Mental health after paediatric concussion: a systematic review and meta-analysis

Gornall, Alice; Takagi, Michael; Morawakage, Thilanka; Liu, Xiaomin; Anderson, Vicki

doi:10.1136/bjsports-2020-103548

Cited by 58 publications

(49 citation statements)

References 99 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Still, existing studies that have evaluated affective symptoms, specifically anxiety, after concussion have focused on the acute postconcussion period; few have considered the role of preinjury or long-term symptoms. 3,21 Thus, additional work is needed to determine the appropriate type and timing of affective symptom assessments, and how they can best be applied in different settings and contexts, alongside clinical judgment. However, in contexts where formal screening and/or diagnostic measures may not be feasible, it may prove useful to first utilize and inspect symptom assessment tools used during SRC management (eg, SCAT-22) to help identify athletes after SRC who may be at risk for prolonged symptoms and recovery—as demonstrated here.…”

Section: Discussionmentioning

confidence: 99%

The Role of Reported Affective Symptoms and Anxiety in Recovery Trajectories After Sport-Related Concussion

et al. 2022

View full text Add to dashboard Cite

Background: There is growing awareness and clinical interest in athletes with affective symptoms after sport-related concussion (SRC), as these symptoms may contribute to overall symptoms and represent a modifiable risk factor of longer recovery. However, evidence of their effects on the entire return-to-play (RTP) trajectory, particularly among women and men, is limited. Purpose/Hypothesis: To examine the relationship between affective symptom reporting and RTP progression after SRC among a cohort of Division 1 student-athletes. We hypothesized that those endorsing affective symptoms, specifically nervous-anxious symptoms, spend more time in RTP progression and recovery. Study Design: Cohort study; Level of evidence, 3. Methods: Using SRC data from the Ivy League–Big Ten Epidemiology of Concussion Study among varsity athletes through February 2020, we identified the 4 affective symptoms from the Sport Concussion Assessment Tool symptom inventory. We modeled the relationship between a 4-category affective symptom variable and time to symptom resolution, RTP, and RTP progression, adjusting for nonaffective symptom prevalence and concussion history. Cox regressions were used to estimate hazard ratios for time to event outcomes, and linear regressions were used to evaluate mean differences for continuous outcomes. Results: Among 2077 student-athletes (men, 63.5%) with SRC symptoms, affective symptom prevalence was 47.6% and 44.3% in women and men, respectively, and nervous-anxious prevalence was 24.2% and 22.5%, respectively. When comparing women with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with affective symptoms, and women with nervous-anxious symptoms spent significantly longer in RTP progression. When comparing men with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with co-occurring affective symptoms, and affective symptoms were not associated with time in RTP progression. Conclusion: Student-athletes with affective symptoms and nervous-anxious symptoms exhibited delayed clinical recovery and RTP timelines, particularly for time in RTP. Symptom prevalence and concussion history contributed to this; however, unmeasured confounding remains, as indicated by the poor model fit. This study motivates future work to explore affective symptoms and RTP timelines, considering anxiety and risk/protective factors over time.

show abstract

Section: Discussionmentioning

confidence: 99%

The Role of Reported Affective Symptoms and Anxiety in Recovery Trajectories After Sport-Related Concussion

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Concussion remained a significant predictor in boys for suicide attempts after controlling for other variables. That said, children and adolescents presenting to specialty clinics for treatment and rehabilitation following concussion often experience emotional health difficulties, such as anxiety and depression ( 74 , 75 ). Having pre-injury mental health problems is a risk factor for experiencing post-injury anxiety and depression ( 74 , 76 , 77 )—and these are risk factors for suicidality.…”

Section: Discussionmentioning

confidence: 99%

Association Between Concussions and Suicidality in High School Students in the United States

Iverson

Karr

2022

Front. Neurol.

View full text Add to dashboard Cite

ImportancePrior research has shown a statistically significant association between sustaining a concussion and suicidality in adolescents, but this prior research controlled for relatively few variables predictive of suicidality.ObjectiveTo examine whether sustaining a concussion remained a significant predictor of suicidality after controlling for relevant covariates (e.g., sexual abuse/assault, bullying, substance use, depression), hypothesizing that the relationship between concussion and suicidality would become non-significant after controlling for these variables.DesignThis study involved secondary data analysis of the 2019 Youth Risk Behavior Surveillance (YRBS) System, a national cross-sectional study of adolescents. Analyses were stratified by gender.SettingA national sampling of U.S. high school students.ParticipantsEleven thousand two hundred sixty-two students in the YRBS database, including 5,483 boys and 5,779 girls.Exposure(s)Participants included in the analyses reported whether, in the last year, they experienced a concussion and/or suicidality.Main Outcomes and MeasuresThe main outcome was suicidality (i.e., ideation, planning, attempt), which was predicted by concussion in an unadjusted analysis and by concussion along with other risk factors in a multivariable analysis.ResultsThe final sample included 11,262 participants with available data on concussion and suicidality in the last year (14–18 years-old; 51.3% girls; 49.0% White). Per unadjusted odds ratios with 95% confidence intervals, there was a relationship between concussion and suicidal ideation [girls: OR = 1.46 (1.24, 1.73); boys: OR = 1.69 (1.41, 2.03)], planning (girls: OR = 1.39 [1.16, 1.66]; boys: OR = 1.76 [1.44, 2.14]), and attempt [girls: OR = 1.70 (1.32, 2.19); boys: OR = 3.13, (2.37, 4.15)]. These relationships became mostly non-significant after controlling for relevant risk factors for suicidality. The adjusted odds ratios showed no relationship between concussion and suicidal ideation [girls: OR = 1.11 (0.86, 1.44); boys: OR = 1.24 (0.92, 1.69)] or planning (girls: OR = 1.07 [0.82, 1.40]; boys: OR = 1.12 [0.82, 1.55]); but a significant relationship with suicide attempts in boys [OR = 1.98 (1.28, 3.04)], but not girls [OR = 1.05 (0.74, 1.49)].Conclusions and RelevanceThere was an association between concussion and suicidality in U.S. high school students; however, after controlling for other variables (e.g., depression, sexual abuse/assault, illicit drug use), there was no association between concussion and suicidality aside from a significant relationship between concussion and attempts in boys.

show abstract

“…Concussions affect 42 million people worldwide annually (1). Psychological factors are important to consider when conceptualizing concussion symptomology and recovery (2)(3)(4)(5). Anxiety, in particular, has the potential to amplify other symptoms, prolong recovery, and reduce quality of life following concussion.…”

Section: Introductionmentioning

confidence: 99%

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

2022

View full text Add to dashboard Cite

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.

show abstract

Mental health after paediatric concussion: a systematic review and meta-analysis

Cited by 58 publications

References 99 publications

The Role of Reported Affective Symptoms and Anxiety in Recovery Trajectories After Sport-Related Concussion

The Role of Reported Affective Symptoms and Anxiety in Recovery Trajectories After Sport-Related Concussion

Association Between Concussions and Suicidality in High School Students in the United States

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

Contact Info

Product

Resources

About