Depressive Symptoms in Individuals With Persistent Postconcussion Symptoms: A Systematic Review and Meta-Analysis

Abstract

ImportanceApproximately 15% to 30% of individuals with a history of concussion present with persistent postconcussion symptoms (PPCS). Individuals with PPCS are at greater risk of experiencing depressive symptoms.ObjectiveTo synthesize the association between depressive symptoms and PPCS in children, adolescents, and adults via meta-analysis and to investigate potential moderators of that association.Data SourcesSystematic search of Ovid Medline, CINAHL, PsycInfo, and Embase from 1995 to January 2022 was performed. Additionally, references from included studies were hand-searched to ensure relevant articles were captured in the search.Study SelectionStudies that involved participants who experienced PPCS and quantified depressive symptoms were included. The definition of PPCS was limited to physician-diagnosed or self-reported concussion, with symptoms lasting for a minimum of 4 weeks postinjury. Two authors independently screened all articles to determine study eligibility.Data Extraction and SynthesisStudy characteristics were extracted independently by 2 trained investigators. Study data were meta-analyzed using a random-effects meta-analysis.ExposurePPCS.Main Outcomes and MeasuresThe the primary outcome was depressive symptoms.ResultsData were extracted from 18 studies with a total of 9101 participants. Of the 18 studies, all were cohort studies, and 13 (72%) comprised adult populations. The mean (SD) time since concussion was 21.3 (18.7) weeks. After accounting for potential publication bias, the random-effects meta-analysis found a significant positive association between PPCS and depressive symptoms, (odds ratio, 4.56; 95% CI, 2.82-7.37; P < .001). There were no significant moderators, likely due to the small number of studies included.Conclusions and RelevanceIn this meta-analysis, experiencing PPCS was associated with a higher risk of experiencing depressive symptoms. There are several important clinical and health policy implications of the findings. Most notably, the development of strategies for effective prevention and earlier intervention to optimize mental health recovery following a concussion should be supported.

Relations between concussion symptoms and depression among patients with mild traumatic brain injury: A moderated mediation model

“…Our model showed a strong correlation and significant, positive direct effect between concussion symptoms and depression status. This is consistent with the previously described 18-study systematic review of patients (N = 9101) with a history of concussion, which showed a large effect of concussion symptoms on depression status (Lambert et al, 2022).…”

“…Identifying the precursors of depression in these patients, and the factors that may protect them against depression, may facilitate interventions that improve health outcomes (Juengst et al, 2017). Moreover, individuals displaying concussion symptoms often exhibit intense depressive symptoms (Ho et al, 2020), as supported by a meta-analysis of 18 studies involving 9101 participants (Lambert et al, 2022) and a scoping review of 25 studies (Sheldrake et al, 2022). Concussion symptoms following mild traumatic brain injury jeopardize both mood status, particularly depression, and sleep quality.…”

Emotional Regulation and Adolescent Concussion: Overview and Role of Neuroimaging

“…Prominent in mood and anxiety disorders, these symptoms are typically transient in concussion, resolving within one to two weeks of injury [ 32 ]. However, in some adolescents, these symptoms persist for longer (more than four weeks), with a significant minority experiencing emotional dysregulation symptoms up to one year post-injury [ 17 , 18 , 37 , 38 ]. For example, in a large ( N = 14,765) sample of high school students in the United States, 36% of students with a concussion history reported persistent depressive symptoms for up to 12 months [ 35 ].…”

“…This may lead to persistent symptomatology, with approximately 21–35% of concussed adolescents developing PPCS [ 14 , 15 , 16 ]. PPCS in adolescents can adversely affect social functioning and academic performance [ 4 ] and are often associated with emotional dysregulation [ 17 , 18 ].…”

The altered TBI fecal microbiome is stable and functionally distinct

“…In an Ohio based study, 1 in 5 adults reported a TBI with loss of consciousness and for 10% of respondents the TBI occurred before they were 15 years old ( Corrigan et al, 2018 ). TBI are associated with long-term health issues including increased risk of stroke ( Esterov et al, 2023 ), early onset dementia ( Bellomo et al, 2022 ), depression ( Lambert et al, 2022 ), and decreased olfaction ( Tai et al, 2022 ). Post-TBI sequelae frequently include fatigue and altered cognition that compromise quality of life and productivity as described by the brain injury associated fatigue and altered cognition syndrome (BIAFAC) ( Yuen et al, 2020 ).…”