Understanding the Deleterious Impact of Sports- and Physical Activity-Related Concussions on Mental Health Among Adolescents: Findings from a Population-Based Study

Background and Purpose: Depression and suicidal behaviors are common mental health problems among adolescents in the United States (U.S.). On the one hand, research has shown that engaging in organized sports and/or physical activity is protective against mental health outcomes. On the other hand, research suggests that adolescents who participate in school sports and/or physical activity are at greater risk of experiencing sports- or physical activity-related concussion (SPAC). While a large body of research has focused on examining the association between SPAC on mental health outcomes among college students, few studies have investigated the impact of SPAC on mental health outcomes among adolescents. Thus, the objective of this study was to investigate the cross-sectional association between SPAC and depression and suicidal behaviors among adolescent high school students in the U.S.

Methods: This study used data from the 2017 and 2019 Youth Risk Behavior Survey, a biennial, school-based, nationally representative survey of adolescents in grades 9 to 12 (N = 14,496). The outcome variables examined were symptoms of depression and suicidal behaviors (suicidal ideation, suicide plan, and suicide attempts). The main explanatory variable examined was SPAC and was measured based on response to the question, “During the past 12 months, how many times did you have a concussion from playing a sport or being physically active?” A concussion is 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. Data were analyzed using chi-square test of association and binary logistic regression.

Results: Of the 14,496 adolescents, about a third (34.3%) had depressive symptoms, 17.1% reported experiencing suicidal ideation, 14.4% made a suicide plan, and 7.0% attempted suicide during the past 12 months. About one in seven adolescents (13.6%) experienced SPAC during the past year. Controlling for demographic, risk, and protective factors, adolescents who had SPAC had 1.29 times higher odds of experiencing symptoms of depression (Adjusted odds ratio (AOR)=1.29, p=.003, 95% CI=1.09-1.52), 1.32 times higher odds of experiencing suicidal ideation (AOR=1.32, p=.001, 95% CI=1.13-1.55), 1.26 times higher odds of making a suicide plan (AOR=1.26, p=.005, 95% CI=1.07-1.47), and 1.56 times higher odds of making a suicide attempt during the past year (AOR=1.56, p<.001, 95% CI=1.28-1.89) when compared to their counterparts who did not have SPAC. Victimization and substance use factors were all positively associated with the symptoms of depression and suicidal behaviors. However, adolescents who played on a sports team or described their academic performance as mostly A’s or B’s were less likely to report symptoms of depression, suicidal ideation, suicide plan, or suicide attempt.

Conclusions and Implications: The findings of this study highlight the increased risk for adverse mental health outcomes among adolescents who experienced SPAC. Providing resources for adolescents to engage in physical activity and sports teams may help prevent the onset of depression and suicidal behaviors; however, resources must also be available to monitor any concussions related to these activities to support students' emotional well-being.