If you've been around youth sports lately, you know concussions are a hot topic. But here's something that doesn't get talked about nearly enough: the mental health side of things. As someone who's spent the last four years studying kinesiology and working with athletes, as well as having a few concussions myself, I've become fascinated by how a knock to the head can affect so much more than just physical symptoms. Let's dive into what the research is telling us.
The Numbers Are Eye-Opening
First, let's talk about how common this problem really is. According to the CDC, about 7 out of 10 emergency department visits for sports-related TBIs and concussions involve kids 17 and under. That's huge. And when you look at the research more closely, the numbers get even more interesting.
A massive study in Hawaii tracked nearly 93,000 high school athletes over six years and found 5,993 concussions—that's almost one concussion per 100 athletes. But here's where it gets really interesting: the highest-risk sport wasn't what you might think. Sure, football had a rate of 1.60 concussions per athlete, but girls' judo topped the list at 1.92.
The gender piece is fascinating too. Research shows that in comparable sports like basketball, soccer, and softball, female athletes have 1.5 to 2 times the relative risk of concussion compared to their male counterparts. Some researchers think this might be due to differences in neck strength, head-to-ball ratios, or even hormonal factors, but we're still learning about the exact mechanisms.
The Mental Health Connection We Can't Ignore
Here's where things get really important for anyone working with youth athletes. We used to think concussions were mainly about headaches, dizziness, and taking some time off. But the research is showing us something much more complex: there's a significant link between concussions and mental health issues, particularly depression.
A systematic review of studies on elite athletes found that depression was the most commonly studied mental health outcome, appearing in over 70% of the research. And the evidence is pretty solid that there's an association between concussion exposure and depression symptoms. While some studies showed these symptoms resolved after about a month, others found longer-lasting effects.
The numbers from college athletes are even more concerning. One study found that student-athletes with a previous concussion had a 46% higher risk of mental health disability. That's not a small bump—that's a significant increase in risk that we need to take seriously.
And here's something that really hit home for me: research published in Athletic Training & Sports Health Care found that athletes with a history of concussion reported significantly higher levels of both aggression and depression compared to athletes who had never been concussed. Think about what that means for team dynamics, personal relationships, and long-term athlete well-being.
Why Does This Happen?
You might be wondering: why would a brain injury lead to depression or anxiety? It's not just about feeling bummed about missing games (though that's definitely part of it). A 2022 study explains that changes in glutamatergic signaling and the neurometabolic cascade after a concussion can literally alter brain chemistry. These changes can make it harder for the brain to meet its energy demands, potentially leading to behavioral impairments over time.
There's also a huge psychological component. Research from The Clinical Journal of Sports Medicine highlights that athletes who can't participate in their sport may experience social withdrawal and depression, especially if they feel disconnected from their teammates. For a lot of young athletes, their sport is a huge part of their identity. Taking that away, even temporarily, can be really tough mentally.
What About the Evidence on Anxiety?
The research on anxiety is a bit more mixed than depression, but it's still important. Several studies have looked at anxiety following concussion, but the results vary more than with depression. Some athletes show increased anxiety, particularly around returning to play or getting hit again. Others don't show significant changes.
Interestingly, research on college athletes found that having baseline anxiety symptoms (without an actual diagnosis) didn't necessarily predict longer recovery times. But athletes who had higher anxiety scores on standardized tests were 1.29 times more likely to have mental health disabilities. It's a nuanced picture that tells us we need to look at each athlete individually.
The Long-Term Picture
Here's something that keeps me up at night as someone going into this field: we're still learning about the long-term effects. Some research suggests that while a single well-managed concussion might not lead to permanent problems, there are concerns about repeated concussions and their cumulative effects on mental health.
The good news? Studies show that many symptoms resolve within a month with proper management. The key phrase there is "with proper management." This is where proper protocols, baseline testing, and comprehensive care really matter.
What This Means for Coaches, Parents, and Athletes
If you're working with youth athletes (ages 12-20, which is what most of this research focuses on), here's what you need to know:
- Watch for more than just physical symptoms. Changes in mood, social withdrawal, increased irritability, or loss of interest in activities can all be signs that an athlete is struggling mentally after a concussion.
- Girls may need extra attention. The CDC notes that girls are more likely to report severe and long-lasting symptoms following a concussion, and mental health symptoms are more common in girls.
- Prior concussions matter. Research clearly shows that athletes with a history of concussion are at higher risk for mental health issues. This means we need to be especially vigilant with athletes who've been concussed before.
- The 30% rule. About 30% of athletes with concussions may have symptoms lasting more than four weeks. If symptoms aren't improving after two weeks, it's time to see a specialist.
- Don't minimize the emotional impact. Being sidelined sucks. Acknowledge that, validate it, and make sure athletes know it's okay to talk about how they're feeling.
The Bottom Line
As we learn more about concussions, it's becoming crystal clear that we can't just treat the physical symptoms and call it good. The mental health component is real, it's significant, and it needs to be part of every concussion management protocol.
The exciting news is that we're developing better tools and protocols to address this—things like baseline qEEG testing and neurofeedback training (which I'll cover in my next post) that can help us both prevent and treat these issues more effectively.
For now, the message is simple: if you're working with young athletes, stay educated about concussions, take every head injury seriously, and remember that the athlete sitting on the bench might be struggling with more than just a headache. Their mental health matters just as much as their physical recovery.
References
- Ingram, V. I. et al. (2025). The Incidence of Sports-Related Concussion in Children and Adolescents: A Systematic Review and Meta-Analysis. Sports Medicine - Open. https://link.springer.com/article/10.1186/s40798-025-00834-9
- Ikei, S. et al. (2020). Concussion Epidemiology in Youth Sports: Sports Study of a Statewide High School Sports Program. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC7734362/
- Centers for Disease Control and Prevention. (2025). Data on Sports and Recreation Activities. HEADS UP. https://www.cdc.gov/heads-up/data/index.html
- Kontos, J. R. et al. (2019). Incidence and Risk of Concussions in Youth Athletes. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC6345352/
- Rice, S. M. et al. (2018). Sport-Related Concussion and Mental Health Outcomes in Elite Athletes: A Systematic Review. Sports Medicine. https://link.springer.com/article/10.1007/s40279-017-0810-3
- Rice, S. M. et al. (2018). Sport-Related Concussion and Mental Health Outcomes in Elite Athletes: A Systematic Review. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC5775382/
- Williams, J. B. et al. (2022). Previous concussions increase risk of mental health disability in college athletes. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9260347/
- Williams, J. B. et al. (2022). Previous concussions increase risk of mental health disability in college athletes. Journal of Clinical and Translational Research. https://accscience.com/journal/JCTR/8/3/10.18053/jctres.08.202203.004
- Covassin, T. & Savage, J. L. (2018). Mental Health Outcomes Following Sport-Related Concussion. Athletic Training & Sports Health Care. https://journals.healio.com/doi/10.3928/19425864-20171010-03
- St. Charles Health. The psychological effects of concussions on youth athletes. https://stcharleshealthcare.org/news/psychological-effects-concussions-youth-athletes
- Buckley, T. A. & Broglio, S. P. (2024). Association of Premorbid Anxiety and Depression Symptoms in Concussion Recovery. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC11569539/
- Purcell, L. K. (2023). Mental Health in the Youth Athlete. PubMed. https://pubmed.ncbi.nlm.nih.gov/37949505/
- National Federation of State High School Associations. Return To Play Guidelines Essential In Concussion Recovery. https://nfhs.org/stories/following-return-to-play-guidelines-essential-in-concussion-recovery