Concussions associated with higher risk of mental health concerns in kids

By Melissa Couto Zuber
THE CANADIAN PRESS

Children who suffer concussions may be at a 40 per cent increased risk of developing mental health problems, a new study suggests, with researchers urging doctors to pay closer attention to possible mental health symptoms during concussion recovery.

The study, done by scientists at the CHEO Research Institute in Ottawa, examined rates of mental health problems among Ontario children aged five to 18 over a 10-year period, comparing those who developed mental health conditions following a concussion to those who had mental health problems after sustaining orthopedic injuries.

Researchers found that incidence rates of mental health concerns, including psychopathologies, psychiatric disorders and self-harm, were higher among the concussion group.

Researchers conducted the study over the last two years, retrospectively analyzing data from April 1, 2010 to March 31, 2020 to see how many children developed mental health problems following a concussion diagnosis. 

The study was published Monday in JAMA Network Open, a journal published by the American Medical Association.

Neuroscience expert and lead researcher Andrée-Anne Ledoux said the findings suggest that doctors need to assess children for pre-existing and new mental health symptoms throughout concussion recovery and either treat those symptoms or refer the patient to a pediatric mental health specialist. 

The study found “no statistically significant difference” in death by suicide between children who sustained concussions versus those who had orthopedic injuries, noting that was likely due to the low number of deaths by suicide in the population studied. Authors urge doctors to assess suicidal ideation and self-harm behaviors during concussion evaluation and followup visits.

“It’s really extremely important for physicians to screen for mental health, to screen for factors that might predispose the child to mental health problems and to intervene,” Ledoux said. “The earlier we seek help for the child…the earlier the child can recover.” 

Ledoux said the 40 per cent increased risk that the study found was surprisingly high, “but at the same time, not surprising because a concussion does impact your brain.”

She said concussions may contribute to mental health problems in a number of ways, including by triggering biomechanical mechanisms in the brain itself.

But Ledoux said concussion recovery — including each child’s unique situation in dealing with their own concussion — may also contribute to the risk of developing mental health problems.

Family environment could be a factor, she said, noting anxious or depressed parents might influence how a child heals, while one who has more socialization may recover differently.

“(A concussion) is a trauma…and there are numerous symptoms that go with that trauma,” Ledoux said. “Depending on if the child has the coping mechanisms to deal and adapt to that trauma, that will predict how this child recovers from the concussion.”

Ledoux and other researchers have helped put together an online guideline for pediatric concussion care (pedsconcussion.com) that shares resources and tools for health-care professionals diagnosing and managing concussions in children.

She said parents can watch for “worrying indicators,” including behavioural fluctuations and higher levels of anxiety, to determine whether their child has developed a post-concussion mental health problem.

Ledoux said it can be hard to distinguish symptoms of a mental health issue from post-concussion recovery, however, because signs often overlap. She noted it can be normal to experience anxiety and depression following a concussion.

“But where it gets not as normal is when these symptoms persist over time,” she said.  

The study looked at numbers of patients who were diagnosed with a mental health problem after seeking help from either a doctor or an emergency department.

A total of 152,321 children with concussions and 296,482 children with orthopedic injury were included in the study. Children who had sought medical care for a mental health concern in the year before their injury were excluded.

The CHEO Research Institute says the study is the first of its size to look at an association between concussions and subsequent mental health issues in children.

The median age of both the concussion group and the orthopedic injury group was 13, and each had more male participants (approximately 57 per cent) than female.

The mental health conditions researchers observed included anxiety and neurotic disorders, adjustment reactions, behavioural disorders, mood and eating disorders, schizophrenia, substance use disorder, suicidal ideation, and disorders of psychological development.

Secondary outcomes that were assessed included self-harm, psychiatric hospitalization, and death by suicide.

The study says concussions may “exacerbate existing mental health issues,” adding that “little evidence exists on whether concussion is associated with the onset of new psychopathologies or long-term mental health problems.”