Monitor a patient’s mental well-being after a concussion

Frequency of concussion exposure modulates suicidal ideation, planning, and attempts among US high school students

Kay JJM, Coffman CA, Tavakoli AS, Torres-McGehee TM, Broglio SP, Moore RD. J Athl training. 2022 doi: 10.10.4085/1062-6050-0117.22. E-publishing prior to printing.

Full text freely available

Take home message

High school students who reported a sports and recreation-related concussion in the past 12 months were more likely to report depressive symptoms and suicidal ideation than those who did not. Students who reported multiple concussions in the past 12 months were about twice as likely to report suicide attempts than those who reported a single concussion.

Background

A history of repeated concussions can increase the risk of adverse mental health outcomes, including suicidal ideation, the second leading cause of death among adolescents in the United States. However, we lack evidence to inform clinical practice about this risk in adolescents and whether the risk differs between men and women.

Study aim

Kay and colleagues completed a retrospective cross-sectional study to examine the association between concussion and suicidal thoughts or behavior in biological males and females.

Methods

The researchers used data from the National system for monitoring young people’s risk behavior to investigate this question. The survey was conducted in 2017 and 2019 among students aged 9^e to 12^e degree in both private and public schools. The authors summarized self-reported responses to sports- or recreation-related concussions as 1) no history, 2) a single concussion, or 3) multiple concussions. The survey included five yes/no questions related to mental health: 1) feeling sad/hopeless, 2) suicidal ideation, 3) suicide plans, 4) suicide attempts, and 5) harmful suicide attempts. The time frame for all variables was “within the past twelve months.”

Results

Fifteen percent of respondents reported at least one concussion in the past twelve months. A higher proportion of female respondents answered yes to every mental health question. The authors observed an overall association between history of concussion and the likelihood of reporting feelings of depression, suicidal ideation, and behavior. Respondents who reported multiple concussions in the past twelve months were about twice as likely to report a suicide attempt than those who reported a single concussion. Although this finding occurred in men and women, this association was stronger in men.

Viewpoints

Interestingly, the authors found that a high school student who reports a history of a concussion in the previous year is more likely to report negative mental health outcomes. However, they also noted that when a person sustains multiple concussions, he/she may be at even greater risk of attempting suicide. However, these data come from a cross-sectional study. Therefore, it is impossible to know the timing of these adverse mental health effects. Could they precede concussion and cause someone to take more risks and have more concussions? Is this an acute or chronic outcome that occurs after a concussion, or a vicious cycle where a concussion causes adverse mental health consequences that increase the risk of another concussion and worse outcomes that manifest as a suicide attempt? This information will be essential to understand and help inform prevention strategies. Hopefully, this study will encourage future longitudinal research that can assess the timing of events and the impact of multiple concussions. Future research could also explore the role of concussion severity in relation to mental health outcomes.

Clinical implications

Clinicians must recognize that even a single concussion can be associated with negative mental health consequences within 12 months. Clinicians should monitor mental health outcomes after a concussion and educate family members on how to recognize changes in a patient’s mental health status.

Questions for discussion

How do you currently discuss or monitor a patient’s mental health after a concussion? Given the findings of this study, is there anything you would like to change in your clinical practice?

Written by Kyle Harris
Reviewed by Jeffrey Driban

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