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. 2022 Mar 1;5(3):e221235.
doi: 10.1001/jamanetworkopen.2022.1235.

Risk of Mental Health Problems in Children and Youths Following Concussion

Andrée-Anne Ledoux  1   2 , Richard J Webster  1 , Anna E Clarke  3 , Deshayne B Fell  1   3   4 , Braden D Knight  1   3 , William Gardner  1   4 , Paula Cloutier  1 , Clare Gray  1   5 , Meltem Tuna  4 , Roger Zemek  1   6
Affiliations

Risk of Mental Health Problems in Children and Youths Following Concussion

Andrée-Anne Ledoux et al. JAMA Netw Open. .

Abstract

Importance: 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.

Objective: To investigate associations between concussion and risk of subsequent mental health issues, psychiatric hospitalizations, self-harm, or suicides.

Design, setting, and participants: 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.

Exposures: Concussion or orthopedic injury.

Main outcomes and measures: 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).

Results: 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).

Conclusions and relevance: 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Zemek reported having a clinical research chair in Pediatric Concussion from the University of Ottawa, receiving competitively funded research grants from the National Football League scientific advisory board, serving on the concussion advisory board for Parachute Canada (a nonprofit injury prevention charity), and being the co-founder, scientific director, and a minority shareholder in 360 Concussion Care, an interdisciplinary concussion clinic. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flow Diagram
MH indicates mental health; OHIP, Ontario Health Insurance Plan; and TBI, traumatic brain injury.
Figure 2.
Figure 2.. Cumulative Incidence of Mental Health Outcome, Psychiatric Hospitalization, Self-harm, and Suicide
Shaded areas represent 95% CIs. OI indicates orthopedic injury.
See this image and copyright information in PMC

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