The Effect of Concussion History and Gender on Symptoms of Depression and Anxiety

Background: Each year in the United States, at least 1.7 million people suffer a traumatic brain injury (TBI) resulting in an estimated cost of $60 billion annually. The majority of these injuries are considered relatively mild. Depression, anxiety, and cognitive impairment are among the most common symptoms affecting people suffering a mild Traumatic Brain Injury (mTBI). Here we use a community-wide sample of adolescent athletes to examine a reported history of mTBI’s impact on symptoms commonly associated with depression and anxiety.

Method: After applying exclusionary criteria (history of substance, ADD/ADHD, brain surgery, etc.), a total of 14,082 adolescent athletes were used in this study. Participants were assessed using the Post-Concussion Symptom Scale (PCSS) embedded in the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) tool for baseline testing. Multivariate Analysis of Variance (MANOVA) was used to examine the effect of gender and number of concussions on depression and anxiety symptoms reported.

Results: Results indicated that self-reported severity of fatigue (p<.001), initial insomnia (i.e., sleep onset insomnia) (p<.001), hyposomnia (p<.001), emotionality (p=.031), mental sluggishness (p<.001), fogginess (p<.001), and concentration problems (p<.001) significantly increase with number of concussions suffered. When examining effect of gender, females were found to report significantly higher scores on fatigue (p<.001), hyposomnia (p<.001), and emotionality (p<.001) than males. Furthermore, an interaction effect was found for fatigue (p=.009), hyposomnia (p=.001), and memory problems (p=.001), with females reporting significantly higher scores than males as number of concussions increases. Reported symptoms of hypersomnia, irritability, fogginess, sadness, and nervousness were not significant for number of concussions or gender, although hypersomnia (p=.057) was found to be marginally significant as an interaction effect.

Conclusion: The results of this study support an increase in certain symptoms associated with anxiety and depression as self-reported number of concussions increases. While further studies are needed, this large scale study adds to the current literature reporting anxiety and depressive symptoms being found in student athletes after concussions and indicates a need for health professionals to monitor for these symptoms in student athletes.