Acute psychological symptom profiles in high school football players following sport-related concussion

Maryam Y. Jawid Vanderbilt University School of Medicine, Nashville, Tennessee

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Kristen L. Williams Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center
Department of Neurological Surgery, Vanderbilt University Medical Center

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Jacob Jo Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center
Department of Neurological Surgery, Vanderbilt University Medical Center

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Tyler M. Hill Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center
Department of Neurological Surgery, Vanderbilt University Medical Center

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Olivia L. Prosak Vanderbilt University School of Medicine, Nashville, Tennessee

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Amad Amedy Vanderbilt University School of Medicine, Nashville, Tennessee

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Trevor J. Anesi Vanderbilt University School of Medicine, Nashville, Tennessee

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Douglas P. Terry Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center
Department of Neurological Surgery, Vanderbilt University Medical Center

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Scott L. Zuckerman Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center
Department of Neurological Surgery, Vanderbilt University Medical Center

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Publication Date:
17 Nov 2023
Page Range:
1–9
Volume/Issue:
Publish Before Print
DOI link:
https://doi.org/10.3171/2023.9.PEDS23301
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OBJECTIVE

In a cohort of high school football athletes, the authors sought to 1) describe the proportion of those with acute psychological symptoms postconcussion, 2) determine predictors of more acute psychological symptoms postconcussion, and 3) determine if acute psychological symptoms impact recovery.

METHODS

A retrospective cohort study of high school football athletes (14–18 years of age) who sustained a sport-related concussion between November 2017 and April 2022 and presented to a multidisciplinary concussion center was performed. Based on their Post-Concussion Symptom Scale (PCSS) scores at the initial clinic visit, their total psychological symptom cluster score was calculated by summing their scores for the four affective symptoms (irritability, sadness, nervousness, and feeling more emotional). The psychological symptom ratio was defined as the ratio of the psychological symptom cluster score to the total initial PCSS score. Primary outcomes included time to return to learn (RTL), symptom resolution, and return to play (RTP). Uni- and multivariable regression analyses were performed controlling for demographic factors, learning disabilities, attention-deficit/hyperactivity disorder, and personal and/or family history of psychological diagnoses and migraine.

RESULTS

A total of 195 male football players (mean age 16.2 ± 1.2 years) were included in the study. About one-third of the sample (n = 70, 35.9%) reported at least one psychological symptom. Of these 70 athletes, their psychological symptom scores were 1 (10.3%), 2 (7.7%), and ≥ 3 (17.9%). Irritability was the most endorsed psychological symptom (25.1%), followed by nervousness (15.9%), feeling more emotional (12.8%), and sadness (11.8%). The multivariable regression model showed that a positive psychological history (B = 2.66, 95% CI 0.74–4.58, p = 0.007) and family psychological history (B = 2.43, 95% CI 0.98–3.88, p = 0.001) were significant predictors of a higher psychological symptom cluster score. Multivariable linear regression analysis showed that a higher psychological symptom cluster score was associated with a longer time to RTP (B = 1.22, 95% CI 0.17–2.264, p = 0.023) but not with time to symptom resolution or RTL. The psychological symptom ratio was not a significant predictor.

CONCLUSIONS

In a cohort of male football players, 36% reported at least one psychological symptom, with irritability being most commonly reported. Athletes with a personal and/or family history of psychological disorders experienced more acute psychological symptoms following a sport-related concussion. A higher psychological symptom cluster score was associated with delayed time to RTP but not time to RTL or symptom resolution.

ABBREVIATIONS

ADHD = attention-deficit/hyperactivity disorder; LOC = loss of consciousness; PCSS = Post-Concussion Symptom Scale; RTL = return to learn; RTP = return to play; SRC = sport-related concussion.
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Contributor Notes

Correspondence Kristen L. Williams: Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN. kristen.williams.1@vumc.org.

INCLUDE WHEN CITING Published online November 17, 2023; DOI: 10.3171/2023.9.PEDS23301.

Disclosures Dr. Terry reported personal fees from HitIQ and REACT Neuro Inc., and grants from Amgen and Football Research Inc. outside the submitted work. Dr. Zuckerman reported personal fees from the NFL Head Neck and Spine Committee during the conduct of the study.

  • 1

    Refakis CA, Turner CD, Cahill PJ. Sports-related concussion in children and adolescents. Clin Spine Surg. 2017;30(5):191–196.

  • 2

    Veliz P, Eckner JT, Zdroik J, Schulenberg JE. Lifetime prevalence of self-reported concussion among adolescents involved in competitive sports: a national U.S. study. J Adolesc Health. 2019;64(2):272–275.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Iverson GL, Gardner AJ, Terry DP, et al. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941–948.

  • 4

    Zuckerman SL, Apple RP, Odom MJ, Lee YM, Solomon GS, Sills AK. Effect of sex on symptoms and return to baseline in sport-related concussion. J Neurosurg Pediatr. 2014;13(1):72–81.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013;47(1):15–26.

  • 6

    Legarreta AD, Brett BL, Solomon GS, Zuckerman SL. The role of family and personal psychiatric history in postconcussion syndrome following sport-related concussion: a story of compounding risk. J Neurosurg Pediatr. 2018;22(3):238–243.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Brooks BL, Plourde V, Beauchamp MH, et al. Predicting psychological distress after pediatric concussion. J Neurotrauma. 2019;36(5):679–685.

  • 8

    Wilmoth K, Tan A, Tarkenton T, et al. Early psychological symptoms predict concussion recovery time in middle and high school athletes. J Clin Exp Neuropsychol. 2022;44(4):251–257.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Yrondi A, Brauge D, LeMen J, Arbus C, Pariente J. Depression and sports-related concussion: a systematic review. Presse Med. 2017;46(10):890–902.

  • 10

    McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–847.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.

  • 13

    Merritt VC, Meyer JE, Arnett PA. A novel approach to classifying postconcussion symptoms: the application of a new framework to the Post-Concussion Symptom Scale. J Clin Exp Neuropsychol. 2015;37(7):764–775.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Tang AR, Davis PJ, Williams KL, et al. Use of acute cognitive symptom cluster to predict return-to-learn duration following a sport-related concussion. J Neurosurg Pediatr. 2022;30(4):378–385.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Kontos AP, Elbin RJ, Schatz P, et al. A revised factor structure for the Post-Concussion Symptom Scale: baseline and postconcussion factors. Am J Sports Med. 2012;40(10):2375–2384.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Field M, Collins MW, Lovell MR, Maroon J. Does age play a role in recovery from sports-related concussion? A comparison of high school and collegiate athletes. J Pediatr. 2003;142(5):546–553.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Zemek R, Barrowman N, Freedman SB, et al. Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. JAMA. 2016;315(10):1014–1025.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Li Y, Li Q, Zheng J, et al. Prevalence and trends in diagnosed learning disability among US children and adolescents from 1997 to 2021. JAMA Pediatr. 2023:177(9):969–972.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Bishop TW. Mental disorders and learning disabilities in children and adolescents: learning disabilities. FP Essent. 2018;475:18–22.

  • 20

    Mental health of adolescents. World Health Organization. November 17, 2021. Accessed October 2, 2023. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Sufrinko A, McAllister-Deitrick J, Elbin RJ, Collins MW, Kontos AP. Family history of migraine associated with posttraumatic migraine symptoms following sport-related concussion. J Head Trauma Rehabil. 2018;33(1):7–14.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Data and statistics about ADHD. Centers for Disease Control and Prevention. Published June 8, 2022.Accessed October 2, 2023. https://www.cdc.gov/ncbddd/adhd/data.html

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Visser SN, Danielson ML, Bitsko RH, et al. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. J Am Acad Child Adolesc Psychiatry. 2014;53(1):34–46.e2.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Onofri A, Pensato U, Rosignoli C, et al. Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis. J Headache Pain. 2023;24(1):8.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Lumba-Brown A, Teramoto M, Zhang R, et al. Multicentre evaluation of anxiety and mood among collegiate student athletes with concussion. BMJ Open Sport Exerc Med. 2023;9(1):e001446.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Daneshvar DH, Baugh CM, Yutsis M, et al. Athlete enjoyment of prior education moderates change in concussion-reporting intention after interactive education. Inquiry. 2021;58:469580211022641.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Yengo-Kahn AM, Wallace J, Jimenez V, Totten DJ, Bonfield CM, Zuckerman SL. Exploring the outcomes and experiences of Black and White athletes following a sport-related concussion: a retrospective cohort study. J Neurosurg Pediatr. 2021;28(5):516–525.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Wallace J, Affagato R, Brooke M, McAllister-Deitrick J, Moran RN, Covassin T. Racial disparities in parent knowledge of concussion and recognition of signs and symptoms. J Safety Res. 2020;75:166–172.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Wagner R, Zach K, Kobayashi Y, Gottschalk AW. Race and concussion: an emerging relationship. Ochsner J. 2020;20(4):348–349.

  • 30

    Probst JC, Laditka SB, Moore CG, Harun N, Powell MP. Race and ethnicity differences in reporting of depressive symptoms. Adm Policy Ment Health. 2007;34(6):519–529.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Rigney G, Jo J, Williams K, Terry DP, Zuckerman SL. Parental factors associated with recovery after mild traumatic brain injury: a systematic review. J Neurotrauma. Published online July 18, 2023. doi:10.1089/neu.2023.0015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ. Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. J Clin Child Adolesc Psychol. 2018;47(2):199–212.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Cook NE, Iverson GL, Maxwell B, Zafonte R, Berkner PD. Adolescents with ADHD do not take longer to recover from concussion. Front Pediatr. 2021;8:606879.

  • 34

    Rajaprakash M, Leppert ML. Attention-deficit/hyperactivity disorder. Pediatr Rev. 2022;43(3):135–147.

  • 35

    Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–989.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Ollendick TH, March JS, ed. Phobic and Anxiety Disorders in Children and Adolescents: A Clinician’s Guide to Effective Psychosocial and Pharmacological Interventions. Oxford University Press; 2004:xvii.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Weissbourd R, Batanova M, Laski M, McIntyre J, Torres E, Balisciano N. Caring for the Caregivers. The Critical Link Between Parent and Teen Mental Health. Harvard Graduate School; 2023.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Nolan KE, Caccese JB, Kontos AP, et al. Primary and secondary risk factors associated with concussion symptom clusters in collegiate athletes: results from the NCAA-DoD Grand Alliance CARE Consortium. Orthop J Sports Med. 2023;11(4):23259671231163581.

    • PubMed
    • Search Google Scholar
    • Export Citation

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