Context: Depression is common after concussion and is associated with functional outcome and quality of life after injury. However, few baseline predictors of postconcussion depressive symptoms (PCDS) have been found.Objective: To describe the prevalence of depressive symptoms in a collegiate athlete sample at baseline and postconcussion, compare these levels of symptoms and change in symptoms with those of a control group with no reported concussions in the past year, and examine the baseline predictors for PCDS.Design: Case-control study. Main Outcome Measure(s): The Beck Depression Inventory-Fast Screen was administered to the concussion group at baseline and postconcussion and to the control group at 2 time points.Results: Seventeen athletes (20%) showed a reliable increase in depression, and more athletes reported clinically important depression postconcussion than at baseline. Only 2 participants (5%) in the control group showed a reliable increase in depression. Concussed athletes were more likely to show a reliable increase in depression symptoms than control participants (v 2 1 ¼ 5.2, P ¼ .02). We also found several predictors of PCDS in the athletes, including baseline depression symptoms (r ¼ 0.37, P , .001), baseline postconcussion symptoms (r ¼ 0.25, P ¼ .03), estimated premorbid intelligence (full-scale IQ; r ¼ À0.29, P ¼ .009), and age of first participation in organized sport (r ¼ 0.34, P ¼ .002). For the control group, predictors of depression symptoms at time 2 were number of previous head injuries (r ¼ 0.31, P ¼ .05) and baseline depression symptoms (r ¼ 0.80, P , .001).Conclusions: A large proportion of athletes showed a reliable increase in depression after concussion, and we identified several baseline predictors. Given that depression affects quality of life and recovery from concussion, more research is necessary to better understand why certain athletes show an increase in PCDS and how these can be better predicted and prevented.Key Words: concussion, depressive symptoms, sports Key PointsThe prevalence of clinically important depression symptoms was higher postconcussion than at baseline. Postconcussion depression symptoms were related to a higher level of baseline depression symptoms and baseline postconcussion symptoms, lower estimated full-scale IQ, older age at first participation in organized sport, and fewer number of games missed due to concussion. Nonwhite ethnicity was associated with increased postconcussion depression symptoms. More research is needed to better predict which athletes might have more severe depression symptoms postconcussion.

Objective: To describe a model of multidisciplinary concussion management and explore management methods in the acute and post-acute settings. Setting: A multidisciplinary concussion management program within a large health system. Participants: Patients with sports and non–sports-related concussions aged 14 to 18 years with persisting concussion symptoms at 4 weeks postinjury or beyond. Design: Pilot randomized controlled trial comparing a subsymptom threshold exercise program with standard-of-care treatment in the post-acute setting. Main Measures: Beck Depression Inventory-II and the Post-Concussion Scale-Revised. Results: Across groups, 60% improvement in concussion symptoms was noted. After removing the influence of depression, the intervention showed a large effect on symptom reduction, with participants in the intervention group improving more than those in the control group. There was no difference in response to the intervention by the sports and nonsports groups. Conclusion: Results demonstrate that exercise intervention is effective in reducing symptoms in adolescents with persisting symptoms. The finding that participants in the control group who underwent education, light activity, and sophisticated monitoring still had meaningful recovery supports the utility of active engagement in a multidisciplinary management program. Finally, depression had a clinically meaningful effect on recovery, highlighting the need for targeted intervention of noninjury factors relevant to persisting symptoms.

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These findings suggest that, in addition to evaluating the postconcussion total symptom score, there may be value in examining more specific symptom indices such as the global indices of distress variables and symptom clusters.

These results suggest that evaluating additional symptom indices beyond the total symptom score from the PCSS is beneficial. Findings from this study can be applied to athlete samples to assess reliable change in symptoms following concussion.