Longitudinal Assessment of Depressive Symptoms After Sport-Related Concussion in a Cohort of High School Athletes

Abstract

Background: The long-term effect of sport-related concussion on mood in adolescent athletes is largely unknown. Hypothesis: Longitudinal measures of depression will worsen acutely after sport-related concussion and improve with concussion symptom resolution. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: A population-based sample of 2160 high school athletes from 31 urban, suburban, and rural high schools completed preseason baseline concussion symptom evaluation and Patient Health Questionnaire–9 (PHQ-9) assessments over 2 years. Athletic trainers recorded onset of sport-related concussion, and concussed athletes completed the PHQ-9 assessment within 24 to 72 hours, 7 days, date of return to sport, 3 months, 6 months, and 12 months after sport-related concussion. Scores at each time point were compared to baseline with mixed-effects models and repeated-measures analysis of variance. Sex-based differences were assessed using mixed-effect models. Results: Of the 2160 athletes enrolled in the study, 125 (5.8%; 80 males, 45 females) sustained a sport-related concussion. PHQ-9 scores worsened from baseline at 24 to 72 hours (+1.05; 95% CI, 0.26-1.84; P = 0.003) and 7 days (+0.91; 95% CI, 0.23-1.60; P = 0.006). However, PHQ-9 scores improved from baseline to date of return to sport (−1.38; 95% CI, −2.20 to −0.55; P < 0.001), 3 months (−1.08; 95% CI, −1.88 to −0.28; P = 0.003), 6 months (−1.19; 95% CI, −2.04 to −0.34; P = 0.001), and 12 months after sport-related concussion (−0.76; 95% CI, −1.43 to −0.08; P = 0.028). Female athletes reported more severe concussion symptoms 24 to 72 hours after sport-related concussion compared with male athletes (female, 20.5 [interquartile range (IQR), 10.0-36.2]; male, 9.0 [IQR, 4.0-19.5]; P = 0.003). Neither PHQ-9 scores nor change in PHQ-9 scores differed between male and female athletes at any time point. Conclusion: Sport-related concussion did not worsen longitudinal measures of depressed mood in this cohort of high school athletes. Clinical Relevance: Emotional symptoms are common after sport-related concussion, but typically resolve by return to sport.

Changes in the Health of Adolescent Athletes: A Comparison of Health Measures Collected Before and During the COVID-19 Pandemic

“…The PreCOVID-19 cohort consisted of 5231 athletes (age ¼ 15.7 6 1.2 years, females ¼ 65%) who were enrolled in cohort and longitudinal studies in 2015 to 2018. 22,[30][31][32][33] The PreCOVID-19 participants resided in 56 Wisconsin counties (78%). A total of 4399 (84%) attended a publicly funded school; the median (interquartile range) school enrollment was 654 (range ¼ 299-1017).…”

“…The purpose of our study was to measure changes in the mental and physical health of Wisconsin adolescent athletes manifested during the COVID-19-related school closures and sport cancellations. To measure these changes, we compared athlete self-report data on depression, physical activity, and HRQoL that we collected in May 2020 (During COVID-19) with Wisconsin data from investigations 22,[30][31][32][33] carried out by the study team during normal high school sport operations in the years 2015 to 2018 .…”

Which psychosocial factors are associated with return to sport following concussion? A systematic review

“…After duplicates were removed, 1995 unique records were assessed based on title and abstract and, of these, 295 full texts were assessed for eligibility. Fourteen studies 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 met our inclusion criteria. There was substantial agreement between reviewers for abstract/title selection (κ = 0.70).…”

“…All studies were published between 2016 and 2021, inclusively, and none were included in previously published reviews in this field. 9 , 42 , 43 Of the 14 included studies, 10 (71%) were quantitative cohort studies, 28 , 29 , 32 , 33 , 34 , 35 , 36 , 37 , 40 , 41 involving 1 case-control 33 ( n = 52) and 9 studies 28 , 29 , 32 , 34 , 35 , 36 , 37 , 40 , 41 ( n = 1980) prospective cohort studies with repeated measures; 4 (29%) were qualitative studies 30 , 31 , 38 , 39 consisting of mixed epistemological and methodological approaches ( n = 66) ( Table 1 ). Eight out of the 10 outcome measures used had not been identified in 3 previous systematic reviews in this area.…”

Changes in the Health of Adolescent Athletes: A Comparison of Health Measures Collected Before and During the CoVID-19 Pandemic

“…To measure these changes, we compared athlete self-report data on depression, physical activity and HRQoL that we collected during-CoVID- with Wisconsin data from a series of previous investigations carried out by the study team during normal high school sport operations in the years 2015-2018 (PreCoVID-19). [30][31][32][33][34] We hypothesize that adolescent student athletes will report significantly worse mental health, as well as lower quality of life and physical activity scores during the CoVID-19 pandemic shutdown, than has previously been reported prior to CoVID-19.…”