The Risk of Mental Health Problems are Greater in Children and Youths Following Concussion

A new study shows that, troublingly, among children and youths between the ages of 5 to 18, concussion is linked with an augmented risk of mental health issues, psychiatric hospitalization, and self-harm. The findings were published in JAMA Neurology.

Concussions stand as a significant concern among children. Data show that from 2008 to 2013, rates of pediatric emergency department visits jumped by as much as 4-fold in the U.S. and Canada. While most cases of concussion resolve in two to four weeks, in 30% of cases, symptoms will persist post-concussion, and manifest in physical, emotional, and cognitive ways. As the investigators of this study noted, the extent to which a concussion increases the risk of psychopathology or the new onset of psychiatric disorders is currently unclear.

To elucidate on how concussions affect adolescent mental health, researchers conducted a population-based retrospective cohort study. The study comprised 448,803 children and youths with either concussion or orthopedic injury in Ontario, Canada from April 2010 to March 2020. The population of interest had no previous mental health visit in the year prior to concussion, and no concussion or brain injury in the five years prior to mental health visit.

According to the results, the incidence rates of any mental health problem were 11,141 per 100,000 person-years (exposed group) and 7,960 per 100,000 person-years (unexposed group); with a difference of 3181 (95% CI, 3073-3291) per 100 000 person-years. The researchers observed that children and youths exposed to concussion incurred a greater risk of developing a mental health issues (adjusted hazard ratio [aHR]=1.39; 95% CI, 1.37-1.40), self-harm (aHR=1.49; 95% CI, 1.42-1.56), and psychiatric hospitalization (aHR, 1.47; 95% CI=1.41-1.53) following the event. However, it is notable that the study found no discernible difference in death by suicide between exposed and unexposed groups (HR=1.54; 95% CI, 0.90-2.61).

“Our study found that, compared with an OI group, rates of postconcussion mental health visits were high and were associated with new MHPs. In Ontario, 1 in 5 children and/or youths has a mental health disorder. The proportion of children and youths with an MHP was higher in both of our study groups,” the researchers concluded.

“Our results suggest that clinicians should assess for preexisting 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 ideation and self-harm behaviors during evaluation and follow-up visits for concussion.”