Concussions and their association with mental health in Canadian adolescents

Findings from the 2018 Health Behaviour of School-aged Children (HBSC) Study.

On this page

• Introduction
• Prevalence of concussions among youth
• Prevalence of concussions by race
• Activities associated with concussions
• Locations where concussions occur
• Association between concussion and mental health
• Limitations
• Conclusions
• Methods
• References
• Acknowledgements

Introduction

There is growing public awareness about the importance of concussions in the lives of young Canadians (PHAC, 2020b). Population-level data on concussion and its causes is essential to the planning of health promotion initiatives.

Concussions have short-term and long-term effects on the brain (McCrory et al., 2013). It is plausible that concussions influence areas of mental health that are of importance to youth.

This report describes the prevalence of concussions among Canadian youth and examines the relationship between concussion and indicators of mental health status among young people.

This report is based on information from the HBSC national report (PHAC, 2020) and Farmer et al, 2021.

Prevalence of concussions among youth

In 2018, 11.0% of students in grade 6 to 10 reported that they had a medically diagnosed concussion within the past year. 8.7% of these students reported that they had a single concussion and 2.3% reported that they had multiple concussions.

Concussions were more common in grade 8 to 10 students than in grade 6 to 7 students.^*

Figure 1: Text equivalent

About 1 in 10 youth had a concussion within the past year.

Source: Health Behaviour in School-aged Children (HBSC), Canada, 2018.

* Refer to Chapter 9 of the HBSC national report for more information on concussions, including prevalence by grade and gender.

Prevalence of concussions by race

This figure illustrates the percentage of youth who reported that they had a concussion in the past year according to race.

Concussions were the most common among Indigenous youth (14.2%) and least common among East Indian and South Asian youth (6.2%).

Figure 2: Text equivalent

Percentages (95% confidence intervals) of students who reported having had one or more concussions in the past year according to race

Race	Indigenous	White	Other races	Latin American	East & Southeast Asian	Black	Arab & West Asian	East Indian & South Asian
Percentage having concussions	14.2	11.7	10.5	8.8	8.7	8.3	7.1	6.2
Percentage low to high	11.5 to 17.0	11.1 to 12.2	9.2 to 11.7	5.8 to 12.6	6.5 to 11.1	6.6 to 10.4	4.7 to 10.3	4.5 to 8.2
Source: Health Behaviour in School-aged Children (HBSC), Canada, 2018

Activities associated with concussions

Almost 6 in 10 concussions among youth occurred while they were participating in a sport. Concussions occurred during both contact and non-contact sports. Boys were more likely than girls to have sustained their most recent concussion while participating in sport.

Figure 3: Text equivalent

Percentage of concussions among youth that occurred during different activities

N/A	Boys	%	Girls	%
Sport	Boys: 32.0%, team sport with intentional contact 18.5%, team sport without intentional contact 8.3%, individual sport with intentional contact 6.5%, individual sport without intentional contact	65.4%	Girls: 22.9%, team sport with intentional contact 19.4%, team sport without intentional contact 6.4%, individual sport with intentional contact 3.9%, individual sport without intentional contact	52.6%
Driving or passenger in a motorized vehicle (includes off-road vehicles)	-	4.6%	-	3.9%
All other activities	-	30.0%	-	43.5%
Source: Health Behaviour in School-aged Children (HBSC), Canada, 2018

Locations where concussions occur

The most common place for concussions to occur were community facilities such as recreation buildings and sports fields.

Figure 4: Text equivalent

Percentage of concussions among youth by location

Community recreation building or sports field	40.0%
School building or school grounds	28.1%
Street or parking lot	5.4%
All other locations	26.5%
Source: Health Behaviour in School-aged Children (HBSC), Canada, 2018

Association between concussion and mental health

Youth who had a concussion in the past year were less likely to be highly satisfied with their life and more likely to report a lot of emotional problems and poor psychological well-being.

Concussions were associated with many poor/negative mental health outcomes among youth.

Figure 5: Text equivalent

Percentages (95% confidence intervals) of youth who reported specific mental health outcomes by whether or not they had a concussion in the past year

Percentages of youth	Mental health outcomes
	High life satisfaction	High emotional problems	Poor psychological well-being
No concussions	53.0%	26.4%	24.6%
(% low to high)	(52.3 to 53.8)	(25.7 to 27.0)	(23.9 to 25.2)
1 or more concussions	45.6%	38.5%	29.0%
(% low to high)	(43.5 to 47.8)	(36.4 to 40.6)	(27.1 to 31.0)
Source: Health Behaviour in School-aged Children (HBSC), Canada, 2018

• High life satisfaction: Respondent ranks how happy they are with their life as at least 8 on a laddered scale of 1 to 10.
• High emotional problems: Respondent reports that they often have difficulty getting to sleep and frequently feels depressed, in a bad mood, and nervous.
• Poor psychological well-being: Respondent reports that their life is not "filled with things that interest them", and they often do not feel: "in good spirits", "calm and relaxed", "active and vigorous", or "fresh and rested".

Limitations

All research studies have limitations and it is important to interpret results in light of their limitations.

1. All data in the HBSC were collected using self-report, which is prone to reporting biases (Choi & Pak, 2005). This could have led to an underestimate of the true number of concussions. Concussions can be difficult to diagnose and the rate of diagnosis can vary across demographic groups (Bressan & Babl, 2016, Bergeron, 2019).
2. All data in the HBSC were collected in schools. Students who were absent from school while recovering from a concussion would not have participated in the survey, leading to an underestimate in the number of concussions among students.
3. The cross-sectional design of the HBSC does not allow for the inference of causality. Longitudinal designs would be required to determine that concussions led to poorer mental health outcomes.
4. Students were asked to respond to the question "Are you male or female?" by selecting from the three responses, "male", "female" or "neither term describes me". Students who indicated "neither term describes me" did not comprise a large enough group to include in the statistical analyses.

Conclusions

• About 1 in 10 youth reported having a concussion in the last 12 months.
• Boys, older youth, and Indigenous youth were at increased risk of having a concussion.
• About 6 in 10 concussions in youth occur while they were participating in a sport and concussions occurred in both contact and non-contact sports.
• Most concussions occurred at community and school locations where youth engage in sport and other physical activities.
• Concussions were associated with many negative mental health outcomes.

Methods

Data source

Data are from the 8th cycle of the Canadian Health Behaviour in School-aged Children (HBSC), a World Health Organization cross-national research study that focuses on the health of 11-15 year-old students and is conducted every 4 years.

The main purposes of the HBSC are to understand youth health and well-being, and to inform education, health policy and health promotion programs in Canada and abroad.

Eligible school classrooms across Canada were selected at random and invited to participate in the study. In 2018, all provinces and two territories participated. In total, 21,753 Canadian youth from 394 schools completed the study.^*

* Refer to Chapter 1 of the HBSC national report for more information on the HBSC survey methods.

Statistical analysis

Standard descriptive statistics were used to describe the sample. Nationally-representative estimates were calculated using survey weights, which reflected student enrollment within grades 6 to 10 by province/territory.

Chi-square tests augmented by confidence intervals were used to determine whether concussion prevalence differed by gender, race and socioeconomic status, as well as how the frequency of the mental health outcomes differed across youth based on their concussion status. To supplement the analyses that compared the prevalence (likelihood) of mental health outcomes groups of children with and without concussions, regression models were also employed. Bivariate logistic regression models were used to compare the relative odds of the mental health outcomes according to concussion status. Subsequent models adjusted for confounding variables.

References

Bergeron, G. L. (2019). Incidence, Awareness, and Reporting of Sport-Related Concussions in Manitoba High Schools. Can J Neurol Sci, 46(4), 443-450. https://doi.org/10.1017/cjn.2019.58

Bressan, S., & Babl, F. E. (2016). Diagnosis and management of paediatric concussion. J Paediatr Child Health, 52(2), 151-157. https://doi.org/10.1111/jpc.12967

Choi, B. C. K., & Pak, A. W. P. (2005). A catalog of biases in questionnaires. Preventing Chronic Disease, 2, A13.

Farmer, M., Pickett, W., & Janssen, I. (2021). Concussions and their associations with mental health amongst Canadian youth. Manuscript submitted for publication.

McCrory P., Meeuwisse W.H., Aubry M., et al. (2013). Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. British Journal of Sports Medicine 2013; 47:250-258.

Public Health Agency of Canada [PHAC]. (2020). The health of Canadian youth: Findings from the health behaviour in school-aged children study. Retrieved from https://www.canada.ca/en/public-health/services/publications/science-research-data/youth-findings-health-behaviour-school-aged-children-study.html

Public Health Agency of Canada (2020b). Spotlight on traumatic brain injuries across the life course. Ottawa: PHAC, Cat.: HP15-14/2019E-PDF, 150p.

Acknowledgements

• Health Behaviour in School-aged Children (HBSC) is an international study carried out in collaboration with the World Health Organization, European Region (WHO/EURO). The International HBSC Coordinator was Dr. Joanna Inchley (University of Glasgow, Scotland) for the 2017/18 survey and the Data Bank Manager was Dr. Oddrun Samdal (University of Bergen, Norway). The Canadian 2017/18 HBSC survey was funded by the Public Health Agency of Canada, the principal investigators were Drs. (the late) John Freeman, William Pickett and Wendy Craig (Queen's University), and the national coordinator was Matthew King (Social Program Evaluation Group, Queen's University).