The Association Between Concussion History and Increased Symptom Severity Reporting Is Independent of Common Medical Comorbidities, Personality Factors, and Sleep Quality in Collegiate Athletes

Abstract

Objective: We investigated the degree to which the association between history of concussion with psychological distress and general symptom severity is independent of several factors commonly associated with elevated symptom severity. We also examined whether symptom severity endorsement was associated with concussion injury specifically or response to injury in general. Setting: Academic medical center. Participants: Collegiate athletes (N = 106; age: M = 21.37 ± 1.69 years; 33 female) were enrolled on the basis of strict medical/psychiatric exclusion criteria. Design: Cross-sectional single-visit study. Comprehensive assessment, including semistructured interviews to retrospectively diagnose the number of previous concussions, was completed. Single-predictor and stepwise regression models were fit to examine the predictive value of prior concussion and orthopedic injuries on symptom severity, both individually and controlling for confounding factors. Main Outcome Measures: Psychological distress was operationalized as Brief Symptom Inventory-18 Global Severity Index (BSI-GSI) ratings; concussionrelated symptom severity was measured using the Sport Concussion Assessment Tool. Results: Controlling for baseline factors associated with the symptom outcomes (agreeableness, neuroticism, negative emotionality, and sleep quality), concussion history was significantly associated with psychological distress (B = 1.25 [0.55]; P = .025, R 2 = 0.034) and concussion-like symptom severity (B = 0.22 [0.08]; P = .005, R 2 = 0.064) and accounted for a statistically significant amount of unique variance in symptom outcomes. Orthopedic injury history was not individually predictive of psychological distress (B = −0.06 [0.53]; P = .905) or general symptom severity (B = 0.06 [0.08]; P = .427) and did not explain the relationship between concussion history and symptom outcomes.

Subtle impairments of perceptual-motor function and well-being are detectable among military cadets and college athletes with self-reported history of concussion

“…Such vulnerability may be particularly insidious among collision sport athletes who have experienced default mode network alteration as a result of repeated head acceleration events ( 15 ). Consistent with recent work that has documented the predictive value of self-reported HxC with symptom severity among college athletes ( 42 ), SFWI responses identified headaches, trouble falling asleep, and anxiety as complaints more commonly reported by individuals with HxC. In contrast to the widely used 22-item Sport Concussion Assessment Tool and the 22-item Post-Concussion Symptom Scale, the Overall Wellness subcomponent of the SFWI includes muscle aches and joint aches as response options that were among the most frequent problems reported by individuals with HxC.…”

“…In addition to cognitive dysfunction, altered connectivity among brain networks is believed to play a central role in development of physical, affective, and sleep-related symptoms ( 41 ). Behavioral changes associated with prior concussion tend to be subtle and not disruptive to daily function among young athletes, but they can be detected ( 42 ). An incremental increase in the severity of symptoms reported after more than one concussion suggests that a vulnerability to future brain injury may exist among athletes with a concussion history ( 43 ).…”

Diffusion tensor imaging in the courtroom: Distinction between scientific specificity and legally admissible evidence

“…It has also been recently proposed as informative of the persistent physiological effects of concussion after clinical symptoms have abated. This assertion, if accurate, would aid in decisions about return to play/work as well as inform the period of vulnerability of a second concussion[ 82 ]. Fourth, it has been shown that DTI abnormalities persist after recognizable symptoms have abated and may be the precursor for degenerative changes[ 83 ].…”

“…Dr. Shenton herself was a co-author of a paper that reported a study, funded by the Veterans Administration and the NIH, which relied upon DTI to assess the microstructure of limbic and paralimbic structures in the context of PTSD severity[ 83 ]; again, not as a pathognomonic biomarker but as part of the pathological profile. The assessment of the white matter microstructure can correlate with chronic post-concussive symptom severity[ 51 ] and reveals evidence consistent with persistent neurological disruption[ 82 , 85 , 86 ].…”