Research In Action

Research In Action

teen sitting
Mental Health and Concussion
May 27, 2021

A growing body of research highlights the importance of mental health in pediatric concussion recovery. For all patients, concussion serves as a significant source of stress. Disrupted routines, concern about missed school or makeup assignments, and worry about ongoing symptoms all present unique challenges to mental health following injury. Most patients recover within 1 to 3 months after injury and rebound quickly from the stress of concussion. However, a subset of youth experience more difficult recoveries.

Mental Health Concerns and Risk of Delayed Recovery

As many as a third of youth report elevated symptoms of anxiety or depression after concussion. Among these youth, about half describe mental health concerns prior to injury while half describe new symptom onset following concussion. Mental health concerns place patients at increased risk for delayed recovery from concussion. CHOP Minds Matter Concussion Program researchers found that youth with pre-existing anxiety or depression took twice as long to recover from injury.

1/3 of youth report elevated symptoms of anxiety or depression after concussion​​​​.

In addition, youth who sustain a concussion via motor vehicle collision or other trauma are at risk for post-traumatic stress symptoms like hyperarousal and avoidance. Left untreated, mental health concerns after concussion are associated with major challenges, including delayed concussion recovery, academic decline, reduced social engagement, and increased suicide risk.  

Cognitive Behavioral Therapy As An Effective Tool

Fortunately, we know how to improve the mental health of children and adolescents. Cognitive behavioral therapy (CBT) is a well-researched intervention which teaches new ways of coping with difficult emotions and physical symptoms. In addition to reducing symptoms of anxiety, depression, disruptive behavior, and post-traumatic stress, research has demonstrated that youth who complete CBT report decreased concussion symptoms. This suggests that any child or adolescent struggling to get back to their regular activities after a concussion could benefit from CBT. 

What Providers Can Do

Providers should be aware of the role of mental health during concussion recovery. Here are some tips for promoting mental health care:

  • Normalize the subject by talking about mental health early and often. 
  • For patients with a history of mental health concerns, recommend that they continue or begin working with a psychologist or counselor. 
  • With all patients, talk about the mind-body connection and the links between physical and emotional health. Encourage patients to lean on their social supports like friends and family, practice relaxation strategies like deep breathing, and make time for activities they enjoy especially as other stressors are heightened after concussion. 
  •  When patients report emotional or behavioral changes after a concussion, or if patients report concussion symptoms that do not resolve within expected time frames, consider referring them for CBT to help promote their recovery and overall well-being.