Children and adolescents with concussion at 40% higher risk for mental health issues than peers with orthopedic injury

By Sam Kanny. This article was initially published in our Concussion Update newsletter; please consider subscribing.

In a recent study published by JAMA Network Open, researchers at the CHEO Research Institute found that children and adolescents who sustain a concussion are at an increased risk of developing mental health issues. The results indicated that "young people who sustain a concussion are at a 40% higher risk of mental health issues, psychiatric hospitalization, and self-harm compared to those who sustain an orthopedic injury". This study is the first of its size and scope to investigate children and adolescents with no prior mental health visits and examine the association between a concussion and subsequent mental health problems. 

Authors Andrée-Anne Ledoux et al. conducted a 10-year, population-based retrospective cohort study of youth ages 5-18 across Ontario. The study compared 296,482 patients with orthopedic injury with 152,321 patients with concussion, excluding anyone from the two groups who had a mental health visit within the previous year. Patients in the 'concussion' group were more likely than those in the 'orthopedic' group to develop mental health issues such as "anxiety and neurotic disorders, adjustment reactions, behavioral disorders, mood and eating disorders, schizophrenia, substance use disorder, suicidal ideation, and disorders of psychological development."

Additionally, mental health problems such as self-harm and psychiatric hospitalization were significantly more prevalent in the concussion cohort group. The authors did not find a statistically significant change in the suicide rate, possibly due to the low number of suicides, but "it is clinically relevant that the concussion group had approximately twice the incidence rate of suicide." 

The study concludes that physicians should screen for "pre-existing and new mental health symptoms" when conducting initial concussion and follow-up visits––including assessing for suicidal and self-harm behaviors and treating or referring patients to specialty pediatric mental health providers. The authors note that "collaborative care and mental health treatment improve outcomes in pediatric concussion with chronic symptoms."

Concussion Alliance would like to note the following: 

The results from this study indicate the importance of monitoring children and adolescents during the concussion recovery process. Parents can support their children by being watchful for concerning indicators and creating a space that allows their children to speak openly about how they are feeling or what they are going through.

Providers can be instrumental in the early identification of problems and intervening to give children and adolescents the tools they need to cope with the trauma and symptoms of a concussion. By providing young people the skills to understand and deal with the possible mental health symptoms caused by a concussion, providers can help lessen or prevent the impacts of long-term mental issues.