Q&A with Dr. Kelly Russell: Pediatric Concussion and Psychosocial Outcomes
ENRRICH Co-lead Dr. Kelly Russell has dedicated her research career to understanding pediatric injuries, including how concussions affect children and youth through their lives. Research has shown that professional athletes and military personnel have a greater risk of mental health disorders and may struggle later in life after having a concussion, multiple concussions, or repetitive head trauma. But professional athletes and military personnel are quite different from the child who gets one concussion playing soccer or falls off their bike. We do not really know a lot about the long-term risks among youth who have a concussion.
In Manitoba, we have excellent population-based, administrative data at the Manitoba Center for Health Policy which allows us to follow people over time and build a picture of their life. In this recent study, Dr. Russell and her colleagues were able to look at youth who had a concussion and follow them for up to 16 years. The team looked at youths’ mental health and social outcomes all the way into young adulthood. We asked Dr. Russell some questions about her study.
What was the purpose of the study?
We wanted to identify long-term risks of negative outcomes in youth diagnosed with concussion. We looked at mental health outcomes such as being newly diagnosed with a mood disorder (e.g., depression or anxiety), attention-deficit hyperactivity disorder, psychosis, etc. and any new medication prescriptions to treat mental health disorders. Social outcomes that we considered were interactions with the justice system; involvement with Child and Family Services; and receiving aid from government resources. We wanted to compare these outcomes among youth who had a concussion to those who had never had a concussion.
What did you find out from the study?
There were several significant findings in this study. Compared to youth who have never had a concussion, youth who had a concussion were 34% more likely to be diagnosed with any mental health disorder, 30 % more likely to be diagnosed with a mood disorder, 43% more likely to be diagnosed with psychosis, and 67% more likely to be diagnosed with a substance abuse disorder . They are also 31% more likely to be prescribed medication for a mental health disorder. We also found that females were at 89% higher risk of receiving a diagnosis or medication for a mental health disorder post-concussion.
On the social side, the concussed youth were at a higher risk of being involved with the justice system as adults: with a 29% increased risk of being a victim, 16% increased risk of being a witness (HR 1.16; 95% CI 1.01-1.32), and a 22% increased risk of being accused of crime. Youth who had a concussion were also 33% more likely to have contact with Child and Family Services. They were not more likely to access income or housing support as adults compared to youth with no concussion diagnosis.
Overall, concussion can have a broad effect on many aspects of youths' lives. Compared to their peers without concussion, they are at a higher risk for several negative outcomes. These outcomes could alter their expected development or make the transition into young adulthood more difficult.
What are the next steps for research in this area?
There is research showing that not all athletes, parents, coaches, or healthcare providers know that concussions can lead to mental health disorders. Our study shows that we need to focus on the early identification of youth who are at risk for these negative long-term outcomes. If we can identify youth as early as possible, we can focus on medical care and social supports to prevent or mitigate these outcomes.
What do you want youth, parents, and clinicians to take away from these findings?
Concussions are common injuries, especially among youth. They are serious injuries and should not be ignored or underestimated. Youth who think they might have a concussion need to tell their parents and see a doctor. This is important because youth diagnosed with concussion are at risk for various mental health disorders and social outcomes that may require supports from physicians and health professionals. By making sure youth receive the treatment they need, we can reduce the risk of these poor outcomes. We want clinicians to know that youth are at increased risk of mental health disorders after a concussion and to ask their patients about their mental health regularly.
To read more about this study, you can find it at: https://www.jpeds.com/article/S0022-3476(23)00278-0/fulltext. This study was funded by the Canadian Institutes of Health Research.
About the Author
Dr. Kelly Russell received her PhD from the University of Calgary and completed a post-doctoral fellowship in traumatic brain injuries and sport at St. Michael’s Hospital in Toronto. She was recruited to the University of Manitoba in 2012 and developed a research program in sports-related injuries in children. Her interests include the prevention, management, and outcomes of sport-related concussion, particularly related to physical and psycho-social outcomes after concussion. Dr. Russell’s work also includes identifying risk factors for sport injuries among children and avenues for preventing these injuries. Her research is funded by CHRIM, Research Manitoba and CIHR, among others. She is an Associate Professor in the Department of Pediatrics and Child Health and holds the Robert Wallace Cameron Chair in Evidence Based Medicine.