Mental Health
While a concussion can be physically taxing, it can also result in a greater mental and emotional burden. These emotional and psychological symptoms can have a large impact on concussion patients’ quality of life following a concussion. As such, it is important to consider factors that might contribute to worse mental health, as well as strategies and treatment options that can help eliminate or reduce these symptoms.
Does this page apply to me?
The Rivermead Post-Concussion Symptoms Questionnaire tests concussion patients on the possible presence of a range of symptoms following their concussion. The following questions are adapted from the mental health symptoms mentioned in this questionnaire:
Compared with before your concussion, do you feel significantly more irritable or easily angered?
Compared with before your concussion, do you feel significantly more depressed or tearful?
Compared with before your concussion, do you feel significantly more frustrated or impatient?
If you answered yes to any of these questions, this page may be a helpful resource in understanding how your concussion might be impacting your mental health, as well as finding ways to improve or eliminate your symptoms.
How might a concussion impact my mental health?
Mood swings: sudden, intense shifts in mood, or moods that seem out of place (e.g. feeling angry for no reason, crying unexpectedly)
Irritability: feeling easily frustrated or upset, agitated, impatient
Anxiety: feelings of worry or fear that can be generalized or specific to a situation
Depression: feelings of sadness, hopelessness, emptiness, or a loss of interest or pleasure in normal activities
Post-Traumatic Stress Disorder (PTSD): recurrent nightmares or flashbacks, feelings of withdrawal or isolation, feelings of sadness or hopelessness, frequent thoughts about harming self/others or death
Suicidal ideation: thinking about, considering, or planning to take your own life
These mental health symptoms can be new, or they can be pre-existing symptoms that have worsened as a result of the concussion.
What are some factors that might influence mental health symptoms?
Stress
Increased stress often has a detrimental effect on mental health. Unfortunately, dealing with the complications following a concussion can result in increased stress levels. Uncertainty about how to resolve symptoms or find treatment can create a cycle of frustration and worry, which may be compounded by legal or insurance issues surrounding the concussion event. Feeling overwhelmed or incapable of dealing with medical, social, or financial complications has the potential to worsen mental health symptoms following a concussion.
Loss of Function/Loss of Identity
Concussions often lead to feelings of isolation and disconnection, which can negatively affect mental health.
Sports
A study interviewing hockey players found that athletes struggle to re-evaluate their identity in the absence of being able to play their sport. In addition, as mental toughness forms a core part of athlete identity, many of the interviewed players said that they would be perceived as weak if they admitted to having a mental illness following their concussion. The study also found that individuals who received empathy and validation were able to reconstruct their sense of identity with new goals and activities, which ultimately helped them gain acceptance and emerge stronger from their experience with concussions.
A sense of urgency to return to normal activities may motivate individuals who have experienced a concussion event to rush the healing process. Athletes might hide or minimize their symptoms in order to return to play as soon as possible.
School and Work
In terms of school and work, financial and social pressures may increase feelings of anxiety and stress associated with physical or cognitive symptoms. Not being able to carry out necessary daily activities or obligations has the potential to further worsen mental health symptoms. As such, finding appropriate accommodations and a strong support system can go a long way toward facilitating recovery.
Lack of Empathy and Support From Others
Given the lack of common knowledge about post-concussion symptoms and the absence of visible indicators of a problem, many concussion patients feel like their experience is not understood by those around them. Consequently, they feel like their struggle is not valid in the eyes of others, which can be incredibly isolating. Therefore, receiving empathy and support from others is crucial.
This topic is further explored on The Invisible Injury page.
Sleep Problems
Good sleep is crucial for the immune system, memory, mental health, and general functioning. Sleep deprivation and poor sleep (e.g. waking up frequently, not feeling rested) can exacerbate pain, cause memory problems, and lead to emotional disturbances. Since insomnia is often experienced following a concussion (see our page on Persistent Symptoms After Concussion), it is important to be aware of how insufficient sleep might impact mood and mental health.
The Sleep page and the Cognitive Behavioral Therapy page have more information on sleep and sleep disorders related to concussions.
Other Concussion Symptoms
Feedback Loops
Post-concussion symptoms can worsen mental health; similarly, mental health symptoms can worsen concussion symptoms. For example, post-concussion cognitive problems can produce feelings of anxiety, which can subsequently increase difficulties falling asleep. In addition, frustration with new physical or cognitive limitations and fear of the unknown can lead to feelings of anxiety or depression.
Catastrophization and Limiting Behavior
Research suggests that catastrophization (the tendency to exaggerate the severity of an event or experience) and limiting behavior (an aversion to engaging in activities) are two specific behaviors that facilitate the connection between anxiety and post-concussion symptoms. Engaging in these two behaviors is likely to make an individual more susceptible to higher levels of anxiety and more debilitating symptoms.
More information on how feedback loops and catastrophization can be addressed through therapeutic practice can be found on the Cognitive Behavioral Therapy page.
History of Mental Health Problems
A study involving 1,155 patients with concussions and 230 patients with non-head orthopedic injuries found that patients with concussions were more likely to report major depressive symptoms and/or PTSD in the 3-6 months after injury. In particular, having a preexisting mental health problem was an exceptionally strong risk factor for the appearance of PTSD or depression post-concussion. In some cases, the concussion event can result in the continuation or worsening of a pre-existing mental health disorder. However, a concussion can also trigger a new episode of a previous mental health problem.
In addition, a review of the association between pre-concussion mental health problems and clinical outcomes (measurable changes in health or function as a result of medical care) in sports-related concussions demonstrated strong evidence for greater complications in patients with preexisting mental health problems. The study presented a possible link between preexisting mental health problems and worse clinical outcomes, including a longer symptom duration and an extended recovery period.
What populations are at a greater risk for developing these symptoms?
Veterans and Survivors of Intimate Partner Violence
Concussions that involve assault or other violence are much more likely to result in PTSD post-injury (as shown in this study). The prevalence of mental health symptoms is relatively low following sports-related concussions compared with other concussions, as there is a low likelihood of perceiving the injury as potentially life-threatening. In contrast, when the concussion event is more traumatizing, the possibility of mental health symptoms, particularly PTSD, is much greater.
More information on these populations can be found on the Populations page.
Individuals with Pre-existing Mental Health Conditions
See History of Mental Health Problems section above.
What can I do to help myself?
The Concussion Awareness Training Tool (CATT) outlines suggestions for managing mental health during concussion recovery. These self-management techniques suggested by CATT are not all-encompassing and may not work for everyone. In addition, CATT recommends that these techniques are combined with treatment from a licensed health care professional in order to be most successful. The suggested techniques are listed below; for further information, reference the link above.
CATT suggestions:
Light aerobic activity
Deep breathing exercises
Identify symptoms of stress and possible triggers in order to find ways to reduce stress levels
Meditation
Progressive muscle relaxation (PMR)
Memory aids
More self-management techniques can be found on the Overview of Self-Care page.
Building a support system
A good support system can reduce feelings of isolation and exclusion that can result from physical, cognitive, and emotional symptoms following a concussion. As such, having a solid support system can serve as a protective factor against mental health symptoms. Members of a support system can provide both emotional and practical support by sharing resources and making the affected individual feel more accepted and supported throughout their recovery.
Youth
A study interviewing girls between the ages of 14 and 19 found that social support plays an integral role in concussion recovery by decreasing anxiety, increasing feelings of social inclusion, and providing validation for their invisible injury. Based on a series of interviews, the study recommended the following methods of support:
School accommodations: Accommodations are most helpful when they are determined in a collaborative process involving parents, teachers, school administrators, guidance counselors, and clinicians working with the affected youth to address their specific needs. Often, this process is limited by a lack of knowledge regarding concussion symptoms, requests for formal medical documentation, and unwillingness on the part of schools to trust the account of the student. In addition, concussion patients often struggle to advocate for themselves, and people in their support system often don’t know how to advocate on their behalf.
Close friends: Close friends have been shown to provide the primary source of emotional support. Given their presence in the school setting, friends can help the affected individual feel more accepted and limit feelings of social isolation. Our Personal Stories page focuses on the social impact of concussions and highlights the importance of validation from close friends.
Parents: Parents are crucial for practical support of their child following a concussion. Given their power as an adult, they can access healthcare and concussion resources, drive their child to appointments, and convey a stronger sense of credibility in school settings while advocating for accommodations. We recommend the CATT Concussion Resources for Parents & Caregivers, which includes a section on Return to Learn protocols. In addition, adults can provide emotional support and validation that can help ease the toll on their child’s mental health.
Youth with a personal history of concussion: Peers that have gone through a similar experience are more equipped to empathize with their experience and share personal stories that make the youth feel validated. In addition, given their personal experience, they are often able to anticipate and address post-concussion needs.
Adults
Given that concussion recovery can be an isolating experience, taking advantage of online support groups can be a great way to avoid feeling alone and hopeless. Some online support groups focus more generally on people dealing with concussion and post-concussion symptoms. Other groups are focused on specific populations, such as women or veterans. Our blog post on Where to find online support provides specific links to Facebook and Reddit support groups.
In addition, close friends and peers with a personal history of concussion can be a vital part of a concussion patient’s support system. Having people close by that understand one’s physical, cognitive, and emotional limitations can reduce feelings of isolation and increase feelings of validation and acceptance.
Finding a provider
Ideally, a concussion patient will see a mental health provider who is familiar with concussions and persisting symptoms after concussion. These providers may be psychologists, clinical neuropsychologists, or therapists with an MSW.
Outpatient rehabilitation centers usually have several of these types of mental health providers, and, since outpatient rehabilitation centers commonly work with traumatic brain injury, including concussion, they will be familiar with working with concussion patients.
Cognitive Behavioral Therapy (CBT) is one evidence-based therapy for concussion patients, so looking for a healthcare provider with training in CBT would be one avenue.
We have several sections on our website that will help find providers:
Finding more resources
Building support groups and implementing self-management techniques can be very beneficial in dealing with mental health symptoms. However, seeking help from professionals is often necessary. Included below is a list of possible treatment options that have been shown to be effective in treating mental health symptoms:
Cognitive Behavioral Therapy (CBT): information about how CBT works and where to find a therapist that practices CBT can be found on our Cognitive Behavioral Therapy page.
Medication: Psychiatrists can prescribe serotonin reuptake inhibitors (SSRIs), which can be helpful for depression and anxiety. Specific information about the use of SSRIs following a concussion, as well as other medication options, can be found on the Medication page.
CBD: Some research indicates that CBD can be used to treat anxiety that may result from a concussion event. Further information about the effectiveness of CBD for concussion treatment can be found on the CBD page.
Related articles from our blog
A recent study in the Journal of Athletic Training explored the role of mental health in predicting lower extremity musculoskeletal injuries (LE MSK) after sports-related concussions in NCAA student-athletes. Previous research has found that the rate of LE MSK is elevated post-concussion, although the cause of this increased rate is unknown. In addition, poorer mental health is common post-concussion.