Led by researchers at the CHEO Research Institute, the population-based retrospective cohort study was published by JAMA Network Open on March 7, 2022, indicates that young people who sustain a concussion are at a 40% higher risk of mental health issues, psychiatric hospitalization, and self-harm compared to those who sustain an orthopaedic injury.
“This study shows that concussions can be much more than a physical head injury, there can be long-term emotional and cognitive impacts on a child’s life that we have to be mindful of and help address,” said Dr. Andrée-Anne Ledoux, the study’s lead author and a scientist at the CHEO Research Institute, a pediatric health-care and research centre in Ottawa, Canada.
This is the first study of its size and length of time to examine the association between a concussion and subsequent mental health issues amongst children and youth with no prior mental health visit in the year before their injury. The study compared two cohorts made up of 1) 152,321 children and youth with concussion, and 2) 296,482 children and youth with orthopaedic injury, excluding anyone who had a mental health visit within the previous year. It found that primary outcomes of mental health conditions such as anxiety and neurotic disorders, adjustment reactions, behavioural disorders, mood and eating disorders, schizophrenia, substance use disorder, suicidal ideation, and disorders of psychological development were more prevalent in the concussion cohort than the orthopaedic group. Secondary outcomes in the concussion cohort included self-harm, psychiatric hospital and death by suicide.
“During concussion follow-up visits, it’s extremely important for physicians to screen for mental health issues and factors that might predispose children to a mental health problem. By intervening early and providing children and adolescents with the right tools to cope and adapt to the trauma and symptoms of a concussion, we can help them become more resilient and prevent the impacts of long-term mental health issues,” said Ledoux, who is also an assistant professor at the University of Ottawa.
Consistent with smaller cohort studies, Ledoux’s study found that concussions were associated with a significantly increased risk of self-harm. In contrast to some other studies, it did not find a significantly higher risk of suicide, which was likely due to the low number of deaths by suicide in the population studied. Despite not being statistically significant, it is clinically relevant that the concussion group studied had approximately twice the incidence rate of suicide, again signalling the importance of thorough post-concussion monitoring for mental health issues.
“Knowing there is an increased risk for children and youth to develop mental health issues postconcussion, parents can be on the lookout for worrying indicators and be open to speaking with their child about what they are feeling and experiencing. Together, they can seek out the appropriate tools and care from a physician or a mental health specialist,” said Ledoux.
Reference: Ledoux, A.-A., Webster, R.J., Clark, A., Fell, D., Knight, B.D., Gardner, W., Cloutier, P., Gray, C., Tuna, M., Zemek, R. Mental Health Outcomes in Children and Youths Following a Concussion. JAMA Netw Open. 2022;5(3):e221235. doi:10.1001/jamanetworkopen.2022.1235
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