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• Posted March 9, 2022

Odds for Mental Illness Rise in Kids After Concussion

Kids who've suffered a concussion are at heightened risk of mental health issues in the aftermath, a large new study suggests.

The researchers found that compared with their peers, children and teenagers with a past concussion were 39% more likely to be diagnosed with a mental health condition - including anxiety disorders, depression and behavioral disorders. They were also at greater risk of inflicting self-injuries.

Experts stressed that most kids with concussions fully recover, and the findings are not cause for alarm.

Instead, they said, the study underscores the importance of taking concussions seriously, and paying attention to kids' mental health afterward.

"The association between concussion and mental health outcomes is seen in some kids - not all," said lead researcher Andree-Anne Ledoux, of the Children's Hospital of Eastern Ontario Research Institute, in Ottawa, Canada.

For families, she said, it's important to be aware that mental health problems can arise after a concussion. If they notice any "worrying indicators," Ledoux said, they can talk to their health care provider.

Doctors, meanwhile, should screen kids for mental health issues during their concussion follow-up care, she added.

A concussion happens when a blow or jolt to the head makes the brain move rapidly back and forth within the skull. It can cause various immediate symptoms, like headache, confusion, dizziness and a general sense of feeling unwell.

Most kids with a concussion feel better within a couple of weeks, according to the U.S. Centers for Disease Control and Prevention. But some have prolonged "post-concussion" symptoms that may last months - including headaches, sleep problems, and difficulty with memory and concentration.

Studies have also found that kids can suffer from mental health problems, such as depression and anxiety disorders, in the aftermath of a concussion.

The new findings should bring further attention to those issues, said Talin Babikian, a clinical neuropsychologist at the University of California, Los Angeles.

Babikian emphasized that when kids have a single, uncomplicated concussion, the injury is usually "time-limited."

And when they do develop mental health symptoms afterward, she said, it is likely often related to disruptions in their lives: For some kids, having to curtail sports for a while, or be less engaged in their usual activities, can be distressing.

In some other cases, Babikian noted, kids might have symptoms of post-traumatic stress - if, for example, they sustained the concussion in a car accident.

She said it's important that families receive accurate information about concussion recovery. That's not only so they know what kinds of symptoms can persist or come up, but also to keep things in perspective.

Babikian wrote an editorial accompanying the study, which was published online March 7 in JAMA Network Open.

The findings are based on medical records from nearly 449,000 Ontario children and teens, aged 5 to 18. More than 152,000 had sustained a concussion, while the rest were treated for an orthopedic injury. None had a history of treatment for a mental health condition, or for a previous concussion within the past five years.

Ledoux's team looked at rates of mental health diagnoses, self-injury, psychiatric hospitalization and suicide in the two groups - anywhere from one month to 10 years after the physical injury.

The investigators found that, with the exception of suicide, kids with concussions were at relatively higher risk than their peers.

Around 11% a year were diagnosed with a mental health condition, versus about 8% of kids with orthopedic injuries. Both self-harm and psychiatric hospitalization were much less common, affecting both groups at a rate of less than 1% per year. But again, kids with concussion were at relatively greater risk.

It can be complicated, Ledoux noted, to distinguish post-concussion symptoms from a new-onset mental health condition. Based on the data they had, her team could not tell whether some kids with a mental health diagnosis might have had post-concussion syndrome.

The researchers are not sure why only certain kids develop mental health symptoms after a concussion.

"But," Babikian said, "concussion or not, there are some key ingredients that support kids' mental health."

One, she said, is having a sense of safety and "agency," while another is a feeling of belonging and engagement with peers. It's important, Babikian said, to help kids safely get back to their normal routines after a concussion, to avoid withdrawal or "deconditioning."

And given the importance of social engagement and exercise, no one is saying kids should be kept out of sports or physical activities in the name of concussion prevention.

"We need to take concussions seriously," Babikian said. "But that needs to be balanced by recognizing the benefits of engagement with life."

More information

The U.S. Centers for Disease Control and Prevention has more on preventing and managing concussion.

SOURCES: Andree-Anne Ledoux, PhD, scientist, Children's Hospital of Eastern Ontario Research Institute, and assistant professor, department of cellular molecular medicine, University of Ottawa, Ontario, Canada; Talin Babikian, PhD, clinical neuropsychologist, associate director, UCLA Steve Tisch BrainSPORT Program, David Geffen School of Medicine, University of California, Los Angeles; JAMA Network Open, March 7, 2022, online