Ultimate Guide for Mental Health and Sport-Related Concussions
The harsh reality is that a significant number of athletes develop notable mental health challenges after a concussion. The most common mental health challenges are depression and anxiety
Depression - persistent feelings of sadness, shame, guilt, irritability, impaired concentration, low energy, changes in appetite, suicidal ideation
Anxiety - excessive worry or fear, restlessness or on edge, fatigue, rumination,
As you can see, many of these overlap with concussions symptoms. This is what makes treatment challenging.
Why does this happen? Many reasons, one being the systems in our brain that help regulate our mood are impacted by concussions.
Good news - there are solutions.
The NEED for Mental Health Support
First and foremost, research shows that many athletes meet the threshold for clinical levels of mental health challenge. This means that their symptoms warrant clinical intervention and/or reach diagnostic criteria.
Concussions are challenging enough to recover from, no one needs to suffer more.
In addition to this, psychological factors are proven to:
Prolong symptoms which can worsen mental health challenges
Influence how our body responds to a concussion such as stress hormones, muscle tension, reduced range of motion
Impact treatment outcomes
Delay return to sport
Risk Factors
What increases an athlete's chance of struggling with their mental health after a concussion? There's a few things…
Pre-Existing Mental Health Challenges
Having pre-existing mental health challenges (at some point) can significantly increase the risk of developing or worsening one’s mental health after a concussion
Athletes with mental health challenges before a concussion are 4.25x more likely to develop depressive symptoms and 3.4x more likely to develop anxiety, following a concussion.
Athletic Identity
When sport contributes an (unhealthy) amount to one’s identity and sense of self worth, it can be related to depressive symptoms
History of Concussions
Having multiple concussions has shown to increase the risk of developing and/or worsen mental health symptoms.
Athletes who sustain multiple concussion are two to nine times more likely to develop significant levels of depression (lots of factors play into why this is such a high range).
Given the vast number of athletes who have one (if not multiple) of these risk factors, a huge amount of the population is at risk for significant mental health challenges.
Sources of Mental Health Challenges
In addition to the areas of our brain that regulate our moods being (temporarily & functionally) impacted, what makes concussions so challenging to recover from? A lot.
Identity Loss - feelings of not knowing who one is outside of sport/daily activities which can result in feeling lost, worthless, and reduced confidence in their abilities.
Isolation - reduced social connections due to symptom intolerance and time in treatment
Uncertainty - lack of control or predictability around the entire recovery process (of when symptoms will improve, what treatments help, when you can get back into sport)
Fear - of worsening symptoms, of re-injury, losing a spot on the team, losing friendships,
Invisible - all of these symptoms are compounded by the fact that one “looks normal”. It can be confusing to experience and for people to understand. Friendly reminder that it's not “all in their head”. The symptoms are real.
Recovery…what to expect.
There are too many factors to have a definitive answer on when one’s symptoms will improve such as age, gender, pre-existing health challenges, social support and access to resources and more.
What we do know is that concussion recovery is not linear. This can be very challenging when individuals don't have the education or resources to help cope with this uncertainty.
Some general trends
Emotional recovery does not always align with resolution of physical symptoms
Many athletes experience an improvement in mood related symptoms within one month
Athletes often experience increased anxiety during the return-to-sport phase
Average time to return to sport was 21 days in a study of 21,000 athletes
Around 30-40% of individuals with a concussion (not athlete specific) experience prolonged symptoms (lasting 4+ weeks)
Mental health symptoms tend to worsen if symptoms persist
What SUPPORTS Recovery?
Community
We are social creatures. Being part of a group was crucial to our survival when we lived in caves and this remains a fundamental need for our brain. Although it may look different when recovering from a concussion, remaining connected (quality > quantity) to our support network is fundamental. This is especially important when individuals feel as though they are losing their identity while not engaged in sport.
Read how YOU can help someone through recovery.
Education
Education provides a perceived sense of control over your situation and positively impacts decision making, behaviours and overall mental state. Getting accurate information on concussions and treatment options is critical. Many organizations like Brain Injury Canada, Parachute Canada or Headsup CAN are great places to start.
Specialized Treatment
The psychological response to a concussion differs from other injuries (ex., torn ACL, shoulder dislocations etc). It's often much worse. The gold-standard approach of treating concussions is to have a specialized and multidisciplinary team, including mental health providers.
Mental Skills Training
This is different from mental health support in that it is a more targeted and prescriptive approach to building skills to optimize sports performance versus supporting mental health.
Athletes who engaged in mental skills training returned to sport up to 2.5x faster than those who didn't
Psychological Flexibility
This is a large word that you may have never heard before. It's similar to the concept of resilience and it's proven to protect against mental health challenges and support our recovery. It's a mental process that allows us to adapt with the unpredictable situations in concussion recovery. It's being open, present, and intentional with our actions. Psychological flexibility enables you to work with what's IN YOUR CONTROL instead of being stuck in overwhelm and frustration by what isn’t.
It can take time (and professional support) to change how we perceive things and surrounding yourself with resilient people is a great place to start.
Spirituality
Bet you weren’t expecting this one! Lisa Millers’ research is astonishing. Spirituality has proven to be a protective factor against poor mental health.. Having an established practice physically strengthens areas of the brain that are weakened by depression (also areas of the brain that are functionally impacted by concussions)...
In fact having a spiritual practice is the most effective prevention method against suicidality. Ever.
This can be a tough sell to athletes so let me debunk it. First, spirituality is not religion. Yes, a spiritual practice can involve mindfulness and meditation but it's so much more than that. A spiritual practice is anything that makes you feel connected to something larger than yourself and provides a sense of awe or peace. This looks different for everyone and can include travel, nature, time with pets, relational connections, volunteering, creative hobbies (art, gardening), etc.
Not only are these activities enjoyable, but their impact on our brain's structure and function is incredible…especially for concussion recovery.
Let’s wrap it up…
Although there are some staggering statistics about concussion recovery, know that recovery IS possible. WIth the right education and support from trained professionals, recovery is PROBABLE.
It's a lot to digest, I know. No one should go through this alone.
Book a free discovery call today to see how I can support you in your concussion recovery.
