Early psychological symptoms predict concussion recovery time in middle and high school athletes

ABSTRACT

Introduction

Lingering concussion symptoms can negatively impact a child’s well-being, yet variability in recovery is poorly understood. To aid detection of those at risk for prolonged symptom duration, we explored postconcussion mood and sleep symptoms as predictors of recovery time in adolescent athletes.

Method

We utilized analyses designed to control for potentially confounding variables, such as concussion severity indicators and premorbid psychiatric history. Participants included 393 adolescent athletes (aged 12–18 years) evaluated in outpatient concussion clinics within 2 weeks after injury. Provider-documented date of symptom resolution was obtained via medical record review. Survival analysis for recovery time was conducted in the total sample, and separately for males and females using prior medical history (psychiatric disorder, prior concussion), injury-related factors (loss of consciousness, post-traumatic amnesia [PTA], concussion symptom severity), and psychological symptoms (General Anxiety Disorder-7 Item Scale, Patient Health Questionnaire-8 Item Depression Scale, Pittsburgh Sleep Quality Index) collected at initial clinic visit.

Results

PTA, concussion symptoms, and sleep quality were associated with recovery in the total sample (HRs = 0.64–0.99, ps < .05). When analyzed by sex, only concussion symptoms were associated with recovery for females (with females reporting greater symptom severity than males), while for males PTA and greater depression symptoms were significant predictors of recovery (HRs = 0.54–0.98, ps < .05).

Conclusions

These findings identified differences in symptom presentation between sexes, particularly for mood symptoms, and suggest that assessment of postconcussive symptoms is useful in helping to identify individuals at risk for longer recovery. Continued exploration of post-injury psychological difficulties in athletes is warranted for better concussion management.

KEYWORDS:

• Mild traumatic brain injury
• concussion
• athlete
• postconcussive symptoms
• psychological screening
• sports-related neuropsychology

Acknowledgments

We would like to thank the ConTex research staff as well as the participants and families who contributed to the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The North Texas Concussion Registry (ConTex) was funded by a grant from the Texas Institute of Brain Injury and Repair (TIBIR), a state-funded initiative as part of the Peter J. O’Donnell Jr. Brain Institute at the University of Texas Southwestern Medical Center. Support for the use of REDCap came from the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) under award number UL1TR001105. Neither TIBIR nor NIH had any involvement in the (i) study design, (ii) the collection, analysis, and interpretation of the data, (iii) in the writing of the report, or (iv) in the decision to submit the article for publication.