Early psychological symptoms predict concussion recovery time in middle and high school athletes

Kristin Wilmoth; Alexander Tan; Tahnae Tarkenton; Heidi C Rossetti; Linda S Hynan; Nyaz Didehbani; Shane M Miller; Kathleen R Bell; C Munro Cullum

doi:10.1080/13803395.2022.2118676

Early psychological symptoms predict concussion recovery time in middle and high school athletes

J Clin Exp Neuropsychol. 2022 May;44(4):251-257. doi: 10.1080/13803395.2022.2118676. Epub 2022 Sep 8.

Authors

Kristin Wilmoth^{1

2}, Alexander Tan³, Tahnae Tarkenton¹, Heidi C Rossetti¹, Linda S Hynan⁴, Nyaz Didehbani^{1

2}, Shane M Miller^{5

6}, Kathleen R Bell², C Munro Cullum^{1

7}

Affiliations

¹ Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
² Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA.
³ Department of Psychology, Children#'s Health Orange County, Orange, CA, USA.
⁴ Peter O'Donnell Jr. School of Public Health and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁵ Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁶ Texas Scottish Rite Hospital for Children, Dallas, TX, USA.
⁷ Departments of Neurology and Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.

PMID: 36073744
DOI: 10.1080/13803395.2022.2118676

Abstract

Introduction: Lingering concussion symptoms can negatively impact a child's well-being, yet variability in recovery is poorly understood. To aid detection of those at risk for prolonged symptom duration, we explored postconcussion mood and sleep symptoms as predictors of recovery time in adolescent athletes.

Method: We utilized analyses designed to control for potentially confounding variables, such as concussion severity indicators and premorbid psychiatric history. Participants included 393 adolescent athletes (aged 12-18 years) evaluated in outpatient concussion clinics within 2 weeks after injury. Provider-documented date of symptom resolution was obtained via medical record review. Survival analysis for recovery time was conducted in the total sample, and separately for males and females using prior medical history (psychiatric disorder, prior concussion), injury-related factors (loss of consciousness, post-traumatic amnesia [PTA], concussion symptom severity), and psychological symptoms (General Anxiety Disorder-7 Item Scale, Patient Health Questionnaire-8 Item Depression Scale, Pittsburgh Sleep Quality Index) collected at initial clinic visit.

Results: PTA, concussion symptoms, and sleep quality were associated with recovery in the total sample (HRs = 0.64-0.99, ps < .05). When analyzed by sex, only concussion symptoms were associated with recovery for females (with females reporting greater symptom severity than males), while for males PTA and greater depression symptoms were significant predictors of recovery (HRs = 0.54-0.98, ps < .05).

Conclusions: These findings identified differences in symptom presentation between sexes, particularly for mood symptoms, and suggest that assessment of postconcussive symptoms is useful in helping to identify individuals at risk for longer recovery. Continued exploration of post-injury psychological difficulties in athletes is warranted for better concussion management.

Keywords: Mild traumatic brain injury; athlete; concussion; postconcussive symptoms; psychological screening; sports-related neuropsychology.

Publication types

Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Athletes
Athletic Injuries* / complications
Athletic Injuries* / diagnosis
Brain Concussion* / complications
Brain Concussion* / diagnosis
Child
Female
Humans
Male
Post-Concussion Syndrome* / diagnosis
Post-Concussion Syndrome* / psychology
Schools

Grants and funding

UL1 TR001105/TR/NCATS NIH HHS/United States