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.
Several research articles identify how much of an impact concussion has on the emotional well-being of post-concussion patients. The 6th International Conference on Concussion in Sport Consensus Statement notes that “Common considerations in the context of persisting symptoms include mental health issues”. (1)
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)
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:
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:
Less frequently, but just as important to recognize, patients may experience or exhibit other symptoms such as:
Clinical observation and patient feedback are vital in assessing the severity of symptoms. Tools such as the Glasgow Coma Scale can also be used to evaluate the patient’s cognitive function. SCAT6 & SCOAT6 assessment tools both contain screening questions for mental health symptoms. Mental Health America offers self-assessments in a number of categories. PHQ-9 (Patient Health Questionnaire-9) is a commonly used screening tool, as is the GAD-7 (General Anxiety Disorder-7) questionnaire.
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.
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.
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.
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.
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.
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.
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.
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)
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.
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