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Abstract
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Elsewhere in JAMA Network Open, Ledoux and colleagues1 have shared their work on a 10-year provincewide (Ontario, Canada) population-based cohort study on a retrospective health administration data set showing that children aged 5 to 18 years with concussion were at risk for a novel mental health problem. A total of 152 321 youths with concussion and 296 482 youths with orthopedic injury were matched by age and sex, excluding those with previous mental health conditions or brain injuries. The study found that the concussion cohort had a greater risk for developing mental health issues, self-harm, and psychiatric hospitalization compared with the cohort with orthopedic injury. Death by suicide was also more common in the concussed cohort, although it was not statistically different.
Although previous reports have shown increased risk of mental health concerns in youth with concussion, this study of a large health delivery data set is unique, as it is not prone to the methodological limitations of other studies with selection biases and small sample sizes. Its methods are further strengthened by using a comparison group that arguably accounts for the non-brain injury-related stressors associated with hospitalization and treatment as well as factors that would place youth at risk for an accidental injury. Study limitations, as acknowledged by the authors, include relying on retrospective data in a health systems database that may be prone to misclassification of exposure (concussion) or outcome (mental health condition) and not accounting for potential confounding environmental and treatment factors.
Such a large-scale study highlights associations between concussion and mental health but also raises important unanswered questions. For example, is the risk for increased mental health problems following concussion long-term or transient? Is the increased risk driven by patients with prolonged postconcussive symptoms or equal among those who recover fully? Considering the significant overlap between diagnostic criteria for a concussion and a mental health condition (eg, problems with mood, somatosensations, cognition, and sleep), are patients with concussion more likely to receive a mental health label than their counterparts?
Regardless of the answers to these questions, we know from the seminal work by Ledoux and colleagues1 and others2,3 that concussion can predate or exacerbate a mental health condition...
Language: en |