Athletes work hard, so they can lay it all on the field during game time. When it comes to training, they don’t know the meaning of seeking comfort. Athletes habitually push themselves to get stronger. To get better.
So when a person who defines their life by grit, determination, and working through the pain gets injured, their world stops.
Get in the game? Can’t.
Did you train today? Nope.
Athletes who have put in thousands of hours of practice to excel in their sport suffer a tremendous loss when injured. It can feel like they’ve lost not just their physical edge, but their identity. The ramifications aren’t just physical, but mental.
And if they’ve suffered a head injury? The challenges increase. While most symptoms of sport-related concussions resolve within days or a few weeks, a subset of sport-related concussion patients suffer post-concussive syndrome. Occuring after a head trauma, post-concussion syndrome includes at least three of the following symptoms:
- Difficulty in concentration and performing mental tasks
- Memory impairment
- Reduced tolerance to stress, emotional excitement and alcohol.
As former promising pro hockey player Ryan Phillips describes his experience with post-concussion syndrome, “the ups and downs are a rollercoaster, one day you’re feeling kind of fine and optimistic, and the next day getting out of bed, even putting a shirt on or taking a shower is the hardest thing ever”. 
While researchers continue to assess the relation between the physical and the psychological when it comes to post-concussion syndrome, the correlation is clear:
“Consistent with current recommendations to assess mood disturbance in post-concussive examinations, current evidence suggests a link between sports-related concussion and depression symptoms in elite athletes.” 
Here’s four ways athletes, parents, and decision-makers in sports and concussion care can tackle the mental impact of concussions.
- Educate Athletes On Mental Health Implications of Their Concussion
A National Institute of Health study found that “1 in 5 people had some type of symptom within the first six months after having a mild traumatic brain injury, including post-traumatic stress disorder and major depressive disorder.”  But the highest risk concerns those symptoms which show up three to six months after the injury since it’s easy to overlook their correlation to the original injury.
Athletes, including student-athletes, need to be made aware of the mental health implications of their concussion. Research adopted by the NCAA shows that “Discussion of sport-related concussion as an injury with varying degrees of concurrent neurophysiological and psychological components appears to be the most effective approach with student-athletes.” 
Athletes who don’t realize post-concussion their psychological issues might be a symptom of their concussion can’t seek appropriate treatment.
- Incorporate Mental Health into Concussion Assessment
What specific mental health symptoms should be looked for in concussion patients? The Ontario Neurotrauma Foundation recommends that concussions include assessment of symptoms that meet the criteria for common mental health disorders, including
- depressive disorders
- Anxiety disorders, including Post-traumatic Stress Disorder (PTSD)
- Behavioural changes
- Emotional regulation issues
- Substance use disorders
- Somatoform disorders (a mental illness that causes bodily disorders, including pain) 
- Integrate Mental Health Professionals Into Concussion Care
While mental health professionals don’t necessarily need to be involved in concussion care where symptoms resolve with initial treatment, there are instances where their expertise is essential. Mental health practitioners should be referred if
- Presentation is complex or severe (e.g. suicide risk)
- Initial treatment is not effective
- The usual medication strategies failure or are contraindicated 
Managing the many aspects of concussion care can be complicated, especially as more people get involved in treatment. Technology is developing that can facilitate the integration of concussion care. HeadCheck Health, for example, offers end-to-end solutions for executing concussion protocols and supporting recovery.
- Consider a Broad Range of Treatment Options
Pharmacological treatment, including SSRIs or SNRIs, is considered a first-line treatment for mood and anxiety disorders after concussion. Evidence indicates that non-pharmacological intervention such as cognitive behavioral therapy (CBT) and other psychotherapeutic modalities can also be effective. 
The brain-gut connection also comes into play when it comes to treating concussion. Research has established that traumatic brain injury (TBI) can lead to gastrointestinal dysfunction.  Gut imbalances can in turn cause inflammation, which can impair the body’s — and brain’s — ability to repair itself and cause mental health issues. Appropriate concussion-related mental health treatments should consider the role the role of digestive and nervous systems when it comes to concussion symptoms. Patients and care providers should consider whether natural or holistic care would be helpful.
Athletes shouldn’t be on their own when it comes to managing the mental health symptoms that may arise from their concussion. It’s going to take all of us — parents, trainers, managers, coaches, and providers — to manage the psychological effects of concussion.
So let’s talk.
 Concussion Talk Podcast, Episode 74: Post Concussion Syndrome and Being Happy (10 November 2020).