Which psychosocial factors are associated with return to sport following concussion? A systematic review

Ierssel, Jacqueline van; Pennock, Kaleigh Ferdinand; Sampson, Margaret; Zemek, Roger; Caron, Jeffrey G.

doi:10.1016/j.jshs.2022.01.001

Cited by 27 publications

(24 citation statements)

References 64 publications

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“…[53][54][55] From a psychosocial standpoint, individuals experiencing PPCS often face increased social isolation, academic difficulties, frustration surrounding activity limitations, anxiety related to prognosis uncertainties, and prolonged disengagement from usual roles and identity structures-all factors that may contribute to feelings of hopelessness and emotional distress. [56][57][58] These neurofunctional and psychosocial underpinnings of depressive symptoms in individuals with PPCS may interact with one another. For instance, emotional processing plays a central role for successful social interactions and interpersonal relationships.…”

Section: Discussionmentioning

confidence: 99%

“…While some studies have highlighted the role of the trigeminal cervical complex and pain neuropeptides in specific PPCS, such as headache, depressive symptoms following a concussion could be a direct consequence of postinjury brain changes in the autonomic nervous system, more specifically the amygdala, a brain structure strongly connected to autonomic and neurohormonal axes that plays a crucial role in emotional processing . From a psychosocial standpoint, individuals experiencing PPCS often face increased social isolation, academic difficulties, frustration surrounding activity limitations, anxiety related to prognosis uncertainties, and prolonged disengagement from usual roles and identity structures—all factors that may contribute to feelings of hopelessness and emotional distress . These neurofunctional and psychosocial underpinnings of depressive symptoms in individuals with PPCS may interact with one another.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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 &lt; .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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Section: Discussionmentioning

confidence: 99%

“…However, nowhere in the CISG consensus statement is confidence explicitly defined or explained how confidence should be developed. Additionally, there has not yet been a study that has explicitly investigated confidence to RTS following SRC (van Ierssel et al, 2022). Given our results, there appears to be a need to develop a comprehensive description of the factors involved in confidence to RTS following SRC, as well as practical suggestions to develop confidence during the RTS.…”

Section: Discussionmentioning

confidence: 99%

“…van Ierssel et al (2022) recently led a systematic review of the psychosocial factors involved in RTS following SRC. In particular, the results indicated that fear (of recurrent SRC, of RTS, of losing playing status) was a key psychological element of RTS following SRC (van Ierssel et al, 2022), another point that is not comprehensively assessed in RTS. Thus, athletes recovering from SRC may be returning to the competition before they are psychologically ready.…”

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confidence: 99%

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Exploring student-athletes’ perceptions of their psychological readiness to return to sport following a concussion.

Lassman¹,

Rathwell²,

Black³

et al. 2022

Sport, Exercise, and Performance Psychology

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Athletes returning to sport following a concussion are deemed "ready" once they progress through the return to sport (RTS) steps. However, this process largely overlooks psychological factors involved in returning to sport. We used a constructivist philosophical position to understand 12 (n = 6 females, n = 6 males) formerly concussed Canadian university student-athletes' perceptions of factors involved in feeling psychologically ready to RTS. Each student-athlete participated in two videoconference interviews (Interview 1: M = 103 min; Interview 2: M = 88 min). We identified six themes from the life-story interviews: confidence, fear, identity, pressure, support, and case-bycase. Subsequently, we used creative nonfiction analysis to write two composite stories depicting the athletes' experiences returning to sport following a concussion. Pierre-Olivier's story portrays a second-year university men's ice hockey player who experienced a successful RTS following a concussion. His story focuses on his feelings of psychological readiness leading up to his first game following medical clearance. Andrea's story portrays a women's rugby captain who experienced an unsuccessful RTS following a concussion. Her story depicts a conversation with her doctor regarding medical clearance as well as interactions with a former teammate seeking advice about her own concussion. This study provides insights about the psychological factors experienced by athletes who are attempting to RTS following concussion. Our results highlight a need to better understand and more comprehensively assess the psychological aspects involved in returning to sport following a concussion.

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Symptom Recovery in Children Aged 5 to 12 Years With Sport-Related and Non–Sport-Related Concussion

Ledoux,

Sicard,

Bijelic

et al. 2024

JAMA Netw Open

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ImportanceThere is limited research on clinical features and symptom recovery from sport-related concussion (SRC) and non-SRC in younger children.ObjectiveTo investigate the trajectory of symptom recovery in children aged 5 to 7 years and 8 to 12 years with SRC and non-SRC at 1, 2, 4, 8, and 12 weeks postinjury.Design, Setting, and ParticipantsThis secondary analysis of a prospective multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics) included participants aged 5 to 12 years with acute concussion who presented to 9 pediatric emergency departments within the Pediatric Emergency Research Canada network between August 2013 and June 2015. Analyses were conducted from September 2023 to May 2024.ExposureParticipants had a concussion consistent with the Zurich consensus diagnostic criteria and 85% completeness of the Post-Concussion Symptom Inventory (PCSI) at each time point.Main Outcomes and MeasuresThe primary outcome was symptom change, defined as current minus preinjury ratings 1, 2, 4, 8, and 12 weeks postinjury, measured using the PCSI. Symptoms were self-rated for children aged 8 to 12 years and child- and parent-rated for children aged 5 to 7 years. Mixed-effect models were conducted using total PCSI score adjusting for random effects; fixed-effect indicators included injury setting (SRC and non-SRC), time, injury setting × time, and other variables associated with recovery.ResultsA total of 1747 children, including 513 aged 5 to 7 years (mean [SD] age, 6.57 [0.85] years; 320 male [62.4%]) and 1234 aged 8 to 12 years (mean [SD] age, 10.68 [1.40] years; 806 male [65.3%]) were recruited, of whom 477 aged 5 to 7 years and 1157 aged 8 to 12 years were included in the analysis. Of those included in the analysis, 207 aged 5 to 7 years (43.4%; mean [SD] age, 6.68 [0.84] years; 142 male [68.6%]) and 790 aged 8 to 12 years (67.2%; mean [SD] age, 10.77 [1.40] years; 547 male [69.2%]) sustained an SRC. No significant differences in recovery curves across time postinjury were found between those with SRC and non-SRC (5-7 years: β = −0.09; 95% CI, −1.10 to 0.92; 8-12 years: β = 0.11; 95%CI, −1.50 to 1.70).Conclusions and RelevanceIn this cohort study of children aged 5 to 12 years with an acute SRC or non-SRC, symptom recovery trajectories over time were similar in both groups. This finding suggests similar management protocols can be used for sport and nonsport mechanisms of injury (excluding assault and motor vehicle crash) in the younger population.

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Which psychosocial factors are associated with return to sport following concussion? A systematic review

Cited by 27 publications

References 64 publications

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

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

Exploring student-athletes’ perceptions of their psychological readiness to return to sport following a concussion.

Symptom Recovery in Children Aged 5 to 12 Years With Sport-Related and Non–Sport-Related Concussion

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