Gornall Alice, Takagi Michael, Morawakage Thilanka, Liu Xiaomin, Anderson Vicki
Psychological Sciences, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia.
Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Br J Sports Med. 2021 Sep;55(18):1048-1058. doi: 10.1136/bjsports-2020-103548. Epub 2021 Apr 29.
This systematic review and meta-analysis sought to rigorously examine mental health outcomes following paediatric concussion. To date, heterogeneous findings and methodologies have limited clinicians' and researchers' ability to meaningfully synthesise existing literature. In this context, there is a need to clarify mental health outcomes in a homogeneous sample, controlling for key methodological differences and applying a consistent definition of concussion across studies.
Systematic review and meta-analysis.
We searched Medline, Embase, PsycINFO, CINAHL, SportDiscus, Scopus and PubMed.
Peer-reviewed studies published between 1980 and June 2020 that prospectively examined mental health outcomes after paediatric concussion, defined as per the Berlin Consensus Statement on Concussion in Sport.
Sixty-nine articles characterising 60 unique samples met inclusion criteria, representing 89 114 children with concussion. Forty articles (33 studies) contributed to a random effects meta-analysis of internalising (withdrawal, anxiety, depression, post-traumatic stress), externalising (conduct problems, aggression, attention, hyperactivity) and total mental health difficulties across three time points post-injury (acute, persisting and chronic). Overall, children with concussion (n=6819) experienced significantly higher levels of internalising (g=0.41-0.46), externalising (g=0.25-0.46) and overall mental health difficulties compared with controls (g=0.18-0.49; n=56 271), with effects decreasing over time.
SUMMARY/CONCLUSIONS: Our review highlights that mental health is central to concussion recovery. Assessment, prevention and intervention of mental health status should be integrated into standard follow-up procedures. Further research is needed to clarify the mechanisms underlying observed relationships between mental health, post-concussion symptoms and other psychosocial factors. Results suggest that concussion may both precipitate and exacerbate mental health difficulties, thus impacting delayed recovery and psychosocial outcomes.
本系统评价和荟萃分析旨在严格考察儿童脑震荡后的心理健康结局。迄今为止，研究结果和方法的异质性限制了临床医生和研究人员有意义地综合现有文献的能力。在此背景下，有必要在同质化样本中明确心理健康结局，控制关键方法学差异，并在各研究中应用一致的脑震荡定义。
系统评价和荟萃分析。
我们检索了Medline、Embase、PsycINFO、CINAHL、SportDiscus、Scopus和PubMed。
1980年至2020年6月间发表的同行评审研究，这些研究前瞻性考察了儿童脑震荡后的心理健康结局，脑震荡定义参照《运动脑震荡柏林共识声明》。
69篇描述60个独特样本的文章符合纳入标准，代表了89114名脑震荡儿童。40篇文章（33项研究）对受伤后三个时间点（急性期、持续期和慢性期）的内化问题（退缩、焦虑、抑郁、创伤后应激）、外化问题（品行问题、攻击行为、注意力、多动）和总体心理健康困难进行了随机效应荟萃分析。总体而言，与对照组（n = 56271）相比，脑震荡儿童（n = 6819）在内化问题（g = 0.41 - 0.46）、外化问题（g = 0.25 - 0.46）和总体心理健康困难方面的水平显著更高（g = 0.18 - 0.49），且效应随时间降低。
总结/结论：我们的综述强调心理健康是脑震荡恢复的核心。心理健康状况的评估、预防和干预应纳入标准随访程序。需要进一步研究以阐明心理健康、脑震荡后症状和其他心理社会因素之间观察到的关系背后的机制。结果表明，脑震荡可能既引发又加剧心理健康困难，从而影响延迟恢复和心理社会结局。
