Concussion and Mental Health in Children and Youths

Canada: Concussion in children and youths aged 5 to 18 years is associated with an increased risk of mental health problems compared with their counterparts with an orthopedic injury, reveals a 10-year retrospective cohort study. The study was published in JAMA Network Open on March 7, 2022.

In the pediatric population, concussions are a serious concern that may exacerbate mental health issues. The extent to which a concussion increases the later risk of psychopathology or new onset of psychiatric disorders is not clear. To get clarity on the topic, Andrée-Anne Ledoux, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada, and colleagues aimed to investigate associations between concussion and risk of subsequent mental health issues, self-harm, psychiatric hospitalizations, or suicides in a population-based retrospective cohort study.

The study included children and youths aged 5 to 18 years with a concussion or orthopedic injury. The subjects had no previous mental health visit in the year before the index event for cohort entry and no prior concussion or traumatic brain injury 5 years before the index visit.

The exposed cohort included participants with concussions and those with an orthopedic injury were included in the comparison cohort; these groups were matched in the ratio of 1:2, respectively, on age and sex. Mental health problems, such as psychopathologies and psychiatric disorders, was the primary outcome.

Key Findings of the Study

• A total of 152,321 children and youths with concussion (median age, 13 years; 86,423 male) and 296,482 children and youths with orthopedic injury (median age, 13 years; 171,563 male) were matched by age and sex.
• 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 3,181 per 100,000 person-years.
• The exposed group had an increased risk of developing a mental health issue (adjusted hazard ratio [aHR], 1.39), self-harm (aHR, 1.49), and psychiatric hospitalization (aHR, 1.47) after a concussion.
• There was no statistically significant difference in death by suicide between exposed and unexposed groups (HR, 1.54).

The researchers conclude, "concussion was associated with an increased risk of mental health visits, psychiatric hospitalization, and self-harm among kids who had sustained a concussion compared with their contemporaries who had sustained an OI."

The researchers, therefore, suggest that clinicians should:

1. Assess for preexisting and new mental health symptoms throughout concussion recovery;
2. Treat mental health conditions or symptoms or refer the patient to a specialist in pediatric mental health;
3. Assess suicidal ideation and self-harm behaviors during evaluation and follow-up visits for concussion.

Reference

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

Keywords

JAMA, concussion, mental health problems, psychiatric disorders, hospitalization, suicide, self-harm, Andree-Anne Ledoux, children, youth, pediatric mental health, suicidal ideation