Stakeholder Perspectives on Factors Influencing Mental Health Following Concussion in Youth

OBJECTIVE: To characterize factors influencing mental health following concussion from the perspectives of youth, their parents, and community stakeholders. SETTING: Virtual sessions hosted by a tertiary care children's hospital. PARTICIPANTS: Youth aged 11-17 years with recent concussion, their parents, clinicians, trainers, coaches, and school personnel. DESIGN: Qualitative study using focus groups (FGs) and group-level assessment (GLA) sessions. FGs used semistructured guides to elicit experiences. GLA followed a six-step process to generate, reflect on, and prioritize shared insights. Thematic analysis was applied to FG transcripts, while GLA themes were collaboratively developed. Themes from both methods were synthesized using card-sort methodology and iterative team review. MAIN MEASURES: Thematic synthesis of stakeholder perspectives on factors affecting postconcussion mental health. RESULTS: FG sessions included 20 participants (15 youth, 5 parents); GLA sessions included 32 (10 youth, 9 parents, 13 stakeholders). Five convergent themes emerged: (1) concussion knowledge: education and informed care reassured, whereas limited knowledge, minimization of symptoms, and delays increased distress; (2) support systems: family, peer, school, and clinician support with timely accommodations protected mental health, whereas lack of support, bullying or peer pressure, and pressure to recover quickly hindered recovery; (3) preinjury mental health: previous anxiety or depression heightened risk and complicated recovery; (4) identity and sense of self: adapting expectations and embracing a "new normal" aided adjustment, whereas isolation and role change added strain; and (5) coping strategies: gradual return to activities, self-care, consistent routines, and celebrating progress supported recovery, whereas pressure to "push through" and rushed reintegration were detrimental. CONCLUSION: These qualitative insights revealed multifactorial influences on postconcussion mental health across individual, family, school, and care contexts. Implications include enhancing stakeholder education, promoting coordinated support across settings, integrating routine mental health assessments, addressing identity and role changes, and encouraging adaptive coping strategies to optimize recovery.