Depression, anxiety, and stress as predictors of postconcussion-like symptoms in a non-clinical sample

Edmed, Shannon L.; Sullivan, Karen A.

doi:10.1016/j.psychres.2012.05.022

Cited by 49 publications

(39 citation statements)

References 36 publications

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“…This contrasts with recent adult literature that an individual's anxiety and stress modulates one's prolongation of the concussion symptoms. 24,25 This also contrasts with a prior nonconcussion minor head trauma study that demonstrated that parental anxiety was associated with increased children's morbidity. 26 Given the effect of PCS on the lives of children and their families, it is paramount to determine which prognosticators exist for clinicians to help identify children at highest risk for PCS.…”

Section: Discussionmentioning

confidence: 77%

“…24 Research performed on nonconcussed university students suggested that stress and anxiety may contribute to the reporting of concussion-like symptoms. 25 Casey et al, 26 in their 1987 educational intervention randomized controlled trial of children aged 6 months through 14 years suffering minor head trauma, determined that parental anxiety was closely related to children's morbidity; however, this trial excluded patients with transient loss of consciousness or concussion. Parental anxiety levels and somatic symptom reporting has been examined in other pediatric conditions; mothers of children who suffer recurrent abdominal pain have significantly higher anxiety levels than comparison groups of mothers of healthy controls.…”

Section: Discussionmentioning

confidence: 99%

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Parental Anxiety at Initial Acute Presentation Is Not Associated With Prolonged Symptoms Following Pediatric Concussion

Zemek

Clarkin

Farion

et al. 2013

Academic Emergency Medicine

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Objectives: Anxiety modulates symptom perception in adults following concussion, prolonging the time to full recovery. The authors sought to determine whether parental anxiety was associated with persistent postconcussive symptoms (PCS) in their children following concussion.Methods: A prospective observational cohort with 98 children aged 5 to 17 years following concussion participated from a tertiary pediatric emergency department (ED). The main exposure was parental anxiety at the time of acute presentation following pediatric concussion, measured using the selfadministered, validated Spielberger State-Trait Anxiety Inventory-State Anxiety Scale (STAI-S). The primary outcome measured was presence of PCS in the child at 1 month, per the validated PostConcussive Symptom Inventory (PCSI). Secondary outcome measures included parental anxiety score over time, school absenteeism, and return to sports. Data were collected during the initial ED visit and at 3-day, 7-day, 2-week, 1-month, and 3-month follow-ups.Results: Of 98 children enrolled, 27% (95% confidence interval [CI] = 19% to 36%) developed PCS at 1 month. No significant associations were detected between parental anxiety at the index visits and the number of previous pediatric concussions (p = 0.73), sex (p = 0.61), loss of consciousness (p = 0.43), history of migraines (p = 0.31), or history of anxiety diagnosed in the patients (p = 0.09). A significant association was noted between patient diagnosis of attention deficit hyperactivity disorder (ADHD) and parental anxiety at the index visits (p = 0.001). Parental anxiety at acute presentation was not associated with children's prolonged symptoms at 1 month (p = 0.63). Parental anxiety remained elevated in parents whose children had prolonged symptoms compared to those parents whose children's symptoms resolved (median = 30, interquartile range [IQR] = 22 to 44; and median = 21, IQR = 20 to 25, respectively; p < 0.001). Initial parental anxiety presentation was not associated with school absenteeism (p = 0.23) or not returning to sport or gym class (p = 0.89). There were no significant effects involving ADHD alone (p = 0.44) or together with baseline parental anxiety (p = 0.36 for ADHD and p = 0.55 for anxiety) using logistic regression analysis to examine potential predictive effects of child's ADHD combined with parental anxiety at the index visit on persistent symptoms at 1 month.Conclusions: Parental anxiety at time of acute presentation does not appear to be associated with prolongation of postconcussive symptoms in their children. However, parents of persistently symptomatic children remain significantly more anxious than those whose children's symptoms have resolved. Future research should attempt to reduce the familial burden of concussion through expectation management strategies.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Parental Anxiety at Initial Acute Presentation Is Not Associated With Prolonged Symptoms Following Pediatric Concussion

Zemek

Clarkin

Farion

et al. 2013

Academic Emergency Medicine

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“…78,79 A study by Lewinsohn and colleagues is particularly relevant. These authors examined the association between 44 variables and depression in adolescents.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Activity Restriction After Concussion

DiFazio

Silverberg

Kirkwood

et al. 2015

Clin Pediatr (Phila)

151

108

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The current treatment of concussion or mild traumatic brain injury (mTBI) is primarily based on expert consensus. Most clinical practice guidelines advise cognitive and physical rest after injury including withdrawal from normal life activities such as school attendance, sports participation, and technology use until symptoms resolve. Some individuals who sustain an mTBI experience persistent physical, cognitive, and mental health problems. Activity restriction itself may contribute to protracted recovery and other complications. Williamson's Activity Restriction Model of Depression, formulated more than 20 years ago, is central to this hypothesis. We review research evidence for potential harms of prolonged activity restriction and report an mTBI case as an example of how an "activity restriction cascade" can unfold. According to this model, psychological consequences of removal from validating life activities, combined with physical deconditioning, contribute to the development and persistence of postconcussive symptoms after mTBI in some youth. A modification to mTBI guidelines that emphasizes prompt reengagement in life activities as tolerated is encouraged.

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“…There are a myriad of methods used in past studies to calculate PCS domain scores and this variability makes it difficult to compare results directly. The BC-PSI does not have symptom domain subscales; therefore, these scores were devised using a published standard from a systematic review as a guide [19] and Cronbach's alpha coefficient was calculated to confirm the acceptable internal consistency of each domains. While the approach that was used to create domain scores is similar to that used by Villemure et al [11] and Nolin et al [12], other symptom combinations are possible and could alter results.…”

Section: Discussionmentioning

confidence: 99%

“…Second, in a fixed order, participants completed the demographics questionnaire, open-ended question and mock clinical interview. Third, in counterbalanced order, participants completed the BC-PSI and the Depression Anxiety Stress Scales (DASS [18]; note, DASS data were reported elsewhere [19]). The mock clinical interview was always completed before the BC-PSI so that the items did not prime participants' ability to free-recall symptoms on the mock clinical interview.…”

Section: Methodsmentioning

confidence: 99%

Method of symptom assessment influences cognitive, affective and somatic post-concussion-like symptom base rates

Edmed

Sullivan

2014

Brain Injury

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Depression, anxiety, and stress as predictors of postconcussion-like symptoms in a non-clinical sample

Cited by 49 publications

References 36 publications

Parental Anxiety at Initial Acute Presentation Is Not Associated With Prolonged Symptoms Following Pediatric Concussion

Parental Anxiety at Initial Acute Presentation Is Not Associated With Prolonged Symptoms Following Pediatric Concussion

Prolonged Activity Restriction After Concussion

Method of symptom assessment influences cognitive, affective and somatic post-concussion-like symptom base rates

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