Risk of Mental Health Problems in Children and Youths Following Concussion

Andrée-Anne Ledoux,Roger Zemek,Anna E Clarke,William Gardner,Paula Cloutier,Richard J Webster,Deshayne B Fell,Clare Gray,Braden D Knight,Meltem Tuna

doi:10.1001/jamanetworkopen.2022.1235

Andrée-Anne Ledoux, Roger Zemek + Show 8 more

Open Access

https://doi.org/10.1001/jamanetworkopen.2022.1235

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Abstract

Concussion may exacerbate existing mental health issues. Little evidence exists on whether concussion is associated with the onset of new psychopathologies or long-term mental health problems. To investigate associations between concussion and risk of subsequent mental health issues, psychiatric hospitalizations, self-harm, or suicides. This population-based retrospective cohort study including children and youths aged 5 to 18 years with a concussion or orthopedic injury incurred between April 1, 2010, and March 31, 2020, in Ontario, Canada. Participants had no previous mental health visit in the year before the index event for cohort entry and no prior concussion or traumatic brain injury 5 years before the index visit. Data were collected from provincewide health administrative databases. Participants with concussion were included in the exposed cohort, and those with an orthopedic injury were included in the comparison cohort; these groups were matched 1:2, respectively, on age and sex. Concussion or orthopedic injury. The primary outcome was mental health problems, such as psychopathologies and psychiatric disorders, identified from health care visits in emergency departments, hospitalizations, or primary care settings. Secondary outcomes were psychiatric hospitalizations, self-harm health care visits, and death by suicide (identified in health care or vital statistics databases). A total of 152 321 children and youths with concussion (median [IQR] age, 13 [10-16] years; 86 423 [56.7%] male) and 296 482 children and youths with orthopedic injury (median [IQR] age, 13 [10-16] years; 171 563 [57.9%] male) were matched by age and sex. The incidence rates of any mental health problem were 11 141 per 100 000 person-years (exposed group) and 7960 per 100 000 person-years (unexposed group); with a difference of 3181 (95% CI, 3073-3291) per 100 000 person-years. The exposed group had an increased risk of developing a mental health issue (adjusted hazard ratio [aHR], 1.39; 95% CI, 1.37-1.40), 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. There was no statistically significant difference in death by suicide between exposed and unexposed groups (HR, 1.54; 95% CI, 0.90-2.61). Among children and youths aged 5 to 18 years, concussion was associated with an increased risk of mental health issues, psychiatric hospitalization, and self-harm compared with children and youths with an orthopedic injury.

Highlights

Concussions are a serious concern in the pediatric population
The exposed group had an increased risk of developing a mental health issue, self-harm, and psychiatric hospitalization after a concussion
Among children and youths aged 5 to 18 years, concussion was associated with an increased risk of mental health issues, psychiatric hospitalization, and self-harm compared with children and youths with an orthopedic injury

Summary

Introduction

Concussions are a serious concern in the pediatric population. In 2013, approximately 640 000 emergency department (ED) visits relating to pediatric traumatic brain injury (TBI; mostly concussion or mild TBI)[1,2] were reported in the United States.[3,4] From 2008 to 2013, rates of pediatric visits to EDs and primary care practitioners for concussion have increased by as much as 4-fold in the United States and Canada.[5-7]. The extent to which a concussion increases the risk of later psychopathology or new onset of psychiatric disorders is unclear. A 2014 systematic review[10] indicated a possible association between mental health problems (MHPs) and short-term recovery in youths who sustained a concussion. In most cases, these psychological, behavioral, and psychiatric problems seemed to resolve within 3 to 4 months.[10-12]. Few studies have rigorously examined associations between concussion and risk of psychopathology, new onset of psychiatric disorders, or long-term MHPs.[32,33]. Some studies did not adjust for important covariates, such as prior MHP,[13,19,23,27,32] making it difficult to discern whether concussions precipitated new mental health symptoms or psychiatric disorders.[25]. Research comparing a homogenous concussion sample with an appropriate comparison group while controlling for preinjury, injury, and case management factors is needed

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