History of Concussion Associated With Higher Risk of Adverse Psychiatric Outcomes Postpartum

According to findings published in the Journal of Clinical Psychiatry, people with a history of concussion are approximately 25% more likely to have severe mental health issues following childbirth. The investigators emphasize that the results demonstrate the need for long-term, trauma-informed support for this population’s mental health.¹

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“Sleep is critical to recovery after a head injury, but sleep deprivation is a reality for many new parents,” explained senior author Hilary Brown, PhD, adjunct scientist at the Institute for Clinical Evaluative Sciences, associate professor in the Department of Health and Society, University of Toronto Scarborough, in a news release. “Cognitive impairments, sensitivities to light and noise, and the stress of caring for a newborn can all intensify concussion symptoms, which in turn may raise the risk of mental health issues over time.”¹

For this population-based cohort study, the investigators enrolled pregnant individuals with a singleton live birth between 2007 and 2017 from Ontario, Canada, with a follow-up in 2021. A total of 754,753 participants were included in the study, of which 18,064 had a history of concussion and the remaining subgroup (n = 736,689) did not.^1,2

The primary outcome of the study was severe maternal mental illness, which was defined as a psychiatric emergency department visit, psychiatric hospital admission, or self-harm or suicide within 14 years following delivery. Additionally, the history of a health care encounter for concussion between database launch and the delivery date was compared to those without a recorded health care encounter for concussion. Further, adjustments were made based on maternal age, parity, neighborhood income quintile, rural residence, immigration status, chronic conditions, history of interpersonal violence, and history of mental illness. The investigators note that results were also stratified by history of mental illness.²

The findings showed that the 18,064 enrolled pregnant individuals with a history of concussion had an increased risk of severe maternal mental illness compared to those without a history of concussion (14.7 vs 7.9 per 1000 person-years; adjusted hazard ratio [aHR]: 1.25, 95% confidence interval [CI], 1.20–1.31). Additionally, after stratification by predelivery history of mental illness, the association was strongest in those without mental illness history (aHR: 1.33, 95% CI, 1.23–1.44).²

“We found that individuals with a history of concussion were significantly more likely to experience serious mental health challenges, such as psychiatric emergency department visits or self-harm, in the years following childbirth,” said lead study author Samantha Krueger, a midwife and PhD candidate in Health Research Methodology at McMaster University, in the news release. “This association was especially strong for people with no prior mental health history, meaning that concussion may be an important but overlooked risk factor during pregnancy and postpartum care.”¹

According to the authors, the findings demonstrate a need for early identification and routine screening, such as antenatal screening, for pregnant individuals with a history of concussion. With this information, health care professionals can take appropriate action and informed approaches to prevent adverse psychiatric outcomes for this patient population during the postpartum period.^1,2

“Our study points to a critical need for health care providers to take concussion history into account when supporting new parents,” urged Krueger in the news release. “Early identification and long-term support could make a real difference in preventing serious psychiatric outcomes.”¹

REFERENCES

1. Institute for Clinical Evaluative Sciences. History of concussion linked to higher risk of severe mental illness after childbirth. News release. November 4, 2024. Accessed November 4, 2024. https://www.eurekalert.org/news-releases/1063056

2. Krueger S, Vigod SN, Chan V, et al. History of Concussion and Risk of Severe Maternal Mental Illness. JCP. 2024;85(4):24m15373. doi:10.4088/jcp.24m15373.