Male teens who said they’d had two or more concussions in the past year were twice as likely to report suicidal attempts, compared to those who’d reported just one concussion, according to a study recently published in the Journal of Athletic Training.
And teens who reported any history of concussion in the prior year were more likely to say they’d thought about or attempted suicide than those who hadn’t been concussed, the researchers found.
But researchers don’t know exactly why that is. And they strongly caution against making sweeping conclusions about whether concussions can actually cause depression or suicidal behavior.
“The whole purpose of this study really isn't to elicit any sense of panic among parents with teens that are dealing with concussive injuries,” said lead author Jacob Kay, a rehabilitation scientist at the Prisma Health Children's Hospital in South Carolina.
“The mass majority of [teens with] these injuries recover very well, with very few complications. But it does highlight a really important need to tune in to adolescent mental health in the event that a concussion should occur. And particularly among those that have multiple concussions in a short period of time.”
Beyond the concussion itself, social and environmental factors also likely play a big role, said co-author Steven Broglio, the director of the University of Michigan Concussion Center.
“It doesn't seem logical to me that within 12 months of injury, somebody has CTE [chronic traumatic encephalopathy] and then now they're trying to commit suicide,” he said. “What is far more plausible is, they've had multiple injuries. We know that anybody that has an injury in sport is removed from their team, removed from their social engagement. They are depressed because they feel isolated. And what we believe is that that isolation is what is driving the suicide ideation, and then possibly the suicide attempts.”
Brain injuries and mental health in young people
It’s only in the last decade or so that researchers have been examining how mild traumatic brain injuries, like a concussion, may affect mental health in young people. While most kids and teens who sustain concussions will fully recover, some studies have suggested a link between a concussion and suicide risk in high school students. And multiple factors, like race, ethnicity, sex, and a previous history of depression, seem to play a role.
And the same injury can have totally different impacts on teens, depending on their environment and health history, Broglio said.
“If somebody comes into the injury, and they already have a diagnosis of depression or anxiety or another mental health condition, we believe that the concussion kind of amplifies those problems,” he said. “We sort of call it ‘fragile egg syndrome': If you've already got the injury or you already have these conditions, the injury will make it worse. … And let's be honest, this is a brain injury. So it makes a lot of sense that it's going to get worse.”
Broglio, Kay and their team wanted to look at concussion frequency: Would having more than one concussion within a year make a difference?
They analyzed two years of data from the National Youth Risk Behavior Surveillance System, a set of surveys that track how high schoolers are anonymously self-reporting behaviors that could pose a risk to their health.
One major limitation: The survey doesn’t ask about the timing of those behaviors.
That means you can’t draw conclusions about cause and effect from this study, Kay said
“We can't draw any kind of timeline on when these behaviors happen, so we can't say that the concussion occurred before these observed suicidal behaviors, or vice versa.”
Still, the association between frequent concussions and suicidal behavior is worth paying attention to, and deserves more research, he said.
“When we talk about broader literature, there is evidence that concussion can precipitate, or even exacerbate, existing depression symptoms or mental health challenges. So in the broader context of the literature, it is a bit alarming to see that there's an increase in more of these active suicidal behaviors, and particularly among males.”
How to help a teen who’s sustained a concussion
Kay said parents will frequently ask him: how many concussions is too many?
“My most common response is, it's not necessarily about how many. It's more about how they were managed and how the recovery went.”
First, teens need to feel safe reporting possible concussions, he said. Then they need help figuring out what the right balance of activity will look like as they recover — some exercise can be great for recovery, Kay said, but you want to avoid activity where you could be susceptible to another concussion.
The role that parents, coaches, teammates and teachers can play in concussion recovery is crucial, Broglio said. Make sure they feel like they have a strong support network, and that their likelihood of recovery is high.
“I would never recommend you go have a concussion,” he said. “But I also don't get too concerned when somebody tells me they have a concussion. If the injury is quickly identified, the athlete is removed from play, and they have all the support services around them, the odds of a good recovery are very high.
“Now, I'm not dismissing there’s a low, single-digit percentage of people that have long-term issues. But the odds of a good outcome are actually very good, if you have all the right things in place to take care of that student athlete.”
Making sure a teen isn’t isolated after sustaining a concussion is critical, he says, whether that means finding ways to participate with and feel connected to their team and friends while they recover, or having a plan about how they’ll catch up on any classwork they may have missed.
And even if a teen does struggle or show signs of depression, help is available.
“I think the message then to parents needs to be: If your child has a concussion, you know your child the best,” Broglio said. You need to keep an eye on your child. If you have any suspicion that they aren't progressing the way that you think they should - they're showing signs of depression, they're starting to feel withdrawn - this is very treatable. … Depression is a very treatable condition. And we can stave off some of these tragic outcomes that we reported on.”
