Pediatric Reflections: Winter 2023

The Concussion and Mental Health Connection

Catherine C. McDonald, PhD, RN, is senior fellow with the CHOP Center for Injury Research and Prevention, and Jamie Shoop, PhD, is a pediatric psychologist in the Minds Matter Concussion Program at Children’s Hospital of Philadelphia.

Caring for a teen after concussion requires attention not only to their physical and academic needs but also to their social and emotional well-being. Our Minds Matter Concussion Program recently published a paper exploring anxiety and depression symptoms in adolescents with concussion, highlighting the importance of addressing youth mental health to support concussion recovery.

We collected data from a group of teens ages 13 to 18 years who sustained a concussion within 28 days of their clinical visit to the Minds Matter Concussion Program in the Sports Medicine Clinic. Teens completed the Patient-Reported Outcome Measurement Information System (PROMIS), standardized measures of anxiety and depressive symptoms across different clinical populations. Notably, more than one-third of the concussed adolescents reported symptoms of anxiety or depression that were above normal limits. This suggests that many teens with concussion have mental health needs that warrant further support.

Tips for Providers

The Minds Matter Concussion Program strives to care for the whole child in its comprehensive approach to concussion management. Here are some helpful tips clinicians can use to promote mental health and wellness for teens with concussion:

• Ask about pre-injury mental health at initial visit. Youth with needs before injury are at greater risk after concussion. Encourage patients with a history of mental health concerns to continue or begin working with a counselor or therapist during this period of heightened stress.
• Check in about current mental health. With all patients, ask questions such as, “How have you been feeling emotionally?” Consider using screening tools like the Patient Health Questionnaire-8 and Generalized Anxiety Disorder-7, validated screeners for depression and anxiety in teens ages 12 and up, to identify at-risk patients.
• Encourage teens to use their existing coping strategies, such as relying on their social supports like friends and family, using relaxation strategies like deep breathing, and participating in activities they enjoy.
• Refer for therapy or counseling. If patients report new symptoms of anxiety or depression after injury, refer them for evidence-based treatments like cognitive behavioral therapy (CBT).
• Partner with psychosocial providers. Remember that you don’t have to have all the answers. Tap into providers such as psychologists, social workers, or guidance counselors to provide additional resources and support.

Clinicians working with teens should encourage open communication about emotional health and wellness, including symptoms of anxiety and depression. Doing so can help ensure that teens get the support they need managing the stressors they face after injury.

Learn more on this topic at the Minds Matter Concussion Conference: New Frontiers, a CME set for March 15, 2023, at CHOP. Register here.

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