Post-concussion treatment, suicide prevention ‘a team sport,’ says lead researcher

CBC

March 10, 2020

A leading concussion expert says suicide attempts are much more common among people suffering from concussions than many realize but are preventable if patients get the proper care.

“This issue of suicide is always looming,” said Dr. Charles Tator, director of the Canadian Concussion Centre at Toronto Western Hospital. “We’re always worried about it because we do know that some people do commit suicide after suffering from this.”

The family of Taylor Pryor, 21, who died by suicide last October — a year after suffering a concussion during a soccer game — is calling on the province to provide better care for those suffering from mental health issues.

Pryor’s family says her demeanour drastically changed after the concussion. She went from being a motivated university student to suddenly exhibiting severe post-concussion syndromes like anger, lethargy and sensitivity to light.

Pryor attempted suicide at least 22 times before her death.

“We should be more active in our management of concussion and this terrible episode is a reminder of what we need to do,” said Dr. Tator.

Suicide related to impulsivity, says researcher
There are about 80 different symptoms of post-concussion syndrome, said Dr. Tator, including headaches, dizziness, memory problems, anxiety, depression and post-traumatic stress disorder.

When it comes to suicide, Dr. Tator’s own research shows people who’ve had multiple concussions are more impulsive.

“The usual breaks that someone has that says, ‘No, don’t commit suicide’ aren’t there. So when the impulse arises … they can’t resist the impulse. So that sort of makes it doubly sad.”

According to one 2016 study published in the Canadian Medical Association Journal, “adults with a diagnosis of concussion had an increased long-term risk of suicide.”

The 20-year study looked at more than 235,000 patients who had suffered a concussion on either weekends or weekdays — 667 of those patients died by suicide. The study notes those who suffered concussions on weekdays were three times more likely to die by suicide than the general population.

The authors write that care providers need to pay more attention to the long-term care of concussion patients “because deaths from suicide can be prevented.”

Concussion care ‘a team sport’
For Dr. Tator, that means creating a multidisciplinary support team for each person experiencing long-term concussion symptoms.

Changes in personality — like the ones Pryor’s family saw in her — are very common, Dr. Tator said.

“Symptoms of that type can occur after a concussion, especially if their symptoms aren’t being taken seriously let’s say by practitioners or even family members. They can become even worse,” he said.

Dr. Tator said long-term care includes counselling, antidepressants, cognitive behaviour therapy, handling sleep disorders and sleep deprivation. For that to happen, he said you need a support team, not just one doctor.

“Concussion is a team sport. It’s not just the [medical doctor], but it’s the social worker. It’s the occupational therapists, the physiotherapist,” said. Dr. Tator. “It can’t be the [medical doctor] alone. By its very nature, it needs to be multidisciplinary.”

Pryor’s family said she saw at least 13 psychiatrists and five other medical doctors in less than a year.

A month before she died, a community support plan was drawn up, saying Pryor should be brought to Victoria General Hospital urgent care during a crisis. Pryor was four days away from entering dialectical behavioral therapy at the Selkirk Mental Health Centre when she died.

Her family said there was no mention of any multidisciplinary support.

“Everyone refused to acknowledge the concussion,” Taylor’s father Doug said. “We kept asking for a neuro-psych consult, and we just kept getting stonewalled again and again.”

Family support is key, says advocate
A big part of helping someone with post-concussion syndrome is showing support, according to the Manitoba Brain Injury Association (MBIA). Their support groups help partners and spouses show support for someone going through behavioural and personality changes after injuries — including concussions.

“It relates to the frustration of being in pain,” said Yinka Abiola, who helps advocate for people with brain injuries.

“They can get aggressive about anything, or knowing you can’t even remember what happened for a long time…that can lead to depression, because you’re not the same person you were before the concussion.”

Abiola said it’s not easy for people with brain injuries to navigate Manitoba’s healthcare and work compensation systems — it’s what she spends most of her time doing at work. Her best advice is to be relentless or seek out help from an advocate.

“What I’ve learned with the MBIA is that whenever an organization with a name advocates for someone, then they tend to take it seriously,” she said. “But if it’s an individual, they don’t take it seriously.”

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