Concussion related to child’s mental health problems

According to a 10-year retrospective cohort study in Canada, cerebral tremors in children were associated with an increased risk of mental health problems compared to orthopedic injuries.

Of the more than 400,000 adolescents between the ages of 5 and 18, those with concussion were at increased risk of mental health problems (adjusted HR). [aHR] 1.39, 95% CI 1.37-1.40), and self-harm (aHR 1.49, 95% CI 1.42-1.56) and psychiatric hospitalization (aHR 1.47, 95% CI 1.41-1.53), Andrée-Anne Ledoux, PhD, Eastern Of the Children’s Hospital of the Ontario Institute, and of colleagues.

The incidence of mental health problems was 11,141 per 100,000 person-years in the concussion group, compared to 7,960 per 100,000 person-years in the orthopedic trauma group. JAMA network open..

“Our findings suggest that physicians need to assess a patient’s mental health during a follow-up visit to a concussion,” Ledoux and colleagues write. “Collaboration care and mental health treatment Improve the outcome of childhood concussion With chronic symptoms. “

in the meantime 1 in 5 Canadian children There was a mental health disorder, and this rate was high among the children in both study groups. “This may be due to differences in the time and method of identifying and / or defining mental health problems,” the authors suggested. “This may also reflect the mutual experience of trauma, as it has been reported that people with orthopedic injuries may have long-lasting behavioral changes after the injury.”

“Such a large study not only highlights the link between concussion and mental health, but also raises important unanswered questions,” said Dr. Tallinn Babykian of the University of California, Los Angeles. I am writing in. Invitation commentary.. Despite growing public health concerns about the long-term effects of concussion, “the mechanism of this increased risk remains largely elusive.”

In discussing the role of concussion in increasing mental health problems in adolescents in “Mental vs. Physical, Psychological vs. Neurological, and Organic vs. Environmental Artificial Divisions,” Babykian said, “The dichotomy. I warned about “traps”.

“These departments are largely a remnant of the historical conditioning of our training paradigm,” she explained. “In reality, all of these reference frames characterize the same system, our complex nervous system.”

“Young people reach concussion as a tapestry of personal, family and environmental risks and resilience, not as a blank slate,” says Babykian. Therefore, it is important to maintain “security and independence” and “connection and attribution” when managing concussion.

The study found 296,482 children (median 13 years, 57.9% of boys) with orthopedic injuries from April 2010 to March 2020 in Ontario, Canada, and 152,321 children with cerebral agitation (median). A value of 13 years, 56.7% of boys) was matched.

“Orthopedic injuries have been shown to be an excellent comparative group because they share injuries-related experiences (emergency visits, pain, injury-related stress, etc.) and premorbid characteristics. “We are,” said Ledoux and the team.

The study included the first diagnosed case if the patient had multiple concussion or orthopedic injuries. If you did not have continuous coverage of your Ontario health insurance plan in the 5 years prior to the injury index event, or if you had a mental health diagnosis in the year prior to the event, or you had a mental health diagnostic code in the index. If the child was excluded from the study. visit.

The authors of the study acknowledged that their retrospective design was a “unique weakness” of the study. They also noted that their research relies on diagnostic codes and management databases, which can lead to misclassification errors and does not explain all the mental health services offered.