Depression and Neurocognitive Performance After Concussion Among Male and Female High School and Collegiate Athletes

doi:10.1016/j.apmr.2012.03.032

Archives of Physical Medicine and Rehabilitation

Volume 93, Issue 10, October 2012, Pages 1751-1756

https://doi.org/10.1016/j.apmr.2012.03.032 Get rights and content

Abstract

Kontos AP, Covassin T, Elbin RJ, Parker T. Depression and neurocognitive performance after concussion among male and female high school and collegiate athletes.

Objectives

To prospectively examine the relationship of sport-related concussion with depression and neurocognitive performance and symptoms among male and female high school and college athletes. A secondary objective was to explore age and sex differences.

Design

Pretest, multiple posttest, repeated-measures design.

Setting

Laboratory.

Participants

High school and collegiate athletes (N=75) with a diagnosed concussion.

Interventions

Not applicable.

Main Outcome Measures

Beck Depression Inventory-II and computerized neurocognitive test battery (Immediate Post-concussion Assessment and Cognitive Test), which includes concussion symptoms (Post-concussion Symptom Scale) at baseline and at 2, 7, and 14 days postinjury.

Results

Concussed athletes exhibited significantly higher levels of depression from baseline at 2 days (P≤.001), 7 days (P=.006), and 14 days postconcussion (P=.04). Collegiate athletes demonstrated a significant increase in depression at 14 days postconcussion than did high school athletes (P=.03). There were no sex differences in depression levels. Neurocognitive decrements at 14 days were supported for reaction time (P=.001) and visual memory (P=.001). Somatic depression at 7 days postconcussion was related to slower reaction time at 7 days postconcussion. Somatic depression at 14 days postinjury was related to lower visual memory scores at 14 days postinjury.

Conclusions

Although not clinically significant, athletes experienced increased depression scores up to 14 days after concussion that coincided with neurocognitive decrements in reaction time and visual memory. Somatic depression appears to be most salient with regard to lower neurocognitive performance. Mood assessments after concussion are warranted to help monitor and enhance recovery.

Section snippets

Research Design

A 2-year prospective design was used for the current study. The independent variables were age (high school, collegiate), sex (male, female), and time postinjury (baseline, 2d, 7d, 14d). The dependent variables were total depression scores on the Beck Depression Inventory-II (BDI-II) and computerized neurocognitive test scores (ie, verbal memory, visual memory, reaction time, and processing speed) and symptom scores from the Immediate Post-concussion Assessment and Cognitive Test (ImPACT).

Participants

Demographic Results

A total of 75 athletes sustained a concussion and completed a baseline and 3 postconcussion BDI-II and computerized neurocognitive assessments. The sample comprised 54 high school (mean age ± SD, 15.74±1.28y) and 21 college athletes (mean age ± SD, 19.68±1.33y). There were 40 high school males (mean age ± SD, 15.90±1.28y) and 14 high school females (mean age ± SD, 15.29±SD=1.20y), and 11 collegiate males (mean age ± SD, 19.75±1.05y) and 10 collegiate females (mean age ± SD, 19.60±1.65y) in the

Discussion

To the best of our knowledge, the current study was the first to prospectively examine the relationship between sport-related concussion, depression, and computerized neurocognitive performance in a combined sample of male and female high school and collegiate athletes. Overall, depression was elevated from baseline levels at 2 days, 7 days, and 14 days postconcussion for all athletes. We hypothesized that levels of depression would increase in the acute time period (ie, 2d) after concussion

Conclusions

Although there was no evidence of clinical depression, the increased depression scores after concussion documented in the current study warrant consideration from sports-medicine professionals. Specifically, athletes with concussion reporting increased levels of depression, particularly somatic depression, may need additional attention and monitoring to ensure that depression symptoms do not prolong recovery time. Ignoring the emotional changes that can accompany concussion may negatively

References (30)

M. Field et al.
Does age play a role in recovery from sports-related concussion?A comparison of high school and collegiate athletes
J Pediatr
(2003)
T. Covassin et al.
The female athlete: the role of gender in the assessment and management of sport-related concussion
Clin Sports Med
(2011)
G.L. Iverson
Misdiagnosis of the persistent postconcussion syndrome in patients with depression
Arch Clin Neuropsychol
(2006)
P. Schatz et al.
Sensitivity and specificity of the ImPACT Test Battery for concussion in athletes
Arch Clin Neuropsychol
(2006)
T. Rees et al.
Stressors, social support and psychological responses to sport injury in high- and low-performance standard participants
Psychol Sport Exerc
(2010)
K.R. Cullen et al.
A preliminary study of functional connectivity in comorbid adolescent depression
Neurosci Lett
(2009)
P. McCrory et al.
Consensus statement on Concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008
Clin J Sport Med
(2009)
A.C. Colvin et al.
The role of concussion history and gender in recovery from soccer-related concussion
Am J Sports Med
(2009)
R. Jorge et al.
Mood disorders after traumatic brain injury
NeuroRehabilitation
(2002)
A. Hysenbegasi et al.
The impact of depression on the academic productivity of university students
J Ment Health Policy Econ
(2005)

T. Covassin et al.

Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms

Clin J Sport Med

(2012)

D.M. Erlanger et al.

Neuropsychology of sports-related head injury: dementia pugilistica to postconcussion syndrome

Clin Neuropsychol

(1999)

K.M. Guskiewicz et al.

Recurrent concussion and risk of depression in retired professional football players

Med Sci Sports Exerc

(2007)

Y.I. Sheline et al.

Hippocampal atrophy in recurrent major depression

Proc Natl Acad Sci U S A

(1996)

J.-K. Chen et al.

Neural substrates of symptoms of depression after concussion in male athletes with persisting postconcussion symptoms

Arch Gen Psychiatry

(2008)

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Between 2010 and 2017, student-athletes at a Southeastern NCAA Division-I institution were surveyed as part of a Performance, Health, and Wellness Program. Analyses were conducted using a sample of 324 student athletes (212 female) with either a prior diagnosis of ADHD, a prior history of a sport-related concussion, both prior diagnosis of ADHD and a history of sport-related concussion, or neither (controls).
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Student-athletes with ADHD and a history of concussion had 16.4 times greater odds of exhibiting clinically significant symptoms of state anxiety and 7.9 times greater odds of exhibiting clinically significant symptoms of depression, relative to control student-athletes. Every participant with both a diagnosis of ADHD and a history of concussion exhibited clinically significant attentional problems.
Having both ADHD and a history of concussion may have a synergistic effect on mental health beyond that of ADHD and/or concussion alone. Additional longitudinal research is necessary to verify current findings. However, athletic trainers and other health care professionals are encouraged to be mindful of student-athletes with ADHD, as they may be more vulnerable to experiencing symptoms of depression and state anxiety with elevated inattentive behaviors following a concussion.
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Citation Excerpt :
Existing research suggests the first month is associated with greater emotional variability, particularly for athletes experiencing concussions. Approximately 30% of athletes report at least one mental health symptom following SRC,94 and a SRC clinical profile associated with anxiety and mood symptoms appears to exist.30 Some emergence of depression symptoms may be due to the overlap in symptomatology between depression and sport-related concussion (SRC).95
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: Supported by the National Operating Committee on Standards for Athletic Equipment.

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

: In-press corrected proof published online on May 11, 2012, at www.archives-pmr.org.

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Original articleDepression and Neurocognitive Performance After Concussion Among Male and Female High School and Collegiate Athletes

Abstract

Objectives

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Research Design

Participants

Demographic Results

Discussion

Conclusions

J Pediatr

Clin Sports Med

Arch Clin Neuropsychol

Arch Clin Neuropsychol

Psychol Sport Exerc

Neurosci Lett

Consensus statement on Concussion in Sport 3rd International Conference on Concussion in Sport held in Zurich, November 2008

Clin J Sport Med

The role of concussion history and gender in recovery from soccer-related concussion

Am J Sports Med

Mood disorders after traumatic brain injury

NeuroRehabilitation

The impact of depression on the academic productivity of university students

J Ment Health Policy Econ

Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms

Clin J Sport Med

Neuropsychology of sports-related head injury: dementia pugilistica to postconcussion syndrome

Clin Neuropsychol

Recurrent concussion and risk of depression in retired professional football players

Med Sci Sports Exerc

Hippocampal atrophy in recurrent major depression

Proc Natl Acad Sci U S A

Neural substrates of symptoms of depression after concussion in male athletes with persisting postconcussion symptoms

Arch Gen Psychiatry

Original article
Depression and Neurocognitive Performance After Concussion Among Male and Female High School and Collegiate Athletes