Concussed students prone to violence, but causal link is missing

Students who experienced a concussion were more likely to engage in potentially risky and dangerous behaviors than their peers who were not concussed, an analysis showed. However, researchers could not establish causality.

“We are not able to make conclusions about a causal link between sports- and physical activity-related concussions and violence based on this study,” Juliet Haarbauer-Krupa, PhD, a senior health scientist in the CDC’s Division of Injury Prevention, told Healio Primary Care.

However, the findings are “consistent with similar previous research out of Canada that surveyed students about [traumatic brain injury] and school violence-related behaviors,” she said.

Haarbauer-Krupa and colleagues analyzed data from 14,765 U.S. high school students who completed the 2017 National Youth Risk Behavior Survey. That year, for the first time, the survey included questions about the frequency of sports- and physical activity-related concussions in the previous 12 months, according to the researchers.

The results, published in the American Journal of Preventive Medicine, showed that 17.1% of male students and 13% of female students experienced a concussion in the past 12 months. Compared with students who did not have a concussion, those who experienced one or more sports- and physical activity-related concussions were more likely to engage in a physical fight outside school (adjusted prevalence ratio [APR] for male students = 1.45; 95% CI, 1.3-1.62; APR for female students = 1.55; 95% CI, 1.25-1.91); carry a weapon outside school (APR for male students = 1.24; 95% CI, 1.06-1.45; APR for female students = 1.79; 95% CI, 1.3-2.47); and fight at school (APR of male students = 1.4; 95% CI, 1.08-1.8; APR for female students = 1.77; 95% CI, 1.19-2.61).

Researchers also found that compared with female students who were concussed, male students who experienced a concussion were more likely to carry a gun (APR = 1.62; 95% CI, 1.4-2.29) and carry a weapon at school (APR =1.73; 95% CI, 1.08-2.75.

“Our findings highlight the need to monitor students in the post-recovery phase after a concussion,” Haarbauer-Krupa said. “It is important for health care providers to collaborate with parents and schools to support students who sustain a concussion as they return to school and other activities.”

The CDC’s website has resources that can help clinicians and parents in this area, she said.

Additional research is needed to establish with certainty that concussions lead to potentially risky or dangerous behaviors, Haarbauer-Krupa said.

Data from “longitudinal samples would be helpful for assessing the temporal sequencing and could potentially shed light on the factors that exacerbate risk for violence among youth with sports- and physical activity related concussion,” she said. “It would be important to have robust baseline data on potential contributing factors and then follow youth over time following their sports- and physical activity related concussion to see which factors distinguish those who engage in violence.”