Concussion may increase risk for mental health issues in youth

Concussion was linked to increased risk for mental health issues, psychiatric hospitalization and self-harm among youths aged 5 to 18 years, according to results of a population-based retrospective cohort study.

“Few studies have rigorously examined associations between concussion and risk of psychopathology, new onset of psychiatric disorders or long-term [mental health problems],” Andrée-Anne Ledoux, PhD, of the Children’s Hospital of Eastern Ontario Research Institute in Canada, and colleagues wrote.

“The studies that investigated these associations lacked adequate sample size; had heterogeneous population samples, including more severe [traumatic brain injuries]; or had small or no comparison groups.

“Some studies did not adjust for important covariates, such as prior [mental health problem], making it difficult to discern whether concussions precipitated new mental health symptoms or psychiatric disorders.”

Ledoux and colleagues aimed to examine links between concussion and risk for subsequent mental health problems, psychiatric hospitalizations, self-harm or suicides among youth with a concussion or orthopedic injury that occurred between April 1, 2010, and March 31, 2020, in Ontario. Participants did not have a prior mental health visit in the year before the index event, as well as no prior concussion or traumatic brain injuries in the 5 years before the index visit.

Researchers collected data from provincewide health administrative databases and included participants with concussion (n = 152,321; median age, 13 years; 56.7% male) in the exposed group and those with an orthopedic injury (n = 296,482; median age, 13 years; 57.9% male) in the comparison cohort.

Researchers matched these groups in a 1:2 ratio, respectively, on age and sex. Mental health problems, including psychopathologies and psychiatric disorders, identified from health care visits in EDs, hospitalizations or primary care settings, served as the primary outcome. Psychiatric hospitalizations, self-harm health care visits and death by suicide served as secondary outcomes.

Results showed incidence rates of any mental health problem of 11,141 per 100,000 person-years in the exposed group compared with 7,960 per 100,000 person-years in the unexposed group, with a difference of 3,181 (95% CI, 3,073-3,291) per 100,000 person-years.

Among the exposed group, researchers noted an increased risk for developing a mental health issue (adjusted HR = 1.39; 95% CI, 1.37-1.4), self-harm (aHR = 1.49; 95% CI, 1.42-1.56) and psychiatric hospitalization (aHR = 1.47; 95% CI, 1.41-1.53) after a concussion. They observed no statistically significant difference in death by suicide between exposed and unexposed groups (HR = 1.54; 95% CI, 0.9-2.61).

“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,” Ledoux and colleagues wrote.

In a related editorial, Talin Babikian, PhD, ABPP, of the department of psychiatry and biobehavioral sciences at the University of California, Los Angeles, highlighted the takeaways of this study.

“When drawing on the literature on risk and protective factors associated with mental health, the potent common denominators that percolate to the top and have strong relevance in concussion management include a sense of safety and agency and sense of connection and belonging,” Babikian wrote. “Studies, such as the one presented by Ledoux et al, strengthen the association between mental health and concussion — and likely any other major disruption to a young person’s physiology and environment. The good news is that we are acknowledging this risk and paying attention.”

References:

• Ledoux AA, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.1235.
• Babikian T. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.1242.