million children, age 17 and under, diagnosed with mild traumatic brain injuries at emergency rooms, urgent care clinics and outpatient clinics between 2000 to 2014.

Its results are important, especially because there is such a “high rate of mental health disorders in the background already, and the pandemic has highlighted that,” said Dr. Tina Master, a pediatrician and sports medicine specialist at the Children’s Hospital of Philadelphia with expertise in brain injury medicine. This study revealed that mild TBIs – which represent the majority of TBIs presented annually – may be aggravating the upsurge in depression, anxiety and other behavioral health issues in children since the COVID-19 pandemic hit.

The fact that having a mild TBI can heighten a child’s chance of having a new behavioral health disorder “down the line – that definitely is a concern,” Master said.

“It’s hard to say if there is a direct correlation one-to-one” between mild TBIs and behavioral health issues, Master added. “But there’s probably some interaction with your own history, your medical history and your genetic make-up.”

According to the study, 10-to-13-year-olds were at highest risk for developing new mood and behavioral disorders three years after a mild TBI. All children who had mild TBIs were at significantly higher risk for mood disorders the first three years after injury, especially during the second year, when there was a 34% increased risk. Children were at a 37% higher risk of developing new behavioral disorders, especially during the second and fourth years after injury, the study showed.

After mild TBIs, doctors should screen children initially and on an ongoing basis for new behavioral health issues – such as depression, anxiety or ADHD – that may become chronic and pose “barriers to recovery,” researchers concluded.

A mild TBI or a concussion generally results from a bump, blow or jolt to the head or hit to the body that causes the brain to move quickly back and forth, according to the U.S. Centers for Disease Control and Prevention. Most people probably know someone who has had a mild TBI or concussion or may have even experienced one themselves, Master said.

The word “mild” is a bit of a misnomer, however, because even though they are common, mild TBIs can “have very serious consequences for an individual and a family,” Master said.

Many people do “just fine” after a mild concussion, but it is important for families to follow-up with a primary care doctor or pediatrician after a child has had a mild TBI. Primary care doctors can steer families to specialists for children and adolescents who seem to have ongoing behavioral health issues after their injuries, Master said.

“We want to make sure those people aren’t slipping through the cracks.”