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

Abstract

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)

Predictors of activities and participation six months after mild traumatic brain injury in children and adolescents

“…These findings are in high accordance with results of previous pediatric mixed TBI-sample studies, in which it was indicated that levels of PTSS and PCS are important predictors for activities and participation [11]. A previous study emphasized that psychological resilience plays an important role in recovery from concussion in adolescents; this relationship may be negatively influenced by anxiety and depressive symptoms [22]. Therefore, emotional distress and maladaptive coping may be considered important predictors of outcome for activities and participation, as well as important components of interventions aiming to prevent longterm problems after pediatric mTBI.…”

“…There are more factors which may further add to the prediction and could be investigated in future studies. For example, resilience [22] and motivation for returning to activities and participation [43,44], coping styles of children and caregivers [40], the child's self-efficacy and emotion-regulation [39], the child's and caregivers personality traits [39], the level of social support from caregivers and peers [45], and other comorbid problems, such as chronic pain, substance abuse, life stress and protracted litigation [47].…”

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

“…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.…”

“…Equally important is our understanding of how mediators may alleviate troublesome symptoms like anxiety and depression during concussion recovery. Durish et al (2019) explored the mediating effect of anxiety and depressive symptoms on self‐reported psychological resilience (measured by the Connor‐Davidson Resilience Scale) and post concussive symptoms (measured by PCSI) in children who were slow to recover following concussion. The authors found that symptoms of anxiety and depression were likely mediated by psychological resilience which may impact PCS, particularly in children who are slow to recover.…”

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

“…Among children with delayed recovery, parent anxiety contributes additional family burden following childhood concussion, indicating a need for management strategies to consider the implications to the entire family. 86 Anxiety and depression significantly mediated the relationship between resilience and post-concussion symptoms, 108 suggesting that mental health has an important impact on recovery from concussion, even accounting for individual characteristics. While children provided different reasons for their emotional distress (eg, inability to play sport, others' lack of understanding about concussion), they consistently reported frustration, depression, anxiety, irritability and feelings of isolation associated with their injury.…”