The Impact of Concussions on Mental Health by Deborah Rich, PhD

The Brain Injury Association of America (BIAA) defines traumatic brain injury (TBI) as “an alteration in brain function, or other evidence of brain pathology, caused by an external force.” Every year there are approximately 2.5 million ER visits, hospitalizations, or deaths associated with TBI in the United States. The leading cause of TBIs between 2006-2010 was falls. There are an estimated 1.6 to 3.8 million sports-related TBIs annually, however, only 300,000 result in loss of consciousness.

Traumatic brain injuries can occur without the loss of consciousness. Due to this fact, as well as lingering mental health stigmas, people do not always seek treatment. 

Symptoms of a TBI may not appear for several days following the injury. Post-concussion syndrome (PCS) occurs 7 to 10 days after a TBI and can last for weeks, months, a year or even longer in some individuals. The severity of the injury does not correlate to the duration of PCS or type of symptoms experienced.

The TBI symptoms fall into four categories: physical, cognitive, sleep, and emotional.

1. Physical Symptoms:

• * Headache is the number one symptom of head injury, occurring in 40% to 86% of individuals with TBI.
• * Dizziness
• * Fatigue
• * Noise sensitivity
• * Light sensitivity

2. Cognitive Symptoms:

• * Memory problems
• * Impaired attention
• * Impaired concentration
• * Impaired inhibition of incorrect response
• * Impaired recognition of mistakes

3. Sleep Disturbance:

• * Impaired sleep-wake cycle - one study found that 72% TBI patients had a sleep-wake disorder (irrespective of location or severity of the injury.
• * Hypersomnia has been found in 22% of TBI patients 6 months post-injury.
• * Excessive daytime sleepiness and fatigue was found in 55% of TBI patients.
• * Insomnia and poor sleep quality is found in 30% of TBI patients.

4. Neuropsychiatric Conditions Associated with TBI:

• * Emotional Expression Disorder (Pseudobulbar Affective Disorder) – a disorder characterized by uncontrollable crying or laughter that is disproportionate or inappropriate to the social context.
• * Depression is the most common psychiatric complication of TBI.
• * Suicide rates are higher among TBI patients than the general population - patients who have had a TBI with loss of consciousness have a 4x greater likelihood of attempting suicide than the general population.
• * Mania - the risk of mania increases 5.3x following TBI.
• * Generalized anxiety disorder (GAD) and panic disorder - TBI increases the risk of GAD by 2.3x and panic disorder by 5.8x - TBI patients remain at a higher risk for GAD for years following the injury - panic disorder can manifest itself over 10 years following TBI, which suggests that the disorder is a slowly evolving reaction to the injury.
• * Post-traumatic stress disorder - TBI patients have a 5.8x increased risk for developing PTSD - 16.5% of TBI patients meet criteria for PTSD.
• * Personality changes/disorders - approximately one-third of TBI patients are affected with personality changes.

TBI patients often don’t recognize these changes, but alterations in personality are a primary source of concern for their family members.
Personality changes include:

• [1] Apathy
• [2] Emotional liability
• [3] Reduced anger control/increased aggression
• [4] Impulsivity
• [5] Impaired social judgment

The mental health of patients with TBI may be greatly impacted. Neuroimaging techniques, biological markers, and neurological/cognitive screening could result in earlier detection and treatment of TBI, improving the outcome for these patients in the future.