Differences in Postinjury Psychological Symptoms Between Collegiate Athletes With Concussions and Orthopedic Injuries

Guo J, Yang J, Yi H, Singichetti B, Stavrinos D, Peek-Asa C. Clin J Sport Med. 2020 July. DOI: 10.1097/JSM.0000000000000621.

Take-Home Message

Collegiate student-athletes who experience a concussion report less fear of return to play and reinjury than those who have an orthopedic injury.


Athletes often experience psychological symptoms (e.g., depression, anxiety, fear of reinjury) after a concussion or orthopedic injury. Athletes with an orthopedic injury usually have a standard timeline for rehabilitation, but athletes with a concussion experience a less predictable recovery, which may make them more likely to experience psychological symptoms. However, it remains unclear whether psychological disturbances differ between types of injuries. The authors designed this prospective cohort study to evaluate differences in psychological symptoms between athletes who suffered a concussion versus orthopedic injury. The authors recruited 957 Division I student-athletes between the 2007-2008 and 2011-2012 seasons. Enrolled athletes completed a baseline survey at the beginning of the season that assessed depressive and anxiety symptoms, and demographic information. An athlete with a new injury completed follow-up surveys until they returned to play. These surveys assessed depressive (CES-D scale) and anxiety (State-Trait Anxiety Inventory) symptoms, fear of return to play (rate 0-10, 0=no fear), and fear of reinjury (rate from 0-10, 0=no fear). The authors defined a concussion as “a trauma-induced alteration of mental status, occurring in sports activities, regardless of whether it restricted the student-athlete’s participation”. Orthopedic injuries also occurred in sports activities, required diagnosis by a team physician, and caused the athlete to miss ≥ 1 day of practice.

The enrolled athletes experienced 71 concussions and 526 orthopedic injuries. While almost all athletes with a concussion returned to play within one week (89%), only 59% of athletes with an orthopedic injury did. Since almost all athletes with a concussion returned to play within one week, we focused on the differences between injury types at baseline and within one week of an injury. While depression and anxiety did not differ between athletes with a concussion or orthopedic injury, the athletes with an orthopedic injury had a greater fear of reinjury and return to play.


The authors found that an athlete with a concussion may have less fear of both return to play and reinjury than an athlete with an orthopedic injury. The authors also found that an athlete with a concussion may have worse depressive symptoms at 1-month postinjury. However, only 8 athletes in the concussion group completed an assessment 1 month after their injury. An athlete having increased fear of return to play and reinjury makes sense after an orthopedic injury as the rehabilitation process is much longer, and the previous injury remains a significant risk factor for future reinjury. However, an athlete having increased depressive symptoms 1 month after a concussion is less obvious and may be related to not returning to play as fast as their peers with prior concussions. Researchers should consider evaluating short- to long-term psychological symptoms among athletes who experience a concussion, even if they return to play. A longitudinal study may help clarify which athletes experience worsening depressive symptoms 1 month after a concussion (e.g., athletes with more severe injury or longer recovery). Athletes may benefit from learning that not all concussions heal quickly and that some can take many weeks. Clinicians can educate their athletes about their possible recovery timeline and what to expect with psychological symptoms, as well as about when a patient should report concerns about reinjury or depressive symptoms. Clinicians should also monitor these psychological symptoms throughout recovery and coordinate with mental health experts to determine when a referral may be appropriate.  

Questions for Discussion

Do athletes with a concussion have worsening depressive symptoms from 1-week to 1-month postinjury? How do these postinjury psychological symptoms differ between youth, collegiate, and professional athletes?

Written by: Ryan Paul
Reviewed by: Jeffrey Driban

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