A third of children and adolescents develop a mental health problem after a concussion, which could persist for several years after the injury, according to a new review of the literature.
The research, conducted by the Murdoch Children’s Research Institute (MCRI) and published in the British Journal of Sports Medicine, found that mental health should be assessed as part of the assessment and management of standard pediatric concussions.
Alice Gornall, MCRI researcher and PhD candidate at Monash University, said that despite the overlap of many post-concussion and mental health symptoms, the relationship between delayed recovery and mental health had remained poorly understood until now. to this literature review.
The review of 69 articles published between 1980 and June 2020, involved nearly 90,000 children, aged 0 to 18, from nine countries including Australia, the United States, Canada and New Zealand, who had a concussion. Falls (42.3%) and sports injuries (29.5%) were the most common causes of injuries, followed by car crashes (15.5%).
It found that up to 36.7% had significantly elevated levels of internalizing problems such as withdrawal, anxiety, depression and post-traumatic stress and 20% of externalizing problems such as aggression, attention problems and hyperactivity after concussion compared to healthy children or children who have suffered a concussion. other injuries such as a broken arm.
Pre-existing mental health problems were a good predictor of mental health problems after a concussion. The review found that 29% of children with a pre-injury mental health diagnosis were re-diagnosed with mental health after a concussion. Up to 26 percent with no previous mental health issues went on to develop symptoms.
Ms Gornall said that while significant improvements in mental health appeared between three and six months after the injury, a minority of children had symptoms that persisted for several years afterward.
The findings follow a recent study, led by MCRI and published in The Journal of Head Trauma Rehabilitation, found that traumatic brain injury in early childhood was associated with lower IQ scores that persist for up to seven years after. the injury.
Ms Gornall said concussions were a growing public health problem, with a third of children having suffered a head injury before the age of 13.
“Despite the high incidence of concussions in children and adolescents, identifying those at risk for persistent difficulties after concussion remains a major challenge for clinicians,” she said.
“On top of that, children take twice as long to recover from a concussion as adults, with one in four children showing symptoms beyond a month after the injury.”
Emma, 17, a Melbourne resident, requested mental health support after suffering two concussions, a year apart.
In 2019, while playing netball, she hit her head on a goal post and last March she was hit with a ball in the back of the head.
Emma said that after the second concussion, she developed anxiety, headaches, feelings of hopelessness and found it difficult to concentrate.
“After my last concussion, I struggled to be motivated for school and everyday life. Doing the simpler tasks like walking was difficult for me, not being able to accomplish these tasks discouraged me which took a toll on my mental health. ,” she said.
Emma’s father Bruce Henry said he welcomed the pressure to make mental health part of the assessment and management of pediatric concussions as many cases would go untreated.
“When a kid has a concussion, they may look good, but you can’t see the underlying impact,” he says. It is so important that mental health is a part of concussion management, which has been essential to Emma’s recovery process. “
MCRI researchers are also testing an intervention, Concussion Essentials, to prevent children from suffering long-term post-concussion symptoms.
The eight-session intervention combines physiotherapy and psychology treatments that target symptoms presenting symptoms with education on common concerns such as headaches, fatigue, and returning to exercise, school and At the sports. Early data shows that the intervention is effective in speeding up recovery.
MCRI Professor Vicki Anderson said assessment, prevention and intervention for mental health issues after concussion should be integrated into standard concussion management.
“Mental health is central to recovery from concussion. Concussion can both precipitate and exacerbate mental health problems, impacting delayed recovery and psychosocial outcomes, ”she said.
“Integrating mental health risks into post-trauma management represents an opportunity to engage children and adolescents in mental health services to prevent unnecessary problems from arising or to address already existing problems.
Developed by world-renowned concussion experts at MCRI and Royal Children’s Hospital and in collaboration with AFL, the HeadCheck app also helps parents, coaches and rescuers recognize the signs of concussion and manage the condition. safe return of the child to school, to play and to organize. sport.