Psychiatric outcomes after mild concussion by treatment timing and age

Previous guidance for mild concussion treatment has recommended physical and cognitive rest. However, it remains unknown if patients who received treatment at different times had differential neuropsychiatric outcomes. We examined if patients who received immediate treatment less than one week after a mild concussion had a different risk for subsequent depression or anxiety compared with those who received delayed treatment greater than one week after the event, stratified by age groups. This multicenter retrospective cohort study used the TriNetX Analytics platform to access de-identified electronic health records of over 100 million patients, including both inpatient and outpatient visits, from 60 healthcare organizations across the United States. A total of 9881 patients with a diagnosis of mild concussion either received either immediate treatment, defined as within 1 week (n = 4053), or delayed treatment, defined as 1 week to 6 months (n = 5828) following the diagnosis of mild concussion. Each group was stratified by age:≤25, 26-64, and 65+ years. Patients who received early treatment had significantly lower risk of depression and anxiety compared with propensity-score matched patients who received delayed treatment during a 5-year follow-up after mild TBI diagnosis, with hazard ratios (HRs) of 0.74 (95 % CI, 0.65-0.84) and 0.75 (95 % CI, 0.68-0.84), respectively. These results are consistent across age groups, with strongest reduction in older adults aged 65 years and older. These findings suggest that timely treatment for concussion may mitigate subsequent adverse psychiatric outcomes.