Anxiety Is Associated With Diverse Physical and Cognitive Symptoms in Youth Presenting to a Multidisciplinary Concussion Clinic

Abstract

IntroductionPre-injury and post-injury anxiety are prevalent and important to consider in the medical management of concussions in youth. We examined the association between anxiety and other physical, cognitive, and emotional symptoms in injured adolescents and young adults undergoing an initial evaluation in a specialty concussion clinic.MethodsParticipants were 158 adolescents and young adults presenting to a multidisciplinary concussion clinic for evaluation and treatment (54.4% girls and women; mean age = 17.3 years; SD = 2.9). Their median days post injury was 29 (interquartile range = 14–49; range = 7–349). They were divided into binary groups based on whether they had a pre-injury history of anxiety diagnosis or treatment and whether they were experiencing current anxiety in the week prior to the evaluation, and then compared on the Post-Concussion Symptom Scale.ResultsYouth with a pre-injury history of anxiety reported greater post-concussion symptoms (Md total score = 36.0, IQR = 21.5–53.0) compared to youth with no pre-injury history of anxiety (Md total score = 20.5, IQR = 6.0–36.0; MW U = 1,520.00 p = 0.001, r = 0.26, small-medium effect size). They reported significantly worse headaches, nausea, balance difficulty, dizziness, vision problems, fatigue, concentration difficulty, irritability, nervousness, sadness, feeling more emotional, trouble falling asleep, and sleeping more than usual. Youth with high post-injury anxiety reported greater post-concussion symptoms (Md total score = 55.0, IQR = 33.0–62.5) compared to youth with low post-injury anxiety (Md total score = 19.0, IQR = 6.0–35.0; MW U = 681.00, p < 0.001, r = 0.49, large effect size). They reported significantly worse headaches, nausea, vomiting, dizziness, vision problems, fatigue, sensitivity to light, feeling mentally foggy, feeling slowed down, concentration difficulty, memory difficulty, irritability, sadness, feeling more emotional, drowsiness, trouble falling asleep, sleeping less than usual, and sleeping more than usual. Logistic regressions revealed that both pre-injury and post-injury anxiety were strong predictors of persistent post-concussion symptoms, with high post-injury anxiety presenting the strongest independent predictor, while attention-deficit hyperactivity disorder and pre-injury migraines were not significant predictors. Essentially all adolescents with high post-injury anxiety (97.1%) and nearly 9 of 10 adolescents with pre-injury treatment for anxiety (87.8%) met criteria for persistent post-concussion symptoms.DiscussionPre-injury and post-injury anxiety are important risk factors for greater post-concussion symptoms among adolescents and young adults. Elevated post-injury anxiety was the strongest predictor of persistent post-concussion symptoms. Assessment of anxiety is important among adolescents presenting for concussion care and delivery of evidence-supported treatments for anxiety are important considerations for treatment planning for these youth.

Comparison of Anxiety and Depression Symptoms in Concussed and Nonconcussed Adolescents

“…When anxiety and depression occur following concussion, they also place adolescents at heightened risk for prolonged recovery. 10,21,22 Thus, early identification and treatment of mental health needs could decrease the likelihood of prolonged concussion recovery, a costly and burdensome public health issue. 10 Interestingly, the difference in groups was not statistically significant in models accounting for sex and prior medical history of depression or anxiety.…”

“…When anxiety and depression occur following concussion, they also place adolescents at heightened risk for prolonged recovery. 10,21,22 Thus, early identification and treatment of mental health needs could decrease the likelihood of prolonged concussion recovery, a costly and burdensome public health issue. 10…”

“…We may see greater differences in mental health symptoms further out from injury if an adolescent is still symptomatic and not yet recovered. 21,36 For example, in a sample of adolescent participants with persistent postconcussive symptoms seen at greater than 30 days postinjury, 40% had significant depressive symptoms and 25% had significant anxiety symptoms. 8 liMitations Our findings should be considered in light of significant limitations.…”

Postconcussion Moderate to Vigorous Physical Activity Predicts Anxiety Severity among Adolescent Athletes

“…Anxiety is an important component of mental health, as high anxiety may negatively affect quality of life in general and can prolong concussion recovery (9,10). Individuals with postconcussion anxiety symptoms also have more severe concussion symptoms and longer recovery compared with those without anxiety (10)(11)(12). In addition to postconcussion anxiety, research suggests that individuals with a history of anxiety before their concussion report more physical and cognitive symptoms and greater symptom severity after concussion (11,13), and are more likely to develop persistent symptoms compared with those without a preinjury anxiety history (11).…”

“…Individuals with postconcussion anxiety symptoms also have more severe concussion symptoms and longer recovery compared with those without anxiety (10)(11)(12). In addition to postconcussion anxiety, research suggests that individuals with a history of anxiety before their concussion report more physical and cognitive symptoms and greater symptom severity after concussion (11,13), and are more likely to develop persistent symptoms compared with those without a preinjury anxiety history (11). As such, finding interventions to help manage anxiety may be beneficial in promoting recovery and improving mental health outcomes after concussion.…”