Prevalence and risk factors for depression, anxiety and suicidal ideation in youth with persistent post-concussive symptoms (PPCS)

Figures & data

Table 1. Demographics and past medical history of 200 youth with Persistent Post-Concussive Symptoms (PPCS), 2017–2019, Western Washington

		Mean (SD) or N (%)
Age (continuous)		14.7	(1.7)
Female		124	(62.0)
Race
	American Indian or Alaskan Native	1	(0.5)
	Asian	7	(3.5)
	Black	5	(2.5)
	More than one race	17	(8.5)
	Native Hawaiian or other Pacific Islander	1	(0.5)
	White	164	(82.0)
	Other	6	(3.0)
	Unknown	2	(1.0)
Ethnicity
	Hispanic	17	(8.5)
	Non-Hispanic	177	(88.5)
	Other	6	(3.0)
Parent education
	High school or less	13	(6.5)
	Some college	35	(17.5)
	Associate’s degree	32	(16.0)
	Bachelor’s degree	73	(36.5)
	Post-graduate	46	(23.0)
	Other	1	(0.5)
Household income
	<$ 50,000	17	(8.5)
	>$50,000–100,000	38	(19.0)
	>$100,000	145	(66.5)
Insurance
	Medicaid	25	(12.5)
	Private	168	(84.0)
Prior concussions
	0	97	(48.5)
	1	50	(25.0)
	2+	53	(26.5)
Days from injury
	0–30	7	(3.5)
	31–60	117	(58.5)
	61–90	36	(18)
	91–120	20	(10)
	>120	20	(10)
Past medical history
	Anxiety	62	(31.0)
	ADD^a	19	(19.5)
	Depression	36	(18.0)
	Headache	50	(25.0)
Sleep
	Total ASWS^b (range 1–6)	3.9	(0.7)
Trauma history
	Number of traumatic events = 1+ (Youth)	65	(32.5)
	Number of traumatic events = 2+ (Parent)	98	(49.0)
Outcomes
	PHQ-9^c ≥ 11	79	(39.5)
	GAD-7^d ≥ 11	50	(25.0)
	PHQ-9 item 9 ≥ 1 (i.e., thoughts of death or self-harm)	28	(13.9)
	PHQ-9 item 10 ≥ 1 (i.e., thoughts of ending your life)	15	(7.5)

^aADD = Attention Deficit Disorder

^bASWS = Adolescent Sleep Wake Scale

^cPHQ-9 = Patient Health Questionnaire-9 item

^dGAD-7 = Generalized Anxiety Disorder-7 item

Table 2. Poisson regression examining risk factors associated with meeting or exceeding clinical cut-points for depression, anxiety, thoughts of self-harm and suicidal ideation in youth with Persistent Post-concussive Symptoms (PPCS), 2017–19, Western Washington

		Depression ^cPHQ-9 = 11+		Anxiety ^dGAD-7 = 11+		Thoughts of death or self-harm ^cPHQ-9 #9 = 1+		Suicidal ideation ^cPHQ-9 #10 = 1+
	Total^ab (n = 200)	Risk Ratio (95% CI)	p	Risk Ratio (95% CI)	p	Risk Ratio (95% CI)	p	Risk Ratio (95% CI)	p
Age		1.19 (1.09–1.29)	<0.001	1.07 (0.95–1.22)	0.27	1.09 (0.90–1.34)	0.36	0.95 (0.67–1.35)	0.78
Sex	Female	1.32 (0.90–1.93)	0.15	2.15 (1.11–4.15)	0.02	1.36 (0.59–3.13)	0.47	1.46 (0.36–5.96)	0.60
Race	Nonwhite			1.94 (1.23–3.06)	0.004			4.02 (1.09–14.67)	0.04
	White			–				–
Ethnicity	Hispanic					2.36 (1.02–5.49)	0.045	5.42 (1.26–23.27)	0.02
	Non-Hispanic					–		–
Past medical history	H/o Depression			1.73 (1.09–2.75)	0.02	3.56 (1.82–6.99)	<0.001	6.53 (1.74–24.46)	0.005
	H/o Headache	1.84 (1.40–2.44)	<0.001
Sleep	Mean ASWS^e (continuous)	0.48 (0.40–0.58)	<0.001	0.60 (0.44–0.82)	<0.001	0.60 (0.41–0.89)	0.01

^aAge and sex were included in all models regardless of significance, other variables were only included if significant at p < 0.05.

^bAdditional variables examined but not retained due to lack of significance included history of parental trauma, history of child trauma, history of attention deficit/hyperactivity disorder, history of anxiety, prior concussions, duration of symptoms at time of baseline and measures of socioeconomic status (income, insurance status and parental education).

^cPatient Health Questionnaire-9 item

^dGeneralized Anxiety Disorder – 7 item

^eAdolescent Sleep Wake Scale

^fH/o = “History of”

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