UC Davis Health and Kennedy Krieger Institute work to predict mental health issues after concussion

Researchers at UC Davis Health and the Kennedy Krieger Institute have received a five-year, $2.5 million grant from the Centers for Disease Control and Prevention to study mental health and head injuries in youth. The health care teams will develop and validate a clinical tool to predict mental health concerns in adolescents following a concussion or traumatic brain injury.

Concussions are a growing public health concern — especially for children and teens who play sports. Increasing evidence suggests that concussed patients are at an increased risk of depression and mental health issues.

Poor mental health can negatively impact recovery from a concussion. Since one in five teens report having been diagnosed with at least one concussion, properly identifying mental health concerns is critical to getting adolescents back on track.

“While a substantial number of children experience ongoing or worsening mental health concerns in the first three months after a concussion or traumatic brain injury, there are currently no validated prognostic tools to assess risk of ongoing or worsening mental health concerns in these patients,” said Daniel Nishijima, professor of emergency medicine at UC Davis Health and co-principal investigator of the study.

Increased risk of mental health issues in adolescents following a concussion

Prior studies show that 25-50% of adolescents who sustain a concussion or mild traumatic brain injury experience substantial mental health issues during their recoveries.

Moreover, the study showed 31-78% of children with traumatic brain injuries who have new or worsening mental health concerns are not receiving appropriate mental health care. In addition, there are racial, ethnic, and economic inequities in post-traumatic brain injury management and outcomes.

“Our study has the potential to impact the health and wellbeing of injured children worldwide,” added Beth Slomine, assistant vice president of psychology at Kennedy Krieger Institute and co-principal investigator of the study. “The results will be immediately significant, affecting both clinical practice, guidelines, and policy.”

While a substantial number of children experience ongoing or worsening mental health concerns in the first three months after a concussion or traumatic brain injury, there are currently no validated prognostic tools to assess risk of ongoing or worsening mental health concerns in these patients.”—Daniel Nishijima

Assessing the risks of mental health issues after a concussion

Researchers will conduct the study in six emergency departments in the Pediatric Emergency Care Applied Research Network (PECARN), including:

• UC Davis Medical Center
• Children’s Wisconsin
• Texas Children’s Hospital
• Children’s Medical Center of Dallas
• Children’s Hospital of Philadelphia
• Hasbro Children’s Hospital

“Each of these sites treat a large number of children with mild traumatic brain injuries and have a high proportion of children from diverse backgrounds,” Nishijima explained.

The team will enroll a derivation cohort at four sites and a validation cohort at two sites. Patients will be enrolled in emergency departments and include children 11-17 years old who meet the CDC definition of a mild traumatic brain injury.

Each patient will have follow-up evaluations at one to two weeks, one month and three months after the initial emergency department visit. The researchers will measure the patients’ mental health based on a self-report of new or worsening mental health symptoms one to three months after the brain injury. They’ll use the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-8. Researchers will also measure unmet mental health care needs, defined as not receiving any mental or behavioral health care in patients with new or worsening anxiety or depression.

“Our hope is this tool will provide evidence for clinical decision-making, helping to reduce uncertainty amongst clinicians and decrease health disparities for these patients,” Slomine said.

This work is in collaboration with senior collaborators Nathan Kuppermann, Bo Tomas Brofeldt Endowed Chair of Emergency Medicine at UC Davis Health, and Stacy Suskauer, director of the Brain Injury Clinical Research Center at Kennedy Krieger Institute.