A History of Concussion Linked to Maternal Mental Illness

A history of concussion can have serious long-term mental health implications for women, even years after giving birth, according to a new study.

Researchers looked at all people who delivered babies in Ontario, Canada, and found that those with a predelivery history of concussion were 25% more likely to have a serious mental illness up to 14 years after giving birth than those with no history of concussion.

The findings indicate the need for early identification and screening of women with a history of concussion, as well as ongoing, long-term supports to prevent adverse psychiatric outcomes, wrote the authors.

“I played a lot of sports growing up, and I definitely would not have thought about how a concussion could affect childbearing or parenting,” author Samantha Krueger, RM, MSc, told Medscape Medical News. She completed the research as part of her studies at the University of Toronto, Toronto, Ontario, Canada.

The data were published on November 4 in The Journal of Clinical Psychiatry.

Implications for Prevention

“Birthing people, and women in general, are an often-overlooked population in the scientific literature on traumatic brain injury, including concussion. There is a potential interplay between concussion history and the challenges of being a new parent (such as labor and birth, lack of sleep, and increased noise) that make this an important population to study,” said Krueger.

The researchers conducted a population-based cohort study of all women who gave birth in Ontario between 2007 and 2017. Follow-up continued until 2021. The primary outcome was severe maternal mental illness, which was defined as a psychiatric emergency department visit, psychiatric hospital admission, or self-harm or suicide in the 14 years after delivery.

The researchers identified 18,064 women with a predelivery history of concussion and 736,689 women without a history of concussion during the study period. Women with a predelivery history of concussion were more likely than those without such a history to live in a rural area and have a history of assault or mental illness.

Overall, 11.3% (n = 2033) of the women with a predelivery history of concussion developed severe maternal mental illness (14.7 per 1000 person-years) compared with 6.8% (n = 49,928) of the women without a predelivery history of concussion (7.9 per 1000 person-years).

The adjusted hazard ratio (aHR) was 1.25. The association was strongest in women who had a predelivery history of concussion but no history of mental illness (aHR, 1.33).

“We hope to increase awareness of the seriousness of having a concussion, even when it is considered a mild head injury,” Krueger said. “The results have important implications for concussion prevention measures for young people and for the provision of postpartum supports (such as mental health and other social supports like sleep relief) to mitigate the risk of serious mental illness outcomes in birthing people with a history of concussion.”

Healthcare providers, including maternity care providers, should be asking about concussion history and providing mental health screening and supports to clients and their families to detect mental illness before a serious outcome occurs, Krueger added.

“Maternity care providers can help birthing people and their families set up supports for after the baby is born and teach families about mental health symptoms to look out for. It’s also important that providers be certain that their care is trauma informed to avoid triggering a trauma response when providing care,” she said.

Area of Concern

“This research is novel and highlights an area of major concern,” Simon Sherry, PhD, professor of psychology and neuroscience at Dalhousie University in Halifax, Nova Scotia, Canada, told Medscape Medical News. Sherry did not participate in the study.

“Postpartum depression occurs in approximately 10%-25% of mothers, but it is likely that many more cases go undiagnosed. It is attributed to hormonal changes, genetic predisposition, and environmental factors, and while previous depression or mental illness is frequently considered a risk factor, traumatic brain injuries or concussions usually are not,” Sherry said.

“Mothers are already an at-risk population for mental illness, as illustrated by the high rates of postpartum depression, and so are people with a history of concussion or traumatic brain injury. What sets this study apart is that it shows the heightened risk for women with the combination of those two distinct risk factors. Identifying these risk factors is essential to providing preventive care. If care providers know a patient is at increased risk when starting a pregnancy, then they will likely catch warning signs earlier,” he said.

“Additionally, as the article suggests, maternal mental health often is not studied beyond the first postpartum year,” Sherry said.

“Mental health struggles during the first postpartum year have largely been normalized as part of the transition into parenthood, but mental health issues among parents later in life are less accepted. After birth, so much emphasis is moved from the parent to the child. Parents rightly prioritize their children, but our job as care providers is to ensure we are also prioritizing them. The prolonged period of this study helps illustrate how important the practice of prioritizing mothers’ mental health is,” he added.

The study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. The Canadian Institutes of Health Research also supported the study. Krueger is supported by a Canadian Institutes of Health Research Canada Graduate Scholarship Masters Award. Sherry reported no relevant financial relationships.