The Role of Reported Affective Symptoms and Anxiety in Recovery Trajectories After Sport-Related Concussion

D’Alonzo BA, Bretzin AC, Wiebe DJ. Am J Sports Med. The Role of Reported Affective Symptoms and Anxiety in Recovery Trajectories After Sport-Related Concussion. 2022 June 1. doi:10.1177/03635465221098112.

Take-Home Message

Athletes who reported affective symptoms (more emotional, irritability, sadness, and nervous-anxious) had a delayed recovery timeline compared to peers without affective symptoms after a concussion.


After a sport-related concussion, women tend to exhibit more emotional symptoms than men and take longer to reach symptom resolution. Additionally, those with affective symptoms (e.g., depression, anxiety) at baseline and after concussion often report a higher overall symptom burden. However, it is unclear how affective symptoms and sex may influence time to symptom resolution or RTP.

Study Goal

The authors conducted a prospective multi-site observational study to assess whether reporting affective symptoms (more emotional, irritability, sadness, and nervous-anxious) relate to time to recovery and RTP.


The authors used data from over 2000 athletes with a concussion from the Ivy League–Big Ten Epidemiology of Concussion Study (Ivy–B1G Study). The authors received athlete demographic information; symptomology and mechanism of concussion; and dates of injury, symptom resolution, and return to learn and play. Then, the authors compared athletes who experienced affective symptoms after a sport concussion with those who did not, assessing their recovery outcomes: 1) time to being symptom-free, 2) time to RTP, and 3) time from being symptom-free to full RTP. Authors also evaluated between-sex and sport differences.


Overall, 44-48% of athletes reported affective symptoms, including 22-24% that reported nervous-anxious symptoms. Both men and women who endorsed multiple affective symptoms took longer to reach symptom resolution (median 11 days versus 5-6 days for those without affective symptoms) and return to play (median 17-19 days versus 12 days for those without affective symptoms). These patterns were consistent whether the authors looked at 1) any affective symptoms, 2) nervous-anxious symptoms, or 3) the other affective symptoms.


Athletes with affective symptoms often experienced a slower recovery than peers without these symptoms after a concussion. Total symptom burden is still an important factor in recovery after a sport-related concussion, but it appears that symptom type also plays a role. The authors also reported that affective symptoms persisted longer than other symptom types. Hence, athletes may need resources to handle this specific subtype of symptoms.

Clinical Implications

Clinicians should understand the importance of different concussion symptom types and educate athletes with affective symptoms that they should be prepared for a delayed recovery timeline compared to some peers. Adding psychological support in athlete concussion management may be beneficial, especially in those with affective symptoms.

Questions for Discussion

How have you helped athletes who have reported more affective symptoms in their recovery? Have you implemented psychological support into your concussion protocol?

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Written by: Jennifer Xu
Reviewed by Jeffrey Driban

Evidence-Based Assessment of Concussion Course - 5 EBP CEUs