Concussions linked to mental health problems in children
A concussion in children was associated with an increased risk of mental health problems compared to orthopedic injuries, according to a 10-year retrospective cohort study conducted in Canada.
Among more than 400,000 young people aged 5 to 18, those who had suffered a concussion were at higher risk of mental health problems (adjusted RR [aHR] 1.39, 95% CI 1.37-1.40), as well as self-harm (aHR 1.49, 95% CI 1.42-1.56) and psychiatric hospitalization (aHR 1.47 , 95% CI 1.41-1.53), reported Andrée-Anne Ledoux, PhD, of the Children’s Hospital of Eastern Ontario Research Institute and colleagues.
The incidence rate of any mental health condition was 11,141 per 100,000 person-years in the concussion group versus 7,960 per 100,000 person-years in the orthopedic injury group, they noted in Open JAMA Network.
“Our results suggest that during concussion follow-up visits, physicians should assess patients’ mental health,” Ledoux and colleagues wrote. “Collaborative care and mental health treatment have been found to improve outcomes for pediatric concussions with chronic symptoms.”
Although one in five Canadian children has a mental health disorder, this proportion was higher among children in both study groups. “This may be due to differences in the timing and method of identifying and/or defining mental health problems,” the authors suggested. “It may also reflect the mutual experience of trauma, as it has been reported that people with orthopedic injuries may have lasting behavioral changes after injury.”
“A study of this magnitude highlights associations between concussions and mental health, but also raises important unanswered questions,” wrote Talin Babikian, PhD, of the University of California, Los Angeles, in a guest comment. Despite growing public health concerns about the long-term effects of concussions, “the mechanism for this increased risk remains largely elusive.”
Babikian warned of a “dichotomy trap” when discussing the role of concussions in increasing mental health problems in young people, with “an artificial divide between mental and physical, psychological versus neurological and organic versus environmental”.
“These divisions are largely remnants of the historical conditioning of our training paradigms,” she explained. “In reality, all these references characterize the same system: our complex nervous system.
“Young people arrive at a concussion not as a blank slate, but rather as a tapestry of risk and resilience – personal, family and environmental,” Babikian noted. Therefore, when managing a concussion, it is important to maintain a “sense of safety and agency” and a “sense of connection and belonging”.
The study compared 152,321 children (median age 13 years, 56.7% boys) who suffered a concussion to 296,482 who suffered an orthopedic injury (median age 13 years, 57.9% boys) d April 2010 to March 2020 in Ontario, Canada.
“Orthopedic injuries were found to be a good comparison group, as they shared injury-related experiences (e.g., ER visit, pain, injury-related stress) and premorbid characteristics,” Ledoux and his team noted.
If a patient had more than one concussion or orthopedic injury, the first incident diagnosed was included in the study. Children were excluded from the study if they had not had continuous OHIP coverage in the 5 years prior to the index injury event, or if they had a mental health diagnosis in the year prior to the event or a mental health diagnosis code during their index visit.
The study authors acknowledged that their retrospective observational design was an “inherent weakness” in the study. They also noted that their study relied on diagnostic codes and administrative databases, which can introduce misclassifications and does not account for all mental health services provided.
This study was supported by ICES, a not-for-profit research institute whose legal status under Ontario’s Personal Health Information Protection Act allows it to collect and analyze healthcare data. health and demographic data, without consent, for the purposes of evaluating and improving the health system.
Ledoux did not report any disclosures. One study author said he received research grants from the National Football League’s Scientific Advisory Board, sits on the Concussion Advisory Board of Parachute Canada (a non-profit injury prevention charity ) and be the co-founder, chief scientific officer and a minority shareholder of 360 Concussion. Care.
Babikian did not report any disclosures