Longitudinal trajectories of post-concussive and depressive symptoms in adolescents with prolonged recovery from concussion

Stein, Elizabeth; Howard, Waylon; Rowhani-Rahbar, Ali; Rivara, Frederick P.; Zatzick, Douglas; McCarty, Carolyn A.

doi:10.1080/02699052.2017.1380843

Cited by 18 publications

(19 citation statements)

References 45 publications

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“…In particular, the relationship between symptom experience and psychosocial symptoms including depression have been explored. Several studies have explored the symptom experience of concussed adolescents who are slow to recover from concussion (Brooks et al, 2019; Durish et al, 2019; Stein et al, 2017). Stein et al (2017) explored symptom trajectories of depression and post‐concussive symptoms in adolescents aged 11–17 who were deemed slow to recover.…”

Section: Discussionmentioning

confidence: 99%

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Anxiety, depression, and symptom experience in concussed children and youth

Macartney

Woodfield

Terekhov

et al. 2020

Specialist Pediatric Nursing

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PurposeTo describe and explore the relationship between baseline anxiety, depression and symptom experience in children and youth assessed at a concussion clinic.Design and MethodsA retrospective chart review of concussed children and youth referred to a pediatric teaching hospital concussion clinic over a 15‐month period was completed. Kutcher Adolescent Depression Scale (KAD‐6), General Anxiety Disorder Scale (GAD‐7), and the Post‐Concussion Symptom Inventory (PCSI) scores were extracted.ResultsA total of 155 patients were included. The most common symptoms (PCSI) at baseline were headache, fatigue, and feelings of head pressure. Symptoms were rated as mild to moderate in intensity. Overall, mean depression and anxiety scores were low. The mean anxiety scores, as measured by the GAD‐7 (n = 108), was 7.4 (range, 0–24). The mean depression score, as measured by the KAD‐6 (n = 94), was 4.7 (range, 0–18). A statistically significant, moderate positive correlation between PCSI scores with KAD‐6 scores for male (r = .64, p < .001) and female (r = .61, p < .001) participants was identified. Similarly, a statistically significant, moderate positive correlation between PCSI scores with GAD‐7 scores for male (r = .68, p < .001) and female (r = .60, p < .001) participants was identified.Practice ImplicationsConcussed children may experience a wide array of symptoms, including emotional challenges such as anxiety and depression. Feelings of anxiety and depression may contribute to overall post concussive symptoms in concussed children. The electronic health record can be leveraged to provide important patient data. Clinicians should systematically assess symptoms at each visit in concussed children and youth so that appropriate interventions can be implemented and monitored.

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Section: Discussionmentioning

confidence: 99%

“…Both post‐concussive symptoms and depressive symptoms based on the Patient Health Questionnaire (PHQ‐9) decreased over the course of 6 months. The authors noted that higher post‐concussive symptom scores at enrollment predicted a higher depression scores over the study period (Stein et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Anxiety, depression, and symptom experience in concussed children and youth

Macartney

Woodfield

Terekhov

et al. 2020

Specialist Pediatric Nursing

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“…Studies have shown an increased risk of anxiety and depressive symptoms following concussion (Hawley, Ward, Magnay, & Long, 2004;Luis & Mittenberg, 2002), suggesting that increased PCS may lead to greater anxiety/ depressive symptomatology rather than the converse. Given the overlap that exists between depression and anxiety, and many PCS (e.g., fatigue), changes in one may affect changes in the other in a bidirectional manner (see Stein et al, 2017). More research is needed to examine the causal relationships among these variables.…”

Section: Discussionmentioning

confidence: 99%

Psychological Resilience as a Predictor of Symptom Severity in Adolescents With Poor Recovery Following Concussion

Durish

Yeates

Brooks

2019

J Int Neuropsychol Soc

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Objectives: Examine the mediating effects of anxiety and depressive symptoms on the relationship between psychological resilience and post-concussive symptoms (PCS) in children with poor recovery following concussion. Participants and Methods: Adolescents (N=93), ages 13 to 18 years, were assessed at a neuropsychology screening clinic at a children’s hospital. They sustained concussions more than 1 month before the clinic visit (median time since injury=5.1 months; range=42–473 days) and were seen on the basis of poor recovery (i.e., presence of persistent PCS and complaints of cognitive problems). Self-reported psychological resilience was measured using the 10-item version of the Connor-Davidson Resilience Scale; self- and parent-reported anxiety and depressive symptoms were measured using the Behaviour Assessment System for Children – Second Edition; and self- and parent-reported PCS were measured using the Post-Concussion Symptom Inventory. All variables were measured concurrently. Regression-based mediation analyses were conducted to examine anxiety and depressive symptoms as mediators of the relationship between psychological resilience and PCS. Results: Psychological resilience significantly predicted self-reported PCS. Self-reported anxiety and depressive symptoms significantly mediated the relationship between resilience and self-reported PCS, and parent-reported child depressive symptoms significantly mediated the relationship between resilience and self- and parent-reported PCS. Conclusions: Psychological resilience plays an important role in recovery from concussion, and this relationship may be mediated by anxiety and depressive symptoms. These results help shed light on the mechanisms of the role of psychological resilience in predicting PCS in children with prolonged symptom recovery. (JINS, 2019, 25, 346–354)

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“…delayed recovery, 105 further demonstrating mental health as an important target for intervention. Since the majority of children and adolescents with clinical mental health difficulties do not access recommended care, 106 incorporating mental health risk into post-injury management represents an avenue to engage young people with mental health services to either prevent unnecessary problems emerging or to treat premorbid issues.…”

Section: Reviewmentioning

confidence: 99%

Mental health after paediatric concussion: a systematic review and meta-analysis

et al. 2021

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ObjectiveThis systematic review and meta-analysis sought to rigorously examine mental health outcomes following paediatric concussion. To date, heterogeneous findings and methodologies have limited clinicians’ and researchers’ ability to meaningfully synthesise existing literature. In this context, there is a need to clarify mental health outcomes in a homogeneous sample, controlling for key methodological differences and applying a consistent definition of concussion across studies.DesignSystematic review and meta-analysis.Data sourcesWe searched Medline, Embase, PsycINFO, CINAHL, SportDiscus, Scopus and PubMed.EligibilityPeer-reviewed studies published between 1980 and June 2020 that prospectively examined mental health outcomes after paediatric concussion, defined as per the Berlin Consensus Statement on Concussion in Sport.ResultsSixty-nine articles characterising 60 unique samples met inclusion criteria, representing 89 114 children with concussion. Forty articles (33 studies) contributed to a random effects meta-analysis of internalising (withdrawal, anxiety, depression, post-traumatic stress), externalising (conduct problems, aggression, attention, hyperactivity) and total mental health difficulties across three time points post-injury (acute, persisting and chronic). Overall, children with concussion (n=6819) experienced significantly higher levels of internalising (g=0.41–0.46), externalising (g=0.25–0.46) and overall mental health difficulties compared with controls (g=0.18–0.49; n=56 271), with effects decreasing over time.Summary/conclusionsOur review highlights that mental health is central to concussion recovery. Assessment, prevention and intervention of mental health status should be integrated into standard follow-up procedures. Further research is needed to clarify the mechanisms underlying observed relationships between mental health, post-concussion symptoms and other psychosocial factors. Results suggest that concussion may both precipitate and exacerbate mental health difficulties, thus impacting delayed recovery and psychosocial outcomes.

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Longitudinal trajectories of post-concussive and depressive symptoms in adolescents with prolonged recovery from concussion

Cited by 18 publications

References 45 publications

Anxiety, depression, and symptom experience in concussed children and youth

Anxiety, depression, and symptom experience in concussed children and youth

Psychological Resilience as a Predictor of Symptom Severity in Adolescents With Poor Recovery Following Concussion

Mental health after paediatric concussion: a systematic review and meta-analysis

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