Early psychological symptoms predict concussion recovery time in middle and high school athletes.
Wilmoth K, Tan A, Tarkenton T, Rossetti HC, Hynan LS, Didehbani N, Miller SM, Bell KR, Cullum CM. J Clin Exp Neuropsychol. 2022 May;44(4):251-257. doi: 10.1080/13803395.2022.2118676. Epub 2022 Sep 8. PMID: 36073744.
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Take-Home Message
Middle school and high school athletes who reported more concussion symptoms and sleep issues, as well as post-traumatic amnesia, had a greater chance of a prolonged recovery than peers without these concerns. Furthermore, depressive symptoms may help identify males at risk for a prolonged recovery.
Background
Concussion recovery is quite variable. Hence, determining risk factors for prolonged recovery is vital to provide appropriate patient care to reduce this risk. Several post-injury risk factors for prolonged recovery have emerged (e.g., emotional symptoms, sleep disturbance). However, these factors have not been well-established in school-aged athletes.
Study Goal
The authors analyzed clinical data from middle and high school athletes to examine if post-concussion psychological factors and sleep symptoms predict prolonged recovery.
Methods
The authors recruited 393 middle school and high school students (~15 years of age; 45% female) to complete 3 surveys within 14 days of injury (~6 days post injury), which is part of a larger study through Con Tex. Students completed the 3 questionnaires during their clinical evaluation: 1. Generalized Anxiety Disorder 7-item Scale (GAD-7), which screened for anxiety; 2. The Patient Questionnaire 8-item Depression Scale (PHQ-8) to assess for depression; and 3. The Pittsburg Sleep Quality Index (PSQI) to evaluate sleep quality. The authors found the provider-documented date of symptom resolution via a medical record review.
Results
Overall, 17% (n=66) took more than 30 days to recover. The authors found that post-traumatic amnesia, worse concussion signs and symptoms scores, and worse sleep quality predicted longer concussion recovery. Among females, only more severe concussion symptoms predicted a prolonged recovery. In contrast, among males, greater depression and post-traumatic amnesia related to prolonged recovery.
Viewpoints
Someone with more severe symptoms or poor sleep quality within the first 2 weeks after a concussion may be more likely to experience a prolonged concussion recovery. However, the authors found that when they considered sex, there were different predictors. Females with greater symptom severity were more likely to have a prolonged recovery. At the same time, males were more likely to have a prolonged recovery if they had worse depression symptoms or post-traumatic amnesia. It is worth noting that though sleep, anxiety, and depressive symptoms were predictors, the overall scores were low, indicating they probably were not experiencing high levels of anxiety, depression, or sleep disorders.
Clinical Implications
Medical professionals should screen patients after a concussion for signs of anxiety, depression, or sleep disorders because even subtle signs may increase the chance of a prolonged recovery. These assessments may help identify problems early and lead to a more targeted concussion management plan.
Questions for Discussion
Have you noted any specific predictors associated with your athlete’s recovery? How do you work concussion risk into your concussion education/management/baseline protocol?
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Written by: Jane McDevitt
Reviewed by: Jeffrey Driban
I find the results from this quite striking. They show that not only should clinicians be looking at standard signs and symptoms for concussion recoveries but that there may be more underlying concerns when helping youth return to sports. That fact that this study showed that males may have a prolonged recovery when they have depression makes sense with this type of non visible injury. As a former youth male athlete that suffered with a concussion I experienced this myself, when you are told that you are not able to participate in an activity that you love and pour your life into, its very difficult and heartbreaking to take a step back.
These are very interesting results. I find it interesting that both males and females can be susceptible to a prolonged recovery following a concussion, but for different reasons. One would believe that the more severe the symptoms, the longer the recovery process would be for both males and females, but for this to be the major factor in females is shocking. It is also surprising that depressive symptoms were a factor for prolonged recovery in males. I think it is important to be proactive with the symptoms of depression and anxiety both pre- and post-concussion and gain information regarding the mental health of athletes during the PPE because then ATs and other HCPs can create an individualized plan for each athlete based on their needs.
The results here make sense after recently enduring a concussion. Struggling to sleep and mood/emotion fluctuations are constant. This provides the body less time to heal and therefore elongating the recovery process. These mood changes are not talked about enough in male athletes and would make sense as to why depression can be associated with concussions. The athletes experience difficult times due to sports being such a major influence in their life. Sometimes when unforeseen circumstances like this happen, they can feel closed and often have no-one to talk to. Only decreasing their mental health. More advocation needs to be brought to the attention of individuals with the correlations between concussions and depression. I truly feel this research is a great starting point!