The Influence of Psychological Factors on the Incidence and Severity of Sports-Related Concussions: A Systematic Review

Abstract

Background: An athlete’s preexisting psychological factors may influence the incidence and/or severity of sports-related concussions (SRCs). Purpose: To determine if emotional states, personality traits, temperament, life stressors, and explanatory styles (optimism vs pessimism) influence the incidence and severity of SRCs in athletes. Study Design: Systematic review. Methods: A systematic literature search of multiple major medical reference databases was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included that evaluated the effect of preexisting psychological factors on the incidence and severity of SRCs in male and female athletes participating in all sports. Results: The initial search identified 1195 articles. Ten studies met our inclusion criteria and were included in our analysis. Factors such as meanness, aggression, and psychoticism were associated with an increased incidence of SRCs. Baseline traits of irritability, sadness, nervousness, and depressive symptoms were associated with worse symptomatology after SRCs. In young athletes, preexisting psychiatric illnesses, family history of psychiatric illness, and significant life stressors were associated with an increased risk of developing postconcussion syndrome after SRCs. Conclusion: This systematic review demonstrated a potential relationship between an athlete’s preexisting psychological factors and the incidence and severity of SRCs. These associations are not entirely clear owing to the heterogeneity across included studies and the low-to-moderate certainty of evidence. Future studies should attempt to evaluate men and women independently, use well-validated psychological questionnaires, and limit the usage of self-reported SRCs, when possible. Furthermore, the potential efficacy of baseline psychological factor and/or symptom reports on the prevention and management of SRCs should be explored.

Presenting features of female collegiate sports-related concussion in South Africa: a descriptive analysis

“…These findings by Resch et al, who reviewed study cohorts, including male and female high school and collegiate athletes, are consistent with findings of a study in a large cohort of > 9 000 youth soccer players by Brooks et al, [14] which suggested an association between reported post-SRC symptom severity, female sex and prior mental health problems but not with prior concussion history. While the cohort in the study by Brooks et al consisted of youth athletes, the findings in our study of a female collegiate-level athlete cohort supports the findings by Brooks et al An additional consideration to be mindful of, as reported in a recent systematic review by Trinh et al [7] , is that pre-existing psychological traits, such as irritability, sadness, nervousness and depressive symptoms, are traits which may predispose an individual to depression and/or anxiety, and were associated with a worsened clinical outcome after SRC. Furthermore, as noted in the study by Lariviere et al, females consistently report higher symptom severity than do males following concussion.…”

“…[6] Evidence regarding SRC assessment in females is scarce, compared to SRC assessment in males. More data are needed, specifically evaluating females independently, [7] to expand the current evidence base and determine whether females with SRC are presently assessed and managed appropriately. [3] To our knowledge, the association between potential pre-existing risks and SRC has not been investigated to specific symptom type in female collegiate athletes in a culturally diverse developing nation, as the majority of the research in this field has been conducted in developed Northern hemisphere settings.…”

Wellness Survey Responses and Smartphone App Response Efficiency: Associations With Remote History of Sport-Related Concussion

“…Regardless of whether or not persistent health problems among our HxSRC participants were neurologically based, our evidence of effective screening for these concerns is an important new finding. Because negative emotions and life stress can increase the risk for any type of injury (Trinh et al, 2019), and the possibility that postconcussion symptoms may become persistent without early intervention (Hiploylee et al, 2017), comprehensive screening may be profoundly important for avoiding adverse long-term effects of SRC on quality of life (Filbay et al, 2019;Filley & Fields, 2016).…”

“…Symptoms associated with post-concussion syndrome have seemed to be unrelated to injury severity and may depend on the cumulative effects of multiple interrelated biopsychosocial factors, such as genetics, health history, life stress, psychosocial status, or toxic environmental exposures (W€ aljas et al, 2015). Further complicating this clinical problem, corresponding somatic, cognitive, emotional, and sleep-related symptoms have often been reported by athletes who deny any history of SRC (Asken et al, 2017;Cassidy et al, 2014); and pre-existing psychological factors increase the risk for a SRC occurrence (Trinh et al, 2019).…”

Perceptual-Motor Efficiency and Concussion History Are Prospectively Associated With Injury Occurrences Among High School and Collegiate American Football Players

“…Because psychological factors appear to influence both the incidence and the severity of SRC, baseline documentation of an athlete’s perceived status may be important for guidance of efforts to prevent and clinically manage SRC. 53 Although reported findings from studies of SRC symptoms are inconsistent, white matter integrity has been found to mediate a relationship between the oculomotor function and the number of persisting postconcussion symptoms reported. 52 …”