Symptom Presentation After Concussion and Pre-existing Anxiety Among Youth Athletes

Abstract

Our purpose was to evaluate the effect of self-reported pre-injury anxiety diagnosis on persistent symptom development, vestibular symptom severity, and balance control among youth who sustained a concussion. We performed a retrospective study of patients seen at a specialty pediatric concussion clinic. Patients were 18 years of age or younger, examined within 10 days of concussion, and received care until full recovery. A questionnaire was used to assess pre-existing medical and psychiatric conditions, including anxiety. Our main outcomes were prolonged symptom recovery defined as persistent symptoms for > 28 days after concussion) and severity of vestibular symptoms. Patients who reported pre-injury anxiety (n=43; median age=14.9 years; 37% female) were more likely to experience symptoms>28 days post-injury (76 vs. 54%; p=0.04) than those without pre-existing anxiety (n=241; median age=14.9 years; 53% female). After adjusting for sex, history of migraine, depression and ADHD, however, there was no independent association between pre-existing anxiety and prolonged symptom duration (adjusted odds ratio=2.34; 95% CI=0.083–6.63; p=0.11). Pre-existing anxiety was independently associated with self-reported nausea/vomiting severity (β coefficient=0.59, 95% CI=0.07–1.11). A pre-existing anxiety diagnosis does not appear to be associated with persistent symptoms after concussion, although it may be associated with post-injury nausea.

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

“…Moreover, in a large-scale study of youth receiving care in concussion specialty clinics, pre-existing anxiety disorders were associated with more severe symptomology and prolonged recovery in children and adolescents (11). However, Kent et al (12) reported that a pre-existing anxiety diagnosis was not associated with persistent symptoms after concussion, after adjusting for sex and a personal history of migraine, depression, and attentiondeficit/hyperactivity disorder (ADHD). Thus, several, but not all, studies to date suggest that pre-injury anxiety is important to consider during the medical management of youth who sustain concussions.…”