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It is well-established that a mild traumatic brain injury has a direct impact on mental health. Healthcare professionals should be aware of a concussion patient’s emotional & psychological symptoms, and know when and how to provide support, including the possibility of referral to a mental health professional.
This article will provide information about the importance of accessing mental health care after a concussion. It will also discuss the types of mental health services available and how they can help with recovery. Finally, it will provide some tips for managing mental health symptoms following a concussion.
The Importance of Emotional Care After a Concussion
Howlett, Nelson & Stein (2022) state “Mild TBI, once considered a largely benign phenomenon, is now known to be associated with a range of affective symptoms, with suicidality, and with worsening or new onset of several psychiatric disorders including posttraumatic stress disorder and major depressive disorder. Repetitive head impacts, often in athletic contexts, are now believed to be associated with several emotional and behavioral sequelae.” (2)
Specific to pediatric patients, a 2021 systematic review and meta-analysis concluded that mental health is central to concussion recovery. Assessment, prevention and intervention of mental health status should be integrated into standard follow-up procedures. (3)
Who is at Risk of Developing a Mental Health Condition Following a Concussion?
While anyone who experiences a concussion is at risk of developing mental health symptoms, certain individuals are more susceptible than others. These include children, adolescents, athletes, seniors, and those with a preexisting history of mental illness or traumatic brain injury (TBI).
In addition, those who experience post-traumatic stress disorder, either pre-existing or as a result of the current head injury, are also at higher risk. Psychological conditions and mental illnesses in the family alone can increase someone’s chance of post-concussion mental disorders.
Other factors that influence psychological issues following concussion include:
Age (teens take longer than youth or adult)
Sex (females have a higher risk)
Sport type (collision sports more likely to under-report symptoms or refuse to seek help)
Social (isolation, pressure) (4)
What Are the Indicators of Mental Health Conditions After a Concussion?
The manifestation of a mental health condition following a concussion can be subtle and differ among individuals. It’s important to note that these observable signs or reported symptoms may not be immediately linked to the concussion, as they can be mistaken for typical post-injury stress or recovery.
Common issues include:
Sleep problems like insomnia or hypersomnia
Emotional symptoms such as mood disorders, irritability, anxiety, and depression
Cognitive symptoms such as confusion, poor concentration and memory problems
Less frequently, but just as important to recognize, patients may experience or exhibit other symptoms such as:
Behavior changes including irritability, aggression, or withdrawal
Substance use or abuse
How to Assess the Severity of Symptoms and Determine if Referral is Necessary
Additionally, healthcare providers should assess the patient’s daily functioning to gauge how the mental health disorder is impacting their lives. For instance, if the patient has difficulty performing tasks or finds it hard to concentrate and complete assignments, it would warrant more in-depth inquiry.
What Healthcare Providers Can Do to Help
Emphasize the Importance of Early Intervention:
Encourage patients and families to seek help if they notice any changes in behavior or mood that could be attributed to a concussion. Early intervention can help to reduce the severity of mental health issues and improve recovery outcomes.
Assess the Patient’s Current Mental Status:
Regular mental status examinations can help track changes in the patient’s condition and inform treatment decisions. These evaluations should include an assessment of the patient’s mental state, attention and memory, mood and affect, as well as their insight into the condition.
Discuss the Importance of Psychotherapy for Post-Concussive Patients:
Psychotherapy, such as cognitive-behavioural therapy, can help patients cope with emotional distress and cognitive impairments following a concussion. Additionally, it can help to reduce anxiety and depression symptoms, and improve overall quality of life.
Explore Available Options for Treatment and/or Referral to a Qualified Mental Health Professional:
Discuss various treatment options with the patient, including psychotherapy, pharmacotherapy, and lifestyle modifications. Where necessary, refer the patient to a qualified mental health professional for further assessment and treatment.
There are various resources available for individuals who have sustained a concussion and are dealing with mental health symptoms. This includes professional organizations such as the Sports Concussion Institute, the American Psychological Association, the Brain Injury Association of America, and the National Center for PTSD.
Additionally, many hospitals or clinics offer special services for patients dealing with post-concussion mental health issues. Numerous support groups both in person and online can provide emotional support during the recovery process.
Consider an Interdisciplinary Approach to Treatment, Involving Other Specialists such as Neurologists and Primary Care Physicians:
An integrated treatment plan, involving professionals from various fields, can ensure comprehensive care for the patient, addressing all aspects of their condition. This includes monitoring progress and providing support throughout the recovery process.
Provide information for immediate, urgent or emergency intervention:
Patients can contact local hospitals and healthcare centers to inquire about the availability of mental health services. Depending on their geographical location, patients may also be able to schedule a virtual appointment with a mental health specialist through online telehealth platforms.
In the United States, 988 is an emergency number that can be accessed by phone, text or email, and the caller is in immediate contact with a mental health specialist. Having phone numbers of local crisis hotlines readily available for patients is also essential.
Options That May be Discussed with Patients and their Families
Cognitive Behavioral Therapy (CBT):
CBT is an evidence-based therapy that helps patients identify and modify damaging behaviors, thoughts, and beliefs. It can be effective in helping individuals cope with mental health issues related to concussions such as anxiety, depression, and PTSD.
For those struggling with post-concussion mental health problems, attending a support group can be an invaluable resource. Not only do they provide a supportive environment where individuals can connect with others who understand their experience, but they also offer educational materials and other forms of assistance to further aid in the recovery process.
Support groups for family and caregivers can also make a significant difference to not only the patient but also those who care about them.
In some circumstances, a patient may need additional long-term care after recovery from a concussion. Such care should include psychotherapy or cognitive behavioral therapy which can help manage any persistent mental health problems. Cognitive rehabilitation and neurocognitive therapy have both been proven to be effective treatments. (10)
Tips for Helping the Patient Adjust to Life After a Concussion and Preventing Relapse
Encourage patients to gradually return to their normal activities, but also to rest when needed.
Stress the importance of regular follow-ups to monitor progress and adjust treatment plans as needed.
Provide education on lifestyle modifications such as diet, exercise and sleep hygiene that can help to reduce symptoms.
Emphasize the need for ongoing monitoring of mental health issues even after the concussion has healed.
Appreciating the impact of concussions on mental health is no longer optional. Every patient must be assessed for possible emotional, mood, behavioral, and cognitive symptoms that appear as a result of their mild traumatic brain injury. If any signs of mental health conditions arise, it is important to engage assistance from a mental health professional as soon as possible.
Patients can obtain referrals for mental health services through their primary care provider or local healthcare centers. With the right professional care, resources and support system, concussion patients have a great chance of achieving a full recovery and better mental health and well-being.
Patricios JS, Schneider KJ, Dvorak J, et alConsensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022British Journal of Sports Medicine 2023;57:695-711.
Howlett JR, Nelson LD, Stein MB. Mental Health Consequences of Traumatic Brain Injury. Biol Psychiatry. 2022 Mar 1;91(5):413-420. doi: 10.1016/j.biopsych.2021.09.024. Epub 2021 Oct 2. PMID: 34893317; PMCID: PMC8849136.
Gornall A, Takagi M, Morawakage T, Liu X, Anderson V. Mental health after paediatric concussion: a systematic review and meta-analysis. Br J Sports Med. 2021 Sep;55(18):1048-1058. doi: 10.1136/bjsports-2020-103548. Epub 2021 Apr 29. PMID: 33926965.
Gordon A. Bloom, Alicia M. Trbovich, Jeffrey G. Caron & Anthony P. Kontos (2022) Psychological aspects of sport-related concussion: An evidence-based position paper, Journal of Applied Sport Psychology, 34:3, 495-517, DOI:10.1080/10413200.2020.1843200
Centers for Disease Control and Prevention (CDC). (2020). Get the facts about concussion and brain injury. Retrieved from https://www.cdc.gov/traumaticbraininjury/get_the_facts.html
National Institutes of Health (NIH). (2020). Concussion-related mental health issues: Identifying and managing symptoms. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545809/
American Academy of Neurology (AAN). (2020). Concussion management guideline: Mental health referral after concussion in adults and children. Retrieved from https://www.aan.com/Guidelines/home/GetGuidelineContent/1368
American Psychological Association (APA). (2020). Understanding post-concussion syndrome: Symptoms, diagnosis and treatments. Retrieved from https://www.apa.org/topics/post-concussion-syndrome
Allie J. Tracey, André G. Bateman, Shelby E. Baez & Tracey Covassin (2023) Effectiveness of interventions for the improvement of mental health and well-being post-concussion: a systematic review, Brain Injury, 37:10, 1135-1158, DOI: 10.1080/02699052.2023.2219901
Stacey Ritter, MS, ATC has over 30 years of experience in the athletic training/sports medicine profession. She has worked with all ages and competitive levels, including Olympic and professional athletes. She is the owner of Concussion Navigation Services in San Luis Obispo, CA, providing baseline testing, injury management, professional development education and consulting, using the most current, evidence-based standards of care. CNS is one of only 8 CCMI Certified Concussion Clinics in CA.
Stacey has served on a variety of boards & committees and has co-authored several resource documents for the National Athletic Trainers Association (NATA). She is a sought-after speaker at the local, state, district and national levels. Stacey has been honored with multiple awards of achievement, including both the Far West Athletic Trainers Association & NATA Most Distinguished Athletic Trainer, and NATA Athletic Training Service recognitions.