Concussions in Adolescents - A Brief History
Contact sports in high school and college lead to many concussions in adolescents and young adults. One poll conducted by Tim McGuine, PhD showed that over a quarter of high school athletes surveyed had a concussion within the last couple of years. 261 athletes out of 973 to be exact.
Before the 1970s and 1980s, sporting authorities did not guard against concussions in athletic play. Safety agencies also did not identify concussions on many occasions. Many young adults in contact sports like football and lacrosse had to play in conditions that put them at risk for getting concussions. Sometimes they would go undiagnosed for months, or even years.
Since that time concussions in athletics have been researched more. They have also been diagnosed more in clinical settings. Safety standards such as helmets have become universal in all high school and college contact sports. Many sports programs have increased their medical budget and staffing.
So, progress has been made in identifying and treating concussions in young adults. Progress occurred especially in the athletic context, where they are at the most risk.
But scientists are still discovering and researching symptoms and conditions associated with concussions. Researchers are increasingly finding more long-term disorders. Different conditions are being identified more and more as symptoms of post-concussion syndrome. Symptoms of post-concussion syndrome can last anywhere from a week or two weeks to many months.
Now researchers are finding links between depression and post-concussion syndrome
Depression in young adults and adolescents is already a raging epidemic. The National Institute of Mental Health reported many cases in young adults. About 13 percent of adolescents between the ages of 12 and 17 had a major depressive experience in 2017. During the COVID-19 pandemic, this epidemic only worsened. 63 percent of young adults aged 18 to 24 experiencing symptoms of depression and/or anxiety, according to a CDC online survey.
Problems with mental health and depression are at an all-time high, especially among young adults. There are no signs of these issues slowing down.
Researchers are finding more links between concussion symptoms and depressive symptoms. Some of these symptoms they share include an inability to focus well and anxiety. Poor sleep, drowsiness, lethargy, and worsened emotional stability were also cited.
Depression can also affect concussion recovery. Depression can increase the risk of longer recovery from concussion.
So there is a clear link between many of the symptoms of concussions and the symptoms of depression. And it has also been established that young adults in contact sports are at some of the highest risk of concussion out of any demographic. Young adults are also generally some of the people most affected by depression and mental health problems.
Is this to say that the increased depression rates in young adults are caused or increased by the greater risk for concussion? Not necessarily, correlation in this case does not imply causation. But the two ailments can have similar symptoms, and their greatest victims are often adolescents and young adults.
So what are some of the actions being done to decrease the risk of concussions(especially athletic) and increase athlete safety?
The simplest way to prevent concussions is to decrease the amount of contact allowed in a sport by changing up some of the rules. However, this is not ideal for many sports like football, ice hockey, lacrosse, and soccer. They rely on player-to-player contact in their gameplay. There are potential ways to contribute to athlete safety without banning player-to-player contact.
For example, football, from the professional level all the way down to the high-school and middle-school, is a sport played with helmets. Helmets prevent fractures, but do nothing to prevent concussions. Concussions themselves are caused by the brain itself moving. Some experts are calling for the game to be played without helmets. Another idea is for the tackles(the players who tackle are at the most risk) to be less about bashing heads.
Soccer is another sport that presents a large concussion risk, this time in the form of heading the ball. Heading allows for players to make sharp, pointed contact with the ball using their head. Just this act can increase the risk of concussion, but often, two players will hit their heads against each other when they both attempt to head the ball. This is one of the greatest risks of concussion in the game.
High school and college programs unanimously use helmets in football and allow headings in soccer. In fact, these elements are essential to their respective games. It is unlikely that sports programs will change these parts of the game so these risks will stay.
So most of the work regarding athlete concussions is being done after the fact. More research, better treatment, and a greater focus on details are behaviors that have stemmed from better science. Researchers have and continue to discover more risks and how to prevent them. But the rules of many contact sports aren’t flexible enough to change that much.
Depression in adolescents and young adults is going through something similar. There is lots of new science and studies that have found better ways of identifying depression in young adults. But, not much is being done about changing the lifestyle to reduce these issues, just finding more risks.
Adolescents and young adults are in very vulnerable positions to suffer from severe brain damage from athletics. There can also be long-term damages. They can also suffer from untreated changes in the brain due to depression. These afflictions often share similar symptoms.
But can the two ailments affect each other in the same person?
Researchers have shown that those with a concussion history are more likely to be diagnosed with depression. And, there are people who already have depression and then experience a concussion. They often have a worsening of their depressive symptoms.
There is a relationship between symptoms of depression and symptoms of concussion. These include balance, cognitive function, and vestibular stability. Many who had a traumatic head injury reported negative changes related to their personality and stability. Over 80 percent.
Biologically, this makes sense. Both depression and concussions are activators of the brain’s “behavioral inhibition system”. This activates when experiencing a loss. Depression can occur when the behavioral inhibition activates more severely and makes the person more withdrawn emotionally. Since concussion is a large physical pain, the behavioral inhibition can be triggered just as with depression.
Some people who have already had depression can also experience a worsening of their symptoms, as mentioned before. Experiencing a painful experience like a concussion can retrigger or reactivate the brain’s behavioral inhibition, especially when a person’s behavior inhibition system is already sensitive from experiencing depression.
So there are some clear, scientifically proven links between both the causes and symptoms of concussions and depression. The brain is structured in a way where both ailments can influence each other, and can possibly worsen the condition.
However, this link may not necessarily be clear in high school athletes. Although it has been shown that many high school students suffer from both depression and are at a high risk of a brain injury, it is possible that the rates of both diseases may not be linked for high school athletes specifically. The same study by Tim McGuine did not find a significant difference between rates or severity of depressive symptoms.
Generally speaking, adolescents and young adults are currently in an epidemic of depressive symptoms. Mental health problems in that demographic are highest ever recorded, and no are showing no signs of slowing. This same age group also has a high risk of brain injuries and concussion, especially among athletes, and injuries in this crucial development period can have many long term effects.
It remains to see if there is a true causal relationship between the two conditions, but the two overlap both in symptoms and in the way the brain functions.