Is State Anxiety, Trait Anxiety, or Anxiety Sensitivity a Clinical Predictor of Symptoms in Those Presenting With Mild Traumatic Brain Injury or Concussion?

Abstract

Clinical Scenario:Mild traumatic brain injury, or concussion, has been associated with physical, cognitive, and emotional sequelae. Little is understood in regard to many characteristics, such as anxiety, and their effect on post-concussion symptoms.Clinical Question:Is state anxiety, trait anxiety, or anxiety sensitivity a clinical predictor of symptoms in those presenting with mild traumatic brain injury or concussion?Summary of Key Findings:A literature search returned 3 possible studies; 3 studies met inclusion criteria and included. One study reported in athletes that greater social support was associated with decreased state-anxiety, lower state anxiety post-concussion was associated with increased social support, and that those with greater social support may experience reduced anxiety, regardless of injury type sustained. One study reported baseline trait anxiety in athletes was not significantly associated with post-concussion state anxiety, but that symptoms of depression at baseline was the strongest predictor for post-concussion state anxiety. Three studies reported that state and trait anxiety are not related to increased post-concussion symptom scores. One study reported that greater anxiety sensitivity is related to higher reported post-concussion symptom scores, which may manifest as somatic symptoms following concussion, and revealed that anxiety sensitivity may be a risk factor symptom development.Clinical Bottom Line:There is low-level to moderate evidence to support that anxiety sensitivity is linked to post-concussion symptoms. State and trait anxiety do not appear to be related to post-concussion symptoms alone. Post-concussion state anxiety may occur if post-concussion symptoms of depression are present or if baseline symptoms of depression are present. Better social support may improve state anxiety post-concussion.Strength of Recommendation:There is grade B evidence to support that state and trait anxiety are not risk factors for post-concussion symptom development. There is grade C evidence to support anxiety sensitivity as a risk factor for developing post-concussion symptoms.

Does Anxiety Affect Neuropsychological Assessment in College Athletes?

“…Instead, preinjury depression is the strongest predictor of postinjury anxiety, although higher anxiety sensitivity (definition can be found at Hixson et al 11 ), psychological distress, and symptom scores have been found following concussion. 11 Assessing these findings in conjunction with the current literature appraisal, it provides some evidence that anxiety has an impact on various aspects of concussion. Measuring anxiety levels at baseline and monitoring them throughout recovery can be beneficial to gain a more thorough understanding of how athletes may perform on concussion neuropsychological batteries assessments.…”

“…Anecdotally, clinicians have seen a rise in postconcussion psychological and mood disorders, but research supporting these claims is scarce. A critically appraised topic by Hixson et al 11 reported that preinjury state and trait anxiety are not independently associated with an increase in postinjury state anxiety symptoms. Instead, preinjury depression is the strongest predictor of postinjury anxiety, although higher anxiety sensitivity (definition can be found at Hixson et al 11 ), psychological distress, and symptom scores have been found following concussion.…”

“…A critically appraised topic by Hixson et al 11 reported that preinjury state and trait anxiety are not independently associated with an increase in postinjury state anxiety symptoms. Instead, preinjury depression is the strongest predictor of postinjury anxiety, although higher anxiety sensitivity (definition can be found at Hixson et al 11 ), psychological distress, and symptom scores have been found following concussion. 11 Assessing these findings in conjunction with the current literature appraisal, it provides some evidence that anxiety has an impact on various aspects of concussion.…”