Predictors
and Prevalence of Post-concussion Depression Symptoms in Collegiate Athletes

Vargas
G, Rabinowitz A, Meyer J & Arnett P. Journal of Athletic Training.
2015;50(3):250-255. Doi: 10.4085/1062-6050-50.3.02

Take Home Message: Athletes
demonstrated greater rates of depression post-concussion. Older age, baseline
depression symptoms, and increased concussion-related symptoms were factors
most associated with post-concussion depression.

Depression
following a concussion has received significant attention recently due to the high
profile cases covered in the media. Depression symptoms may be characterized in
a variety of ways in athletes, including increases in anger and frustration, declines
in physical performance, and/or diminished motivation to participate. Although
depression is common post-concussion, few studies have recognized risk factors
associated with its development. The purpose of this case-control study
was to identify the prevalence of depression, compare symptom changes between
groups of athletes with and without a concussion, and identify predictors of
depression following a concussion. The authors selected 84 collegiate athletes (NCAA
Division I varsity or club level) with a concussion and 42 undergraduate
students with no history of head trauma. Athletes with a concussion completed
the Beck Depression Inventory-Fast Screen (BDI-FS) when they arrived on campus
and after a concussion. The BDI-FS measures seven key factors relating to
depression: sadness, hopelessness, feeling like a failure, loss of pleasure,
self-esteem, self-blame, and suicidality. The control group of undergraduate
students completed the BDI-FS twice almost 7 weeks apart. The authors also
collected demographic information such as age, sex, and ethnicity as well as
other self-report questionnaires to determine post-concussion symptoms and
health history. Overall, 11% of athletes at baseline and 23% after a concussion
had clinically meaningful depression symptoms. In contrast, only 7% and 10% of
the control students had clinically meaningful depression symptoms at baseline
and follow-up, respectively. The authors found that 17 concussed athletes (20%)
showed an increase in depression symptoms compared with only 2 control
participants (5%). In addition, the authors found several predictors of
post-concussion depression. For example, an athlete was more likely to have post-concussion
depression if they first participated in organized sports at an older age, had
higher baseline depression symptoms, or had more concussion-related symptoms at
baseline.

These
findings are clinically important in many ways. Treating brain injuries are
much more complex than a typical musculoskeletal injury. An athlete’s mental
state and mood may be altered for prolonged time periods following concussions.
Medical professionals should be aware of the personality of the patient to note
changes and monitor depression symptoms following a traumatic brain injury.
Furthermore, as athletes, parents, coaches, and medical practitioners become
more informed of concussions and their consequences, it is more likely that
athletes will be held out of participation and for longer periods of time.  The prolonged removal may contribute to
depression symptoms while recovering from concussions. Early identification of
at-risk athletes suffering from depression symptoms following a concussion is
paramount and may help alleviate depression symptoms. Healthcare practitioners
should have protocols in place for athletes in need of assistance. This study
was completed over a single concussive event so it would be intriguing to see
if multiple concussions in one individual play a role in increasing depression
symptoms. It will also be helpful to see future research confirms these
predictors of depression after a concussion in other athletic populations. For
example, it would be interesting to complete this study with high-school aged
athletes to identify risk factors due to reported higher rates of
post-concussion depression. In the meantime, this study should remind sports
medicine professionals to monitor their athletes after injuries, particularly
concussions, for signs of depression and have a protocol in place for how to
intervene when a patient may need help.

Questions for Discussion:
What is your experience with athletes who suffer multiple concussions? Do you
think they contribute to worsening depression symptom such as anger and
sadness? If an athlete already suffers from depression without a concussion,
how might a concussion impact those symptoms?

Written
by: Jessica Herek and
Adam Rosen
Reviewed
by: Jeffrey Driban

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Vargas, G., Rabinowitz, A., Meyer, J., & Arnett, P. (2015). Predictors and Prevalence of Postconcussion Depression Symptoms in Collegiate Athletes Journal of Athletic Training, 50 (3), 250-255 DOI: 10.4085/1062-6050-50.3.02