Paediatric traumatic brain injury as a risk factor for psychosis and psychotic symptoms: a systematic review and meta-analysis

Psychosis is one of the most disabling psychiatric disorders. Paediatric traumatic brain injury (pTBI) has been cited as a developmental risk factor for psychosis, however this association has never been assessed meta-analytically. A systematic review and meta-analysis of the association between pTBI and subsequent psychotic disorders/symptoms was performed. The study was pre-registered (CRD42022360772), adopting random-effects model to estimate meta-analytic odds ratio (OR) and 95% confidence interval (CI) using the Sidik-Jonkman method. Subgroup (study location, study design, outcome type, assessment type, and adult verses adolescent onset) and meta-regression (quality of evidence) analyses were also performed. The robustness of findings was assessed through sensitivity analyses. The meta-analysis is available online as a computational notebook with an open dataset. We identified 10 relevant studies and eight were included in the meta-analysis. Based on a pooled sample size of 479,686, it was found that the pooled OR for the association between pTBI and psychosis outcomes was 1.88 (95% CI [1.07, 3.30]). There were no subgroup effects and no outliers identified. The association remained robust after removal of studies with low quality of evidence, however the OR reduced to 1.45 (95% CI [1.02, 2.07]). A leave-one-out sensitivity analysis showed the pooled association changed from marginally significant to marginally non-significant after removal of any one of three studies. In conclusion, we report cautious meta-analytic evidence for a positive association between pTBI and future psychosis. New evidence will be key in determining long-term reliability of this finding.