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Sex, Gender, and Concussion

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Tackling the Concussion Epidemic

Abstract

This chapter outlines examples of sex and gender considerations with respect to concussion, a topic that has historically received minimal attention. Definitions of sex (biological characteristics) and gender (social constructs) are provided. Epidemiological studies have shown that there are differential patterns of injury across the lifespan by sex with increasing concussion rates among girls/women. Although the literature is mixed, a compelling number of studies are showing that girls/women may have more severe and prolonged symptoms.

This chapter also presents examples of research across different contexts such as among high-risk workers and older adults, sports, and vulnerable population. Areas of brain injury that have not received much attention, such as intimate partner violence which disproportionally affects women, are also addressed.

Sex differences in concussion rates and outcomes in various contexts are explained in relation to biological and gender or socio-cultural factors. Examples of biological differences include research on reproductive health (e.g., menstrual cycles, contraception) and structural differences in the brain, while gender or socio-cultural differences cover symptom reporting and gender based violence.

Finally, this chapter provides some new developments, including resources to assist researchers and clinicians to facilitate sex and gender considerations in research and clinical practice. This research is still in its infancy stage but has shown much growth and recognition recently.

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References

  1. Gardner RC, Yaffe K. Epidemiology of mild traumatic brain injury and neurodegenerative disease. Mol Cell Neurosci. 2015;66(Pt B):75–80. https://doi.org/10.1016/j.mcn.2015.03.001.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Ontario Neurotrauma Foundation. Guideline for concussion/mild traumatic brain injury & persistent stymptoms, 3rd edn, for adults over 18 years of age. 2018. http://braininjuryguidelines.org/concussion/. Accessed 3 Apr 2019.

  3. Canadian Institutes of Health Research. Definitions of sex and gender. 2015. http://www.cihr-irsc.gc.ca/e/47830.html. Accessed 3 Apr 2019.

  4. Canadian Institutes of Health Research. Science is better with sex and gender. 2018. http://www.cihr-irsc.gc.ca/e/51310.html. Accessed 3 Apr 2019.

  5. National Institutes of Health Research. The science of sex & gender in human health. 2017. https://sexandgendercourse.od.nih.gov/. Accessed 3 Apr 2019.

  6. Sen G, Ostlin P. Gender inequity in health: why it exists and how we can change it. Glob Public Health. 2008;3(Suppl 1):1–12. https://doi.org/10.1080/17441690801900795.

    Article  PubMed  Google Scholar 

  7. Colantonio A. Sex, gender, and traumatic brain injury [special issue]. Arch Phys Med Rehabil. 2016;97(2 Suppl):S1–S70.

    Article  PubMed  Google Scholar 

  8. Cancelliere C, Coronado VG, Taylor CA, Xu L. Epidemiology of isolated versus nonisolated mild traumatic brain injury treated in emergency departments in the United States, 2006-2012: sociodemographic characteristics. J Head Trauma Rehabil. 2017;32(4):E37–46. https://doi.org/10.1097/htr.0000000000000260.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Albrecht JS, Hirshon JM, McCunn M, Bechtold KT, Rao V, Simoni-Wastila L, Smith GS. Increased rates of mild traumatic brain injury among older adults in US emergency departments, 2009-2010. J Head Trauma Rehabil. 2016;31(5):E1–7. https://doi.org/10.1097/htr.0000000000000190.

    Article  PubMed  PubMed Central  Google Scholar 

  10. McGuire C, Kristman VL, Martin L, Bedard M. Characteristics and incidence of traumatic brain injury in older adults using home Care in Ontario from 2003-2013. Can Geriatr J. 2017;20(1):2–9. https://doi.org/10.5770/cgj.20.228.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Zemek RL, Grool AM, Rodriguez Duque D, DeMatteo C, Rothman L, Benchimol EI, Guttmann A, Macpherson AK. Annual and seasonal trends in ambulatory visits for pediatric concussion in Ontario between 2003 and 2013. J Pediatr. 2017;181(222–228):e222. https://doi.org/10.1016/j.jpeds.2016.10.067.

    Article  Google Scholar 

  12. Sutton M, Chan V, Escobar M, Mollayeva T, Hu Z, Colantonio A. Neck injury comorbidity in concussion-related emergency department visits: a population-based study of sex differences across the life span. J Womens Health (Larchmt). 2019;28(4):473–82.

    Article  Google Scholar 

  13. El-Khechen Richandi G, Comper P, Bayley M, Colantonio A. The impact of menstrual phase on outcomes of females with concussion. Poster presented at the International Brain Injury Association 13th World Congress on Brain Injury, Toronto, 13–16 March 2019; abstract published in Brain Injury (2019).

    Google Scholar 

  14. Colantonio A, Mroczek D, Patel J, Lewko J, Fergenbaum J, Brison R. Examining occupational traumatic brain injury in Ontario. Can J Public Health. 2010;101(Suppl 1):S58–62.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gray J, Mollayeva T, Bayley M, Mihailidis A, Liss GM, Gibson B, Lewko J, Sharma B, Nowrouzi-Kia B, Colantonio A. Concussion in the workplace. 2016. https://www.youtube.com/watch?v=4Jpqw1sA2d8.

  16. Kim LH, Quon JL, Sun FW, Wortman KM, Adamson MM, Harris OA. Traumatic brain injury among female veterans: a review of sex differences in military neurosurgery. Neurosurg Focus. 2018;45(6):E16. https://doi.org/10.3171/2018.9.focus18369.

    Article  PubMed  Google Scholar 

  17. Durand E, Chevignard M, Ruet A, Dereix A, Jourdan C, Pradat-Diehl P. History of traumatic brain injury in prison populations: a systematic review. Ann Phys Rehabil Med. 2017;60(2):95–101. https://doi.org/10.1016/j.rehab.2017.02.003.

    Article  CAS  PubMed  Google Scholar 

  18. Topolovec-Vranic J, Ennis N, Colantonio A, Cusimano MD, Hwang SW, Kontos P, Ouchterlony D, Stergiopoulos V. Traumatic brain injury among people who are homeless: a systematic review. BMC Public Health. 2012;12(1):1059. https://doi.org/10.1186/1471-2458-12-1059.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Colantonio A, Kim H, Allen S, Asbridge M, Petgrave J, Brochu S. Traumatic brain injury and early life experiences among men and women in a prison population. J Correct Health Care. 2014;20(4):271–9. https://doi.org/10.1177/1078345814541529.

    Article  PubMed  Google Scholar 

  20. Haag HL, Sokoloff S, MacGregor N, Broekstra S, Cullen N, Colantonio A. Battered and brain injured: assessing knowledge of traumatic brain injury among intimate partner violence service providers. J Women's Health. 2019;28(7):990–6. https://doi.org/10.1089/jwh.2018.7299.

    Article  Google Scholar 

  21. Kwako LE, Glass N, Campbell J, Melvin KC, Barr T, Gill JM. Traumatic brain injury in intimate partner violence: a critical review of outcomes and mechanisms. Trauma Violence Abuse. 2011;12(3):115–26. https://doi.org/10.1177/1524838011404251.

    Article  PubMed  Google Scholar 

  22. Jackson H, Philp E, Nuttall RL, Diller L. Traumatic brain injury: a hidden consequence for battered women. Prof Psychol Res Pract. 2002;33(1):39–45. https://doi.org/10.1037/0735-7028.33.1.39.

    Article  Google Scholar 

  23. Haag HL, Jones D, Joseph T, Colantonio A. Battered & brain injured: traumatic brain injury among women survivors of intimate partner violence - a scoping review. Trauma Violence Abuse. 2019:1–18. https://doi.org/10.1177/1524838019850623.

  24. Cancelliere C, Donovan J, Cassidy JD. Is sex an indicator of prognosis after mild traumatic brain injury: a systematic analysis of the findings of the World Health Organization collaborating Centre task force on mild traumatic brain injury and the international collaboration on mild traumatic brain injury prognosis. Arch Phys Med Rehabil. 2016;97(2 Suppl):S5–18. https://doi.org/10.1016/j.apmr.2014.11.028.

    Article  PubMed  Google Scholar 

  25. Covassin T, Moran R, Elbin RJ. Sex differences in reported concussion injury rates and time loss from participation: an update of the National Collegiate Athletic Association Injury Surveillance Program from 2004-2005 through 2008-2009. J Athl Train. 2016;51(3):189–94. https://doi.org/10.4085/1062-6050-51.3.05.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, Solomon GS. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941–8. https://doi.org/10.1136/bjsports-2017-097729.

    Article  PubMed  Google Scholar 

  27. Covassin T, Savage JL, Bretzin AC, Fox ME. Sex differences in sport-related concussion long-term outcomes. Int J Psychophysiol. 2018;132(Pt A):9–13. https://doi.org/10.1016/j.ijpsycho.2017.09.010.

    Article  PubMed  Google Scholar 

  28. King NS. A systematic review of age and gender factors in prolonged post-concussion symptoms after mild head injury. Brain Inj. 2014;28(13–14):1639–45. https://doi.org/10.3109/02699052.2014.954271.

    Article  PubMed  Google Scholar 

  29. Covassin T, Elbin RJ, Larson E, Kontos A. Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms. Clin J Sport Med. 2012;22(2):98–104. https://doi.org/10.1097/JSM.0b013e31823403d2.

  30. Mollayeva T, Mollayeva S, Colantonio A. Traumatic brain injury: sex, gender and intersecting vulnerabilities. Nat Rev Neurol. 2018;14(12):711–22. https://doi.org/10.1038/s41582-018-0091-y.

    Article  PubMed  Google Scholar 

  31. Mollayeva T, Shapiro CM, Mollayeva S, Cassidy JD, Colantonio A. Modeling community integreation in workers with delayed recovery from mild traumatic brain injury. BMC Neurol. 2015;15:194.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Mollayeva T, Pratt B, Mollayeva S, Shapiro CM, Cassidy JD, Colantonio A. The relationship between insomina and disability inworkers with mild traumatic brain injury/concussion: insomnia and disaibity in chronic mild traumatic brain injury. Sleep Med. 2016;20:157–66.

    Article  PubMed  Google Scholar 

  33. Tierney RT, Higgins M, Caswell SV, Brady J, McHardy K, Driban JB, Darvish K. Sex differences in head acceleration during heading while wearing soccer headgear. J Athl Train. 2008;43(6):578–84. https://doi.org/10.4085/1062-6050-43.6.578.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Collins CL, Fletcher EN, Fields SK, Kluchurosky L, Rohrkemper MK, Comstock RD, Cantu RC. Neck strength: a protective factor reducing risk for concussion in high school sports. J Prim Prev. 2014;35(5):309–19. https://doi.org/10.1007/s10935-014-0355-2.

    Article  PubMed  Google Scholar 

  35. Brown DA, Elsass JA, Miller AJ, Reed LE, Reneker JC. Differences in symptom reporting between males and females at baseline and after a sports-related concussion: a systematic review and meta-analysis. Sports Med. 2015;45(7):1027–40. https://doi.org/10.1007/s40279-015-0335-6.

    Article  PubMed  Google Scholar 

  36. Wright DK, O'Brien TJ, Shultz SR, Mychasiuk R. Sex matters: repetitive mild traumatic brain injury in adolescent rats. Ann Clin Transl Neurol. 2017;4(9):640–54. https://doi.org/10.1002/acn3.441.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Wunderle K, Hoeger KM, Wasserman E, Bazarian JJ. Menstrual phase as predictor of outcome after mild traumatic brain injury in women. J Head Trauma Rehabil. 2014;29(5):E1–8. https://doi.org/10.1097/htr.0000000000000006.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Colantonio A, Mar W, Escobar M, Yoshida K, Velikonja D, Rizoli S, Cusimano M, Cullen N. Women's health outcomes after traumatic brain injury. J Womens Health (Larchmt). 2010;19(6):1109–16. https://doi.org/10.1089/jwh.2009.1740.

    Article  Google Scholar 

  39. Snook ML, Henry LC, Sanfilippo JS, Zeleznik AJ, Kontos AP. Association of Concussion with Abnormal Menstrual Patterns in adolescent and young women. JAMA Pediatr. 2017;171(9):879–86. https://doi.org/10.1001/jamapediatrics.2017.1140.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Biscardi M, Shafi R, Einstein G, Cullen N, Colantonio A. Menopause, anti- Müllerian hormone and cognition in a cohort of women with persistent symptoms following TBI: a case for future research. Brain Inj. 2020;35(8):934–42.

    Article  Google Scholar 

  41. Gallagher V, Kramer N, Abbott K, Alexander J, Breiter H, Herrold A, Lindley T, Mjaanes J, Reilly J. The effects of sex differences and hormonal contraception on outcomes after collegiate sports-related concussion. J Neurotrauma. 2018;35(11):1242–7. https://doi.org/10.1089/neu.2017.5453.

    Article  PubMed  Google Scholar 

  42. Babikian T, Marion SD, Copeland S, Alger JR, O'Neill J, Cazalis F, Mink R, Giza CC, Vu JA, Hilleary SM, Kernan CL, Newman N, Asarnow RF. Metabolic levels in the corpus callosum and their structural and behavioral correlates after moderate to severe pediatric TBI. J Neurotrauma. 2010;27(3):473–81. https://doi.org/10.1089/neu.2009.1058.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Dolle JP, Jaye A, Anderson SA, Ahmadzadeh H, Shenoy VB, Smith DH. Newfound sex differences in axonal structure underlie differential outcomes from in vitro traumatic axonal injury. Exp Neurol. 2018;300:121–34. https://doi.org/10.1016/j.expneurol.2017.11.001.

    Article  PubMed  Google Scholar 

  44. Solomito MJ, Reuman H, Wang DH. Sex differences in concussion: a review of brain anatomy, function, and biomechanical response to impact. Brain Inj. 2019;33(2):105–10. https://doi.org/10.1080/02699052.2018.1542507.

    Article  PubMed  Google Scholar 

  45. Shafi R, Crawley AP, Tartaglia MC, Tator CH, Green RE, Mikulis DJ, Colantonio A. Sex-specific differences in resting-state functional connectivity of large-scale networks in postconcussion syndrome. Sci Rep. 2020;10:21982. https://doi.org/10.1038/s41598-020-77137-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Stergiou-Kita M, Mansfield E, Sokoloff S, Colantonio A. Gender influences on return to work after mild traumatic brain injury. Arch Phys Med Rehabil. 2016;97(2 Suppl):S40–5. https://doi.org/10.1016/j.apmr.2015.04.008.

    Article  PubMed  Google Scholar 

  47. Demakis GJ, Rimland CA. Untreated mild traumatic brain injury in a young adult population. Arch Clin Neuropsychol. 2010;25(3):191–6. https://doi.org/10.1093/arclin/acq004.

    Article  PubMed  Google Scholar 

  48. Stergiou-Kita M, Mansfield E, Bezo R, Colantonio A, Garritano E, Lafrance M, Lewko J, Mantis S, Moody J, Power N, Theberge N, Westwood E, Travers K. Danger zone: men, masculinity and occupational health and safety in high risk occupations. Saf Sci. 2015;80:213–20. https://doi.org/10.1016/j.ssci.2015.07.029.

    Article  PubMed  PubMed Central  Google Scholar 

  49. American Psychological Association Boys and Men Guidelines Group. APA guidelines for psychological practice with boys and men. American Psychological Association. 2018. https://www.apa.org/about/policy/boys-men-practice-guidelines.pdf. Accessed 3 Apr 2019.

  50. Kroshus E, Baugh CM, Stein CJ, Austin SB, Calzo JP. Concussion reporting, sex, and conformity to traditional gender norms in young adults. J Adolesc. 2017;54:110–9. https://doi.org/10.1016/j.adolescence.2016.11.002.

    Article  PubMed  Google Scholar 

  51. Oliffe JL, Phillips MJ. Men, depression and masculinities: a review and recommendations. J Men's Health. 2008;5(3):194–202. https://doi.org/10.1016/j.jomh.2008.03.016.

    Article  Google Scholar 

  52. Lindsay S, Proulx M, Maxwell J, Hamdani Y, Bayley M, Macarthur C, Colantonio A. Gender and transition from pediatric to adult health care among youth with acquired brain injury: experiences in a transition model. Arch Phys Med Rehabil. 2016;97(2 Suppl):S33–9. https://doi.org/10.1016/j.apmr.2014.04.032.

    Article  PubMed  Google Scholar 

  53. Colantonio A, Salehi S, Kristman V, Cassidy JD, Carter A, Vartanian O, Bayley M, Kirsh B, Hebert D, Lewko J, Kubrak O, Mantis S, Vernich L. Return to work after work-related traumatic brain injury. NeuroRehabilitation. 2016;39(3):389–99. https://doi.org/10.3233/nre-161370.

    Article  PubMed  Google Scholar 

  54. Mollayeva T, Cassidy JD, Shapiro CM, Mollayeva S, Colantonio A. Concussion/mild traumatic brain injury related chronic pain in males and females: a diagnostic modelling study. Medicine. 2017;96(7):e5917.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Haag HL, Caringal M, Sokoloff S, Kontos P, Yoshida K, Colantonio A. Being a woman with acquired brain injury: challenges and implications for practice. Arch Phys Med Rehabil. 2016;97(2 Suppl):S64–70. https://doi.org/10.1016/j.apmr.2014.12.018.

    Article  PubMed  Google Scholar 

  56. Despins EH, Turkstra LS, Struchen MA, Clark AN. Sex-based differences in perceived pragmatic communication ability of adults with traumatic brain injury. Arch Phys Med Rehabil. 2016;97(2 Suppl):S26–32. https://doi.org/10.1016/j.apmr.2014.06.023.

    Article  PubMed  Google Scholar 

  57. Mollayeva T, Amodio V, Mollayeva S, D’Souza A, Colquhoun H, Haag HL, Quilico E, Colantonio A. A gender transformative approach to improve outcomes and equity among persons with traumatic brain injury. BMJ Open. 2019;9:e024674. https://doi.org/10.1136/bmjopen-2018-024674.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Harris JE, Colantonio A, Bushnik T, Constantinidou F, Dawson D, Goldin-Lauretta Y, Swaine B, Warren H. Advancing the health and quality-of-life of girls and women after traumatic brain injury: workshop summary and recommendations. Brain Inj. 2012;26(2):177–82. https://doi.org/10.3109/02699052.2011.635361.

    Article  PubMed  Google Scholar 

  59. Heidari S, Babor TF, De Castro P, Tort S, Curno M. Sex and gender equity in research: rationale for the SAGER guidelines and recommended use. Res Integrity Peer Rev. 2016;1(1):2. https://doi.org/10.1186/s41073-016-0007-6.

    Article  Google Scholar 

  60. Status of Women Canada. Appling GBA to concussion prevention & treatment [Video]. 2018. https://cfc-swc.gc.ca/med/multimedia/videos/index-en.html.

  61. Health Canada. Sex and gender implementation report. 2018. Retrieved from: https://www.canada.ca/en/health-canada/corporate/transparency/corporate-management-reporting/sex-gender-based-analysis-action-implementation-report.html.

  62. Canadian Institutes of Health Research. Online training modules: integrating sex & gender in health research. 2017. http://www.cihr-irsc.gc.ca/e/49347.html. Accessed 3 Apr 2019.

  63. Valera EM, Joseph AC, Snedaker K, Breiding MJ, Robertson CL, Colantonio A, Levin H, Pugh MJ, Yurgelun-Todd D, Mannix R, Bazarian JJ, Turtzo C, Turkstra LS, Begg L, Cummings DM, Bellgowan PSF. Understanding traumatic brain injury in females: a state-of-the-art summary and future directions. J Head Trauma Rehabil. 2021;36(1):E1–E17. https://doi.org/10.1097/HTR.0000000000000652.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada

    Angela Colantonio

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  1. Keenan Research Centre, St. Michael’s Hospital, Unity Health Toronto and University of Toronto (Neurosurgery), Toronto, ON, Canada

    Tom A. Schweizer

  2. Departments of Critical Care and Anesthesia, St. Michael’s Hospital, Unity Health Toronto and University of Toronto, Toronto, ON, Canada

    Andrew J. Baker

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Colantonio, A. (2022). Sex, Gender, and Concussion. In: Schweizer, T.A., Baker, A.J. (eds) Tackling the Concussion Epidemic. Springer, Cham. https://doi.org/10.1007/978-3-030-93813-0_10

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