Concussion Among Pediatric Patients Associated With Mental Health Issues

child with concussion being examined, bruise on head
Sport boy’s temple with a bruise
The researchers sought to assess whether sustaining a concussion is associated with an increased risk of mental health problems among pediatric patients.

Among individuals between 5 and 18 years of age, sustaining a concussion is associated with an increased risk for mental health visits, self-harm, and psychiatric hospitalization, compared with their peers who had sustained an orthopedic injury, according to study findings published in JAMA Network Open.

Previous research suggests a concussion may exacerbate existing mental health issues, but little is known about the link between concussion and onset of new psychopathologies or long-term mental illness. The objective of the current study was to assess whether sustaining a concussion is tied to an increased risk of mental health problems among the pediatric patient population.

The population-based, observational, retrospective cohort study on the subject was conducted between April 1, 2020, and March 31, 2020, in Ontario, Canada. The primary study outcome comprised of mental health problems, including psychopathologies and psychiatric disorders, which were identified from hospitalizations, health care visits to emergency departments, or primary care settings. Secondary study outcomes included psychiatric hospitalizations, self-harm health care visits, and death by suicide.

None of the study participants had a mental health visit in the year prior to the index event for cohort entry, nor had any participant sustained a previous concussion or traumatic brain injury 5 years prior to the index event. Those who sustained a current concussion were enrolled in the exposed cohort, whereas those who experienced an orthopedic injury were enrolled in the comparison cohort. The exposed cohort and the comparison cohort were matched, in a 1:2 ratio, respectively, with respect to age and sex.

Following matching on age and sex, a total of 152,321 participants who sustained a concussion (exposed matched group) and 296,482 (comparison matched group) who experienced an orthopedic injury were enrolled in the study. The median age in the concussion group was 13 years (range, 10 to 16 years); 56.7% of this cohort were male. The median age in the orthopedic injury group was 13 years (range, 10 to 16 years); 57.9% of this cohort were male.

The findings revealed that the incidence rates of any mental health problem were 11,141 per 100,000 person-years in the exposed cohort vs 7960 per 100,000 person-years in the unexposed cohort (95% CI, 7905 to 8015) per 100,000 person-years (difference, 3181 [95% CI, 3973 to 3291] per 100,000 person-years.

Participants in the exposed group had an increased risk for the development of a mental health issue (adjusted hazard ratio [aHR], 1.39; 95% CI, 1.37 to 1.40), self-harm (aHR, 1.49; 95% CI, 1.42 to 1.56), and psychiatric hospitalization (aHR, 1.47; 95% CI, 1.41 to 1.53) following a concussion. No statistically significant differences were observed with respect to death by suicide between the exposed and the unexposed groups.

The current study has several limitations, the researchers noted. These include its retrospective, observational design, which has its weaknesses. Concussion, orthopedic injury, and mental health outcomes were defined with the use of diagnostic codes in health administrative databases, thus introducing the possibility of exposure or misclassification.

The researchers concluded that based on the study findings, “clinicians should (1) assess for preexisting and new mental health symptoms throughout concussion recovery; (2) treat mental health conditions or symptoms or refer the patient to a specialist in pediatric mental health; and (3) assess suicidal ideation and self-harm behaviors during evaluation and follow-up visits for concussion.”

Disclosure: One of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures. 


Ledoux AA, Webster RJ, Clarke AE, et al. Risk of mental health problems in children and youths following concussion. JAMA Netw Open. Published online March 7, 2022. doi:10.1001/jamanetworkopen.2022.1235