Predictors and Prevalence of Postconcussion Depression Symptoms in Collegiate Athletes

Abstract

Context: Depression is common after concussion and is associated with functional outcome and quality of life after injury. However, few baseline predictors of postconcussion depressive symptoms (PCDS) have been found.Objective: To describe the prevalence of depressive symptoms in a collegiate athlete sample at baseline and postconcussion, compare these levels of symptoms and change in symptoms with those of a control group with no reported concussions in the past year, and examine the baseline predictors for PCDS.Design: Case-control study. Main Outcome Measure(s): The Beck Depression Inventory-Fast Screen was administered to the concussion group at baseline and postconcussion and to the control group at 2 time points.Results: Seventeen athletes (20%) showed a reliable increase in depression, and more athletes reported clinically important depression postconcussion than at baseline. Only 2 participants (5%) in the control group showed a reliable increase in depression. Concussed athletes were more likely to show a reliable increase in depression symptoms than control participants (v 2 1 ¼ 5.2, P ¼ .02). We also found several predictors of PCDS in the athletes, including baseline depression symptoms (r ¼ 0.37, P , .001), baseline postconcussion symptoms (r ¼ 0.25, P ¼ .03), estimated premorbid intelligence (full-scale IQ; r ¼ À0.29, P ¼ .009), and age of first participation in organized sport (r ¼ 0.34, P ¼ .002). For the control group, predictors of depression symptoms at time 2 were number of previous head injuries (r ¼ 0.31, P ¼ .05) and baseline depression symptoms (r ¼ 0.80, P , .001).Conclusions: A large proportion of athletes showed a reliable increase in depression after concussion, and we identified several baseline predictors. Given that depression affects quality of life and recovery from concussion, more research is necessary to better understand why certain athletes show an increase in PCDS and how these can be better predicted and prevented.Key Words: concussion, depressive symptoms, sports Key PointsThe prevalence of clinically important depression symptoms was higher postconcussion than at baseline. Postconcussion depression symptoms were related to a higher level of baseline depression symptoms and baseline postconcussion symptoms, lower estimated full-scale IQ, older age at first participation in organized sport, and fewer number of games missed due to concussion. Nonwhite ethnicity was associated with increased postconcussion depression symptoms. More research is needed to better predict which athletes might have more severe depression symptoms postconcussion.

Predictors of clinical recovery from concussion: a systematic review

“…Age effects were examined statistically in different ways across the studies. Moreover, some studies reporting no age effects sometimes had fairly restricted age ranges 74–77. There were, however, large studies that did not find meaningful age effects 21 78.…”

“…There was strong evidence of a relationship between acute or subacute symptom burden and worse clinical outcome, although a few studies have not found this association (box 3).

Preinjury characteristics associated with recovery Younger age: Yes: Chermann81; Field82; Terwilliger83; Covassin84; Majerske85; Pellman86; Zuckerman71 No: Lau87; Hang30; McDevitt88; Nelson21; Asplund89; Chrisman75; Vargas74; Morgan58; Meehan42; Meehan90; Meehan6; McCrea91; Lee70; Baker92; Greenhill93; Nelson78; Corwin48; Preiss-Farzanegan94; Heyer80; Kontos67; Kriz77; Miller56, Ellis95; Gibson96 Female sex: Yes: Baker31; Berz97; Henry29, Kostyun79; Bock49; Zuckerman98; Covassin84; Covassin73; Covassin53; Majerske85; Colvin99; Eisenberg68; Ellis95; Miller56; Preiss-Farzanegan(in adults)94; Heyer80; Zemek57 No: Chermann81; Moor100; Hang30; Nelson21; Mayers101; Asplund89; Black72; Chrisman75; Zuckerman102; Zuckerman103; Vargas74; Terwilliger83; Morgan58; Frommer52; Baker92; McDevitt88; Nelson78; Lax104; Ono105; Preiss-Farzanegan (in children/adolescents)94; Covassin106; Kontos67; Wasserman41; Yang107; Meehan90; Gibson96; Meehan6 Race (non-white): Yes: Vargas74; Kontos

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Long-Term Cognitive and Neuropsychiatric Consequences of Repetitive Concussion and Head-Impact Exposure

“…For example, Kontos et al 29 noted elevated depressive symptoms on a scale within 2 weeks of a concussion in high school and collegiate athletes, but the mean score was well below the threshold generally considered consistent with clinically significant depression. Vargas et al 30 …”

Cognitive, Experiential and Genetic Contribution to Depressive Symptoms in Male and Female Students with a History of Concussion

“…Vargas and colleagues (2015) measured depressive symptoms following concussion in a sample of undergraduate student athletes. They reported that, compared to a baseline measure of depression, depressive symptoms increased in 17 of 85 (20%) concussed athletes and only 2 of 42 (4%) control athletes (Vargas et al, 2015). The rate of depressive symptoms after concussion appears to be associated with the number of concussive impacts (Broshek et al, 2015).…”

“…However, not every concussive injury results in depressive symptoms or issues in cognition, especially in the long-term (Ponsford et al, 2000(Ponsford et al, , 2012. Interestingly, the severity of injury does not seem to predict long-term PCS (Vargas et al, 2015). It is possible that premorbid factors contribute to PCS susceptibility, making certain individuals more vulnerable than others (Broshek et al, 2015).…”