Guidelines Quick Access
Mental Health
Pre-injury psychological history or diagnosis of a psychiatric disorder is a predictor of persistent symptoms following mTBI/concussion.50, 51, 68, 70, 306 Additionally, people with high burden of adverse childhood experiences (ACE) (i.e. significant traumatic or stressful events) are more likely to experience mTBI/concussion and risk of mental health and mood problems which may affect recovery.307
People experiencing prolonged symptoms following mTBI/concussion are at an increased risk of developing new or worsening mental health symptoms. Psychological distress following mTBI/concussion can occur even without a premorbid psychological history. Psychological distress is associated with other complaints including subjective cognitive symptoms.308
Diagnosis
Health professionals should routinely monitor for and manage depression and anxiety after mTBI/concussion (children and adults)
EBR (conditional)49,62,64,66,68
Suspected mTBI/concussion should be recognised as soon as possible.
Assessment
Disturbances in mood, cognition, and behaviour are commonly experienced following injury and may signal the presence of a mental health disorder. Pre-existing mental health conditions and symptoms with post-injury onset are predictive of persisting post-concussion symptomatology.49, 50, 311, 312
Questionnaires and assessment tools facilitate assessment and are recommended but are not diagnostic.
EBR (strong)51,62,68,203,204,312-325
Suspected mTBI/concussion should be recognised as soon as possible.
There is no current evidence to indicate that the mental health problems of individuals who have suffered a mTBI/concussion should be treated any differently than mental health problems of other aetiologies. A mTBI/concussion diagnosis should not delay appropriate management and treatment. As such, pharmacological and nonpharmacological interventions including therapeutic interventions that have been found to be helpful in the general population should be considered for individuals who have developed mental health problems post-concussion.
Non-pharmacological Treatments
Psychotherapeutic interventions are generally considered the first-line treatment for mood disorders of mild severity. Cognitive behavioural therapy (CBT) has well-established efficacy for the treatment of mood, anxiety, and trauma and stressor-related disorders.326-331 It has been shown to be efficacious in individuals with TBI when both depression and anxiety are addressed together.332 CBT has been shown to be effectively delivered across various modalities, such as telehealth virtual psychotherapy.333, 334 Remote delivery of CBT may promote retention due to its accessibility and flexibility. Related psychotherapeutic modalities such as cognitive processing therapy, trauma-focused therapy and mindfulness-based interventions may also promote positive outcomes among people with mTBI/concussion.305, 335
EBR (Strong)328
If a mental health disorder is identified, existing practice guidelines for the treatment of the diagnosed condition should be followed. (Children and adults)
EBR (conditional)223,327,328,334-340
Cognitive behavioural therapy (CBT) and other psychotherapeutic modalities delivered by a qualified health care professional should be recommended for people with mental health conditions following mTBI/concussion. (Children and adults)
EBR (conditional)305,341
Mindfulness-based stress reduction may be recommended to help manage chronic symptoms following mTBI/concussion. (Children and adults)
Pharmacological Treatments
Pharmacological treatment should commence if symptoms are persisting, rather than in the acute phase, as experiencing mental ill health may be reactionary following mTBI.
Practice points for children and adult
If pharmacological treatment of mental health disorders, mood and behaviour symptoms in people following mTBI/concussion is considered, a qualified health care professional with experience in managing mental health should be involved.
Treatment of mental health conditions may be conducted in primary care or the person may be referred for more specialised mental health care if needed.
For children, referral to a local mental health professional with experience in the care of children or specialist with experience in paediatric mental health is a consideration if mental health symptoms are prolonged or urgent (presenting with a high risk of acute harm).
Prioritise treatment of mental health conditions early where concerns are identified.
CBR
Treat mental health conditions or consider referral to a mental health specialist, especially where there is a lack of response to treatment. (Children and adults)
Further Australian resources to aid the assessment and management of mental health conditions is available from Beyond Blue, the Black Dog Institute, Headspace and the RACGP. Links are also provided in Box F.