Introduction

You might be a primed athlete, a student just enjoying a sports game, or just going about your everyday routine. All of a sudden, an unexpected incident may happen, which leaves you with a concussion. At first, the pain and the immediate need for rest is the focus. However, as time goes on, you may notice changes in your mood and behaviour that aren't going away. Anxiety may creep in, or irritability, or depression, which casts a shadow over your once bright perspective. 

Concussions are not just physical injuries, they can have heavy mental health implications that often go unnoticed. Understanding the full impact of concussions on mood and behaviour is crucial, not only for those directly affected but also for their families, friends, and communities. This article aims to delve into the link between concussion and mental health, showcasing the challenges faced by those affected and exploring ways to manage and mitigate these effects. 

Understanding concussions

When someone takes a hit or blow to the head that can disrupt the usual brain function. This can cause a concussion, which is a type of traumatic brain injury (TBI).¹ These injuries can happen to anyone at any point in life but are quite common in sports, car accidents and falls.¹ Even though concussions are often labelled as ‘mild’ TBIs, concussions can have important and lasting impacts on a person’s health and well-being.

Mechanism of injury

Concussions happen because the brain quickly moves back and forth inside the skull, either usually due to direct hits or a sudden deceleration or slowing down.² This movement means that the brain can suddenly twist or stretch, which can cause chemical changes and damage to brain cells.² The force of the injury can be extremely varied, which means that even mild/minor impacts can cause a concussion.²

Common causes

• Sports: Activities such as football, hockey, rugby and boxing have high concussion rates due to the physical nature of these sports² 
• Accidents: Car crashes, bicycle accidents, and slips and falls can all lead to concussions²
• Everyday activities: Even routine activities, like playing on the playground or minor household accidents, can result in a concussion²

Symptoms of concussions

There is a wide range of symptoms that can happen as a result of concussions, some instantly and some over time.

Immediate symptoms

• Headache: One of the most common and persistent symptoms³
• Confusion: Feeling dazed or having trouble understanding what is happening³
• Dizziness: Sensation of spinning or loss of balance³
• Nausea or Vomiting: This can occur shortly after the injury³
• Amnesia: Trouble remembering events before or after the injury³

Delayed symptoms

• Fatigue: Unusual tiredness that doesn't go away after resting³
• Sleep disturbances: Trouble falling asleep or sleeping too much³
• Sensitivity to light and noise: Increased sensitivity to stimuli³
• Mood changes: Irritability, anxiety, and depression can develop over time³
• Cognitive impairments: Problems with concentration, memory, and thinking clearly³

It is important to know and understand these symptoms for quick diagnosis and to manage the condition effectively. It is crucial to know that concussions affect BOTH the body and mind, to address the injury. These mental health aspects we will explore further.

The link between concussion and mental health 

Concussions can be both physical and mental, in regards to their impact. It can have various emotional and behavioural changes as aforementioned and we will now delve deeper. 

Short-term mental health impacts

Immediately after a concussion, there could be various emotional and psychological symptoms. Some of those short-term impacts include:

• Anxiety: Increased feelings of worry and nervousness are common after a concussion. People may feel on edge or even experience panic attacks³
• Depression: A concussion can lead to feelings of sadness and hopelessness. This can be made worse by the physical symptoms of injuries such as immobility or loss of physical function³
• Irritability: Being more easily frustrated or angered following a concussion can happen This can strain relationships and make daily interactions more challenging³

Long-term mental health impacts

Some time after a concussion there can be impacts mentally that persist beyond the short term. These include:

• Chronic traumatic ncephalopathy (CTE): Repeated concussions and head injuries can lead to CTE. This is a degenerative brain condition where you get mood swings, depression, and cognitive decline. This condition is most commonly seen in athletes who have experienced multiple concussions, for example, boxers⁴
• Persistent mood disorders: Even one concussion can increase the risk of developing long-term mood disorders. People may experience depression, anxiety, and mood instability⁵

If you want to diagnose quickly and manage effectively, you need to understand and recognise the symptoms. As we explore the connection between concussions and mental health, it is essential to keep in mind the many symptoms and the varied experiences of those affected. Let’s now get into how we diagnose, treat and manage these mental health impacts. 

Diagnosis, treatment, and management

Diagnosis

• Psychological assessments: Evaluations by psychologists or psychiatrists to identify emotional and behavioural changes may be helpful to find out what exactly may be causing any mental health changes or behavioural changes²
• Neuropsychological testing: Comprehensive testing to assess cognitive function and identify specific problems is essential. This may include cognitive tests which assess memory and attention^2,6
• Role of healthcare professionals: Collaboration between neurologists, psychologists, and other specialists is important to create a holistic understanding of someone's condition²

Overall, in order to help diagnose the mental health impacts post-concussion, much testing by healthcare professionals is needed. 

Immediate care post-concussion

Rest and physical recovery:

• Cognitive rest: Patients are advised to avoid activities that require intense concentration. Examples include reading, using devices, or intense schoolwork^7,8
• Physical rest: Limiting physical activities that could make symptoms worse or risk another injury or blow to the head. This includes avoiding sports, heavy lifting, and vigorous exercise⁷

Monitoring for acute symptoms:

• Follow-up appointments: Regular check-ins with healthcare professionals. This is to monitor symptom progression and recovery^9,10
• Symptom monitoring: Keeping track of symptoms like headaches, dizziness, fatigue, and any changes in mood or behaviour^9,10

Long-term management strategies

Every person is different and so treatment should reflect that. Long-term management of the mental health impacts of a concussion should be comprehensive and individualised. Here are some examples.

Psychological interventions:

• Cognitive-behavioural therapy (CBT): This assists patients in controlling their negative thoughts, creating coping mechanisms, and enhancing their emotional self-regulation^11,12
• Techniques for mindfulness and stress reduction: Activities that promote relaxation and mindfulness, such as mindfulness meditation can be useful. They can help lower anxiety and enhance general well-being^13,14

Medications:

• Antidepressants: To treat the symptoms of anxiety and depression, doctors may prescribe SSRIs (selective serotonin reuptake inhibitors) and other antidepressants¹⁵
• Anxiety-reducing medications: Severe anxiety symptoms may be temporarily relieved with benzodiazepines or other drugs¹⁶

Systems of support:

• Family and friends: Including tight support systems to offer consolation, useful help, and motivation during the healing process^17,18
• Support groups: Joining a group of people who have gone through similar things can give you a sense of belonging and common understanding^17,18

Modifications to lifestyle:

• Frequent exercise: Walking or yoga are examples of modest physical activity that can be done to boost mood and general health. They are also extremely helpful for recovery for those recovering from concussion¹⁹
• Healthy diet: Eating a well-balanced diet high in vitamins, antioxidants, and omega-3 fatty acids promotes brain health²⁰
• Sleep hygiene: Creating a peaceful sleeping environment, sticking to a regular sleep schedule, and avoiding stimulants like caffeine right before bed are all examples of good sleep hygiene. Poor sleep can make concussion worse, so optimising sleep quality is beneficial²¹

Prevention:

• Safety equipment: Properly fitted helmets and mouthguards for yourself to cushion the jaw and blows to the head are very useful.²² Alternatively, environmental equipment such as rubber mats and other impact-absorbing surfaces can be very useful. In the home, removing tripping hazards and ensuring proper lighting can also prevent falls²³
• Education and training: Providing education to athletes, coaches, and parents on concussion risks, proper techniques to avoid head injuries, and the importance of reporting symptoms can help prevent concussion.^24,25 Additionally, integrating concussion education into school health programs to raise awareness among students and staff can prevent concussions from being ignored.^24,25 Examples of resources include the ‘Concussion Aware’ campaign by Headway, a brain injury association. They can help provide information and resources to understand concussions and their symptoms

Summary

Overall, a concussion can have profound impacts on an individual's physical health. But the mental aspects must be appreciated as well. From anxiety, depression, mood changes and fatigue, there are a plethora of ways a concussion can mentally affect you. To help mitigate this, prevention is better than cure and safety equipment such as helmets and mouthguards. Treatment can include medications to stabilise mood, therapy and lifestyle modifications to prioritise health such as sleep hygiene and exercise can help on the road to recovery. Please understand you are not alone, and guides like this and organisations like Headway, exist to support you. We hope this article helped you understand the mental impacts of concussions.