Outcomes Following Sports-Related Concussion in School-Aged Children and Adolescents: The Influence of Psychological Factors

Although neurocognitive performance has been a popular topic of investigation in sports-related concussion, biopsychosocial sequelae have received considerably less attention. We reviewed the literature on emotional and psychosocial functioning in school-aged children and adolescents following concussion. MEDLINE and PsycINFO database queries identified 604 studies examining psychological and/or social outcomes of mild traumatic brain injury in children, 11 of those specific to athletes. This small body of literature and extrapolation from the general pediatric concussion literature indicated behavioral disturbances present at least temporarily following injury. Postconcussive anxiety and depressive symptoms are common, though levels may be subclinical. Social and academic disruption was less clearly documented. To aid clinicians in anticipating the psychosocial needs of concussed student athletes, well-controlled and adequately powered research on emotional and psychosocial outcomes are needed. The impact of post-injury psychological functioning on concussion recovery is poorly understood, particularly in youth. To this end, we explored initial mood and sleep symptoms as predictors of prolonged symptom clearance in a sample of adolescents, controlling for previously established injury-related and demographic risk factors. Student athletes (aged 12-18, N=393, 55% male) evaluated in outpatient concussion clinics completed brief self-report anxiety, depression, sleep, and postconcussive symptom scales 0-2 weeks post-injury. Medical record review at three-month follow-up provided date of symptom clearance. Survival analysis for time to recovery was conducted based on 1) self-reported injury/medical factors: sex, psychiatric history, prior concussion history, loss of consciousness, amnesia, initial symptom severity, and 2) psychological factors: anxiety, depression, and sleep screeners. Having amnesia, greater postconcussive symptoms, and worse sleep quality decreased the odds of recovery across time points (HRs = 0.64-0.99, ps < .05) in the total sample. When separated by sex, only postconcussive symptoms were associated with recovery in females, while amnesia and depressive symptoms were the only significant predictors of recovery for males (HRs = 0.54-0.98, ps < .05). Our findings linked brief psychological screeners to prolonged recovery, even considering injury and medical factors. Assessment of mood and sleep may aid in identification of individuals at risk for worse outcomes, though further exploration of postconcussive psychological issues is warranted before drawing firm conclusions.