Head and Heart

             Tears rolled down my cheeks as I squeezed my eyes shut. “What’s wrong?” My mom asked again.

              “I don’t know…I just…I don’t know.”

             I paused, looking for words, “I am so sick of hearing that everything is going to be alright, while nothing changes. Nothing is getting better.”

             In September 2017, I sustained a mild traumatic brain injury (MTBI), also known as a concussion. The word concussion comes from the Latin word concutere, which means to strike together (Mendez, 2005, p. 297). It occurs when a hit to the head causes the brain to collide with the skull. A concussion is described as “when a blow or jolt to the head causes problems such as headaches, dizziness, being dazed or confused, difficulty remembering or concentrating, vomiting, blurred vision, or being knocked out,” (Clements-Nolle, 2019, p. 259). Most people know on some level that concussions can impact neurological health. However, many do not know that concussions are a serious threat to mental health as well. Current research has linked the history of one or more concussions to the onset of depression and suicidal behaviour in young adults.

              When I finally mustered up the courage to tell Dr. Kaey I was feeling depressed, he hesitantly gave me a small psychological assessment to fill out in the waiting room. It was a small questionnaire asking to what extent I agreed or disagreed on a scale of 1-5 with a few statements.

               I feel depressed most of the time.

             I was embarrassed. I did not want to pen down the number five. I did not want to admit it. But the pain in my head never left me alone. Sometimes it clouded my thinking, other times it was more intense, stabbing into the side of my head, but it was always there. What was worse than the pain in my head was the fog and hollowness in my heart. There was no other word for the empty feeling I woke up with every morning; no other word but depression.

             I circled a 3.

             I feel like a burden to my family.

           I read the statement again, and my eyes started to fill with tears. I squeezed them shut. I did not want to cry in a doctor’s office. I was twenty-one, and while my friends were finishing their degrees, I slept most of the day. My parents were understanding, but most days, I could not muster up the energy to even help with supper. My head never stopped pounding, and I relied on my family for everything. I was a burden to my family; how else could I put it? My nose started to run, and I fumbled in my purse for a tissue, but only found an old napkin. I reminded myself that I was in public and tried to pull myself together and move on to the next question.

             I have considered suicide.

            I felt ashamed. Everything in me wanted to circle 1, or 0 if that was an option. But it was not true. I remembered the week before when my head hurt so much, stabbing pain into my temples. I did not want to move. I laid in my bed clutching a stuffed animal like I was four years old. From my basement bedroom, I could hear the sound of my siblings playing with each other, and my mom telling them to sit down for lunch. Laying on my back, tears rolled from the corners of my eyes and into my hair. I felt so alone.

          Then that dark, creeping thought entered my head. Part of me wished it away, and the other part of me knew it was an option. If it were only the pain in my head, I think I could bear it. But in my heart, I knew that it had been seven months since my concussion, and nothing had changed. The doctors did not know what to do with me, except refer me to another doctor.

            The fact was, while the doctors would always try to help me, it might never get better. My life may never return to normal. I used to be angry that I had lost my job, angry that I had had to move back with my parents and away from my friends, and angry that I got a concussion. But now, there was no anger, only deep sadness, and loss. Hopelessness at my utter inability to care for myself. There was no end in sight and I so desperately wanted it to end.

            I slowly circled a three and then quickly got up to give it to the nurse before I changed my mind about handing it in.

         Suicide is the second leading cause of death among 10-24-year-olds (Clements- Nolle, 2019, p. 263). Concussions have been linked not only with depressive symptoms, but with the onset of suicidal behaviour. In a study conducted with over three thousand high school students, it was found that “youth who experience a recent concussion have increased odds of experiencing other mental health risks beyond depressive feelings, which include self-harm, a suicide attempt, and injuries resulting from a suicide attempt,” (Clements-Nolle, 2019, p. 263). Nearly 20% of physically active students were found to have sustained a concussion in the past twelve months. I did not know that concussions were so common, and I certainly did not understand that many young adults were experiencing the same thing I was. Young adults with a history of one or more concussions reported higher rates of self-harm, depressive symptoms, and suicidal behaviours. (2019, p. 262).

             I felt so ashamed to admit my depressive symptoms. I did not even want to tell my doctor. I wish I had known that many people my age experience mental health difficulties following a concussion. When I did seek help for my negative mental health, it was with the assumption from both my doctor and I that I was experiencing depressive symptoms unrelated to my concussion. Many people assume that a concussion may cause neurological difficulties, but not emotional difficulties. A study from the University of Washington found a “History of concussion was associated with a higher prevalence of diagnosed depression in a large nationally representative adolescent data set.” (Chrisman, 2014, p. 252). It is not understood whether concussions cause chemical disruptions in the brain which cause the onset of depression, or if the social withdrawal and pain due to a concussion can circumstantially bring about depression. But concussion and the onset of negative mental health are undeniably linked.

             Several studies have conducted research with the goal to accurately distinguish the cause of depression between concussion and other factors which may contribute to suicidal behaviours in young adults. Dr. Chrisman’s findings confirmed, “we found that history of concussion was associated with greater than a 3-fold risk of a current diagnosis of depression, even after controlling for age, sex, parental mental health, and socioeconomic status,” (2014, p. 585). A similar study specifically looked at other common contributing factors for suicide, such as substance abuse, a history of bullying or victimization, and minority sexual orientation. It found  that “the relationship between sports-related concussions and depressive symptoms and suicidal behaviours remained even after controlling for these strong psycho-social predictors,” (Mantey, 2020, p. 687). Even with other contributing factors, those with concussions are found to be at higher risk for the onset of depression and suicidal behaviours, which is not information that can be taken lightly.

             Many doctors consider a concussion to be a minor injury, with little risk of complication. My doctor had simply prescribed rest, which is the usual treatment for a concussion. One study remarked that “in medicine, rest is often prescribed by default when the presenting condition is poorly understood.” (Chrisman, 2014, p. 585). Monitoring of a young person’s mental health is not standard protocol for concussion care. After finding that post-concussive youth were at a severely higher risk of suicidal behaviour, Dr. Chrisman concluded, “Clinicians should screen for depression in their adolescent patients with concussion” (2014, p. 252).

             My post-concussive symptoms persisted with intensity for over a year and have yet to completely resolve. Dr. Chrisman states that, “It was previously thought that youth recovered quickly from concussion, but new evidence suggests symptoms may persist for months or years, particularly after multiple concussions.” (2014, p. 252). A similar study called for greater education in regards to concussions, concluding that “suicide awareness, education, and prevention efforts should incorporate history of sports-related concussions (or other traumatic brain injuries) as risk factors into interventional programs,” (Mantey, 2020, p. 689).

             C.S. Lewis wrote, “Mental pain is less dramatic than physical pain, but it is more common and also harder to bear. The frequent attempt to conceal mental pain increases the burden: It is easier to say, “My tooth is aching’ than to say ‘My heart is broken,” (Rathod, 2019). Mental pain should not be considered as less important than physical pain, and concussions can cause both. For me, sustaining a concussion was the most pain I had ever experienced, for both my head and my heart. Concussions are not just in the head; they can cause the onset of depressive symptoms and suicidal behaviours. While more research needs to be done, great care needs to be taken to ensure young adults receive support for both the physical and mental health effects of a concussion.

References 

Mendez, Cecilia V, et al. “Mild Traumatic Brain Injury: Neuroimaging of Sports-Related Concussion.” The Journal of Neuropsychiatry and Clinical Neurosciences: Official Journal of the American Neuropsychiatric Association, vol. 17, no. 3, 1 Aug. 2005, pp. 297–303. PsychiatryOnline, EBSCOhost, doi:10.1176/jnp.17.3.297. Accessed 24
Apr. 2020.

Chrisman, Sarah P.D, et al. “Prevalence of Diagnosed Depression in Adolescents with History of Concussion.” Brown University Child & Adolescent Psychopharmacology Update, vol. 16, no. 10, Oct. 2014, pp. 2–3. Academic Search Ultimate, EBSCOhost, search-ebscohost-com.ezproxy.student.twu.ca/login.aspxdirect=true&db=asn&AN=98509390&site=ehost-live&scope=site. Accessed 22 Apr. 2020.

Clements-Nolle, Kristen, et al. “Adolescent Concussion and Mental Health Outcomes: A Population-Based Study.” American Journal of Health Behavior, vol. 43, no. 2, 1 Mar. 2019, pp. 258–265. MEDLINE with Full Text, EBSCOhost,
doi:10.5993/AJHB.43.2.3. Accessed 22 Apr. 2020.

Mantey, Dale S, et al. “Self-Reported History of Concussions Is Associated with Risk Factors for Suicide Completion among High School Students.” Journal of Affective Disorders, vol. 263, 15 Feb. 2020, pp. 684–691. MEDLINE with Full Text,
EBSCOhost, doi:10.1016/j.jad.2019.11.047. Accessed 22 Apr. 2020.

Rathod, N., & Alford, J. “Institute of Global Health Innovation.” Mental Health Blog Archives, May 13, 2019. Retrieved from http://wwwf.imperial.ac.uk/blog/ighi/tag/mental-health/ Accessed 22 Apr. 2020.