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