Risk of mental health problems in children, teens following concussion

Doctors should assess for pre-existing and new mental health symptoms throughout concussion recovery, the researchers say.
Photo by Kentish Plumber

Concussions among young people carry an increased risk of mental health issues, psychiatric hospitalization and self-harm compared to those who experienced an orthopedic injury, researchers have found.

The major Canadian study centered on 448,000 young people in Ontario aged 5 to 18 who had experienced either a concussion or orthopedic injury between April 1, 2010, and March 31, 2020.

Andrée-Anne Ledoux and her fellow researchers, writing in the journal JAMA Network Open, found that children and youths who had sustained a concussion had a 40% increased risk of developing a mental health issue compared with age and sex-matched individuals with an orthopedic injury.

A total of 152,321 of the youngsters had received a concussion while 296,482 had experienced an orthopedic injury.

The incidence rates of any mental health problem were 11,141 per 100,000 person-years among the concussion group, and 7960 per 100,000 person-years among the orthopedic group.

The concussion group had an increased risk of developing a mental health issue, self-harm or psychiatric hospitalization. There was no statistically significant difference in death by suicide between the two groups.

Discussing their findings, the authors noted that pre-concussion mental health has been identified as strongly associated with post-injury mental health problems.

“It is postulated,” they said, “that concussion exacerbates pre-injury mental health problems.

“Our study found that, compared with an orthopedic injury group, rates of post-concussion mental health visits were high and were associated with new mental health problems.”

In Ontario, 1 in 5 young people has a mental health disorder, they noted.

“Our findings suggest that during concussion follow-up visits, physicians should assess patients’ mental health,” they said.

“Future studies should examine acute management protocols and strategies for reducing the risks of later mental health disorders among patients with concussion.”

Young people who incurred a concussion were at three times higher risk of sustaining a subsequent concussion. Multiple concussions may increase the likelihood of mental health problems.

The overall results, they said, suggest that clinicians should assess for pre-existing and new mental health symptoms throughout concussion recovery, treat mental health conditions or symptoms or refer the patient to a specialist in pediatric mental health, and assess suicidal thoughts and self-harm behaviors during evaluation and follow-up visits for concussion.

The study team comprised Ledoux, Richard Webster, Anna Clarke, Deshayne Fell, Braden Knight, William Gardner, Paula Cloutier, Clare Gray, Meltem Tuna and Roger Zemek, variously affiliated with the Children’s Hospital of Eastern Ontario and the University of Ottawa.

Ledoux A, Webster RJ, Clarke AE, et al. Risk of Mental Health Problems in Children and Youths Following Concussion. JAMA Netw Open. 2022;5(3):e221235. doi:10.1001/jamanetworkopen.2022.1235

The study, published under a Creative Commons License, can be read here.





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