Influences of Mental Illness, Current Psychological State, and Concussion History on Baseline Concussion Assessment Performance

2018 ◽  
Vol 46 (7) ◽  
pp. 1742-1751 ◽  
Author(s):  
Michelle L. Weber ◽  
John-Henry L. Dean ◽  
Nicole L. Hoffman ◽  
Steven P. Broglio ◽  
Michael McCrea ◽  
...  
Keyword(s):  
Symptom Severity ◽  
State Anxiety ◽  
Student Athletes ◽  
Psychological State ◽  
Depression And Anxiety ◽  
History Of ◽  
Concussion History ◽  
Assessment Performance ◽  
Current Psychological ◽  
Anxiety Depression

Background: A student-athlete’s mental state, including history of trait anxiety and depression, or current psychological state may affect baseline concussion assessment performance. Purpose: (1) To determine if mental illness (anxiety, depression, anxiety with depression) influences baseline scores, (2) to determine if psychological state correlates with baseline performance, and (3) to determine if history of concussion affects Brief Symptom Inventory–18 (BSI-18) subscores of state anxiety, depression, and somatization. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A sample of 8652 collegiate student-athletes (54.5% males, 45.5% females) participated in the Concussion Assessment, Research and Education (CARE) Consortium. Baseline assessments included a demographic form, a symptom evaluation, Standardized Assessment of Concussion, Balance Error Scoring System, a psychological state assessment (BSI-18), and Immediate Post-concussion Assessment and Cognitive Test. Baseline scores were compared between individuals with a history of anxiety (n = 59), depression (n = 283), and anxiety with depression (n = 68) and individuals without a history of those conditions (n = 8242). Spearman’s rho correlations were conducted to assess the relationship between baseline and psychological state subscores (anxiety, depression, somatization) (α = .05). Psychological state subscores were compared between individuals with a self-reported history of concussions (0, 1, 2, 3, 4+) using Kruskal-Wallis tests (α = .05). Results: Student-athletes with anxiety, depression, and anxiety with depression demonstrated higher scores in number of symptoms reported (anxiety, 4.3 ± 4.2; depression, 5.2 ± 4.8; anxiety with depression, 5.4 ± 3.9; no anxiety/depression, 2.5 ± 3.4), symptom severity (anxiety, 8.1 ± 9.8; depression, 10.4 ± 12.4; anxiety with depression, 12.4 ± 10.7; no anxiety/depression, 4.1 ± 6.9), and psychological distress in state anxiety (anxiety, 3.7 ± 4.7; depression, 2.5 ± 3.6; anxiety with depression, 3.8 ± 4.2; no anxiety/depression, 0.8 ± 1.8), depression (anxiety, 2.4 ± 4.0; depression, 3.2 ± 4.5; anxiety with depression, 3.8 ± 4.8; no anxiety/depression, 0.8 ± 1.8), and somatization (anxiety, 2.3 ± 2.9; depression, 1.8 ± 2.8; anxiety with depression, 2.2 ± 2.4; no anxiety/depression, 0.9 ± 1.7). A moderate positive relationship existed between all BSI-18 subscores and total symptom number (n = 8377; anxiety: rs = 0.43, P < .001; depression: rs = 0.42, P < .001; somatization: rs = 0.45, P < .001), as well as total symptom severity (anxiety: rs = 0.43, P < .001; depression: rs = 0.41, P < .001; somatization: rs = 0.45, P < .001). Anxiety, depression, and somatization subscores were greater among student-athletes that self-reported more concussions. Conclusion: Clinicians should be cognizant that student-athletes with a history of trait anxiety, depression, and anxiety with depression may report higher symptom score and severity at baseline. Individuals with extensive concussion history may experience greater state anxiety, depression, and somatization.

scholarly journals Concussion History, Career Status and Cumulative Years of Football Exposure Influence Concussion Assessment Performance in Elite Football Players

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S17.3-S18
Author(s):  
Brittani Cookinham ◽  
Chad Swank ◽  
Mark Weber ◽  
Ann Medley ◽  
Kelli Brizzolara
Keyword(s):  
Symptom Severity ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Neurocognitive Function ◽  
Football Players ◽  
Professional Career ◽  
Falling Asleep ◽  
Concussion History ◽  
Assessment Performance ◽  
Career Status

ObjectiveTo explore relationship of concussion history, career status, and cumulative years of contact football exposure on total symptoms, symptom severity, neurocognitive function, and balance in elite football players.Background61% of retired football players report sustaining a concussion during their professional career. However, the influence of concussion history, career status and cumulative years played on total symptoms, symptom severity, neurocognitive function, and balance is largely unexplored.Design/MethodsElite football players (n = 102; age M = 27.75 ± 6.95 years) without a concussion (>30 days) underwent SCAT-3 assessments. Players were placed into a low (0–1) or multiple concussion (2+) history group and categorized by career status (draft prospects, active professional players and retired professional players). Data were analyzed using negative binomial regression and multiple linear regression analyses.Results58.8% of players reported symptoms. Most common symptoms were fatigue (33.3%), trouble falling asleep (31.4%), difficulty remembering (29.4%), and difficulty concentrating (20.6%). Multiple concussions group reported 3.07 times greater total symptoms (p < 0.001), 3.58 times higher symptom severity (p < 0.001), and lower SAC scores (1.42 points) (p = 0.033) compared to low concussion group. Professionals reported 1.88 times greater total symptoms (p = .038) and 2.35 times higher symptom severity compared to draft prospects (p = 0.001). Retired players reported 7.07 times greater total symptoms (p < 0.001), 8.97 times higher symptom severity (p < 0.001), lower SAC scores (1.98 points) (p = 0.025), and 3.67 more m-BESS errors (p = 0.002), compared to draft prospects. Players with 11–19 years football exposure reported 3.83 times higher symptom severity compared to players with <11 years football exposure (p = 0.001). Players with >19 years football exposure had 6.87 times higher symptom severity than players with <11 years football exposure (p < .001).ConclusionsRetired players with multiple concussions and 19+ years of contact football exposure are likely to have more symptoms, higher symptom severity, and lower neurocognitive scores.

Specialist Referral and Outcomes in Adolescent Athletes With Prior Concussion History

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S19.2-S20
Author(s):  
Hannah Worrall ◽  
Jane Chung ◽  
Munro Cullum ◽  
Shane Miller
Keyword(s):  
Symptom Severity ◽  
Small Difference ◽  
Limited Evidence ◽  
Adolescent Athletes ◽  
Rates Of Return ◽  
Specialist Referral ◽  
History Of ◽  
Concussion History ◽  
Return To Activity ◽  
Made In

ObjectiveTo examine specialist referral patterns and clinical outcomes in adolescents with differing levels of prior concussion history.BackgroundLimited evidence exists on healthcare utilization and outcomes in concussed adolescent athletes with and without a history of prior concussion.Design/MethodsData were prospectively collected from participants aged 12–18 diagnosed with a sport-related concussion and documented prior concussion history between August 2015-March 2020. Participants were separated into 3 groups: 0, 1, and 2 + prior concussions. Demographics, medical history, specialist referrals, and clinical outcome variables obtained at 3-months post-concussion were analyzed.ResultsOne thousand one hundred ninety-seven participants were included: 114 (10.4%) had 2+, 213 (19.4%) had 1, and 770 (70.2%) had 0 prior concussions. There was no difference in sex or time to presentation. A small difference was found across age (15.3 ± 1.6 vs 14.9 ± 1.6 vs 14.5 ± 1.6 years, p < 0.001). Significant differences were also observed between groups in self-reported history of psychological disorders (14.9 vs 15 vs 8.4%, p = 0.01) and headaches/migraines (25.4 vs 20.2 vs 15.5%, p = 0.02). Significant differences between the groups were found in specialist referrals, with more referrals made in the 2 + group to physical therapy (39.6 vs 28.2 vs 23.4%, p = 0.001), neuropsychology (17.1 vs 5.3 vs 7.5%, p = 0.001), and neurology (8.9 vs 2.9 vs 2.2%, p = 0.001). Fewer participants in the 2 + group recovered in = 30 days (53.6 vs 65.6 vs 68.5%, p = 0.04) and reported lower rates of return to activity at 3-months post-concussion (67.9 vs 85.9 vs 87.6%, p < 0.001). No differences were seen in symptom severity, PHQ-8, or GAD-7 scores. All reported as 2 + vs 1 vs 0.ConclusionsConcussed adolescent athletes with a history of 2 or more prior concussions had a higher rate of specialist referrals, were less likely to have returned to prior level of play/activity 3 months following injury, and were less likely to have resolution of symptoms in 30 days or less.

scholarly journals INITIAL CLINICAL PRESENTATION OF PEDIATRIC PATIENTS WITH PSYCHOLOGICAL DISORDERS FOLLOWING CONCUSSION

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0008
Author(s):  
Hannah M. Worrall ◽  
Shane M. Miller ◽  
C. Munro Cullum ◽  
Jane S. Chung
Keyword(s):  
Symptom Severity ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Anxiety And Depression ◽  
Anxiety Group ◽  
Severity Scores ◽  
Significant Difference ◽  
History Of ◽  
Concussion History ◽  
History Of Depression

Background: There is limited evidence regarding the impact of pre-existing psychological disorders on the initial clinical presentation in pediatric patients following concussion. Hypothesis/Purpose: To examine differences in clinical symptom measures between pediatric patients with a history of depression and/or anxiety and no history of psychological disorder (PD) following a concussion. Methods: Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015 and March 2020. Participants aged 5-18 years diagnosed with a concussion were included. Demographic variables and a range of clinical measures from initial presentation were reviewed, including SCAT-5 Symptom Log, Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7) scale, and Brief Resiliency Scale (BRS). Participants were separated into four groups based on self-reported prior diagnosis: depression, anxiety, depression+anxiety, and no PD. Results: A total of 1770 participants were included: 50 with depression, 82 with anxiety, 84 with both, and 1554 with no history of PD. There was no significant difference in age, sex, prior concussion history, or time to presentation between the depression and no PD group, or between the anxiety and no PD group. A significant difference was found between the depression+anxiety group and no PD group in the following variables: age (15.11±1.8 vs 13.68±2.61 years, p<0.001), prior concussion history (40.5% vs 23.9%, p=0.001), and time to presentation (31.47±25.82 vs 19.85±26.33 days, p=0.01). Additionally, there were more females in the depression+anxiety group than the no PD group (71.4% vs 47.8%, p<0.001). The depression, anxiety, and depression+anxiety groups had significantly higher rates of learning disorders than the no PD group (40%, 47.6%, 46.4% vs 16.4%, all p<0.001). A significant difference in SCAT-5 symptom severity scores between the depression, anxiety, and depression+anxiety groups compared to the no PD group was found. The PD groups all reported higher GAD-7 and PHQ-8 scores and lower BRS scores compared to the no PD group. The depression+anxiety group had the highest symptom severity, GAD-7, and PHQ-8 scores along with the lowest BRS score. Table 1.1 summarizes these significant findings. Conclusion: Differences were seen in participants with a history of depression and/or anxiety at initial clinical presentation, including history of learning disability, SCAT-5 symptom severity scores, and common screening tests for depression, anxiety, and resiliency compared to those without a history of PD. Understanding these differences at initial presentation may urge providers to engage multidisciplinary teams early in facilitating patient recovery. Tables/Figures: [Table: see text]

scholarly journals Effects of previous exposure to psychotherapeutic strategies on depression and anxiety symptoms during the COVID-19 pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Amelia Gulliver ◽  
Michelle Banfield ◽  
Philip J. Batterham ◽  
Alison L. Calear ◽  
Louise M. Farrer ◽  
...  
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Anxiety Symptoms ◽  
Depression And Anxiety ◽  
Health Events ◽  
Breathing Exercises ◽  
Symptoms Of Depression ◽  
Global Pandemic ◽  
History Of ◽  
Anxiety Depression

Background The COVID-19 pandemic has seen an increase in depression and anxiety among those with and without a history of mental illness. Commonly used forms of psychological therapy improve mental health by teaching psychotherapeutic strategies that assist people to better manage their symptoms and cope with life stressors. Minimal research to date has explored their application or value in managing mental health during significant broad-scale public health crises. Aims To determine which psychotherapeutic strategies people who have previously received therapy use to manage their distress during the COVID-19 pandemic, and whether the use and perceived helpfulness of these strategies has an effect on symptoms of depression and anxiety. Method Data (N = 857) was drawn from multiple waves of a representative longitudinal study of the effects of COVID-19 on the mental health of Australian adults, which includes measures of anxiety, depression and experiences with psychotherapy and psychotherapeutic strategies. Results Previous engagement in therapy with psychotherapeutic strategies had a protective effect on depressive but not anxiety symptoms. Common and helpful strategies used by respondents were exercise, mindfulness and breathing exercises. Using mindfulness and perceiving it to be helpful was associated with lower levels of depression and anxiety symptoms. No other strategies were associated with improved mental health. Conclusions Prior knowledge of psychotherapeutic strategies may play a role in managing mental health during unprecedented public health events such as a global pandemic. There may be value in promoting these techniques more widely in the community to manage general distress during such times.

scholarly journals A-32 Acute Concussive Symptom Profiles in Adolescents and Young Adults with History of Depression and Anxiety

2020 ◽  
Vol 35 (5) ◽  
pp. 628-628
Author(s):  
C Presley ◽  
T Meredith-Duliba ◽  
T Tarkenton ◽  
M Stokes ◽  
S Miller ◽  
...  
Keyword(s):  
Young Adults ◽  
Symptom Severity ◽  
Adolescents And Young Adults ◽  
Depression And Anxiety ◽  
Cognitive Fatigue ◽  
Anxiety Group ◽  
Symptom Profiles ◽  
Symptom Profile ◽  
History Of ◽  
History Of Depression

Abstract Objective The aims of this study are (1) to examine the clinical symptom profiles of individuals with depression and/or anxiety history following a concussion and (2) to compare profile differences across groups. Method Participants aged 12-25 (n=129, mean=15.6) with premorbid diagnoses of depression (n=24), anxiety (n=50), or depression+anxiety (n=55) were evaluated within 21 days after sustaining a concussion as part of the North Texas Concussion Registry (ConTex) using the Post-Concussion Symptom Scale (PCSS). Following the model described by Kontos and Collins (2014), symptom clusters were derived from the PCSS to create six domains (cognitive/fatigue, vestibular, ocular, posttraumatic migraine, anxiety/mood, cervical). ANOVAs with Tukey’s post-hoc tests were conducted to compare domain symptom severity and total symptom severity across groups. Results There were no demographic differences between groups. A single symptom profile was prominent across each group, with the primary, secondary, and tertiary symptomatic domains being posttraumatic migraine, ocular, and cognitive/fatigue, respectively. Across each domain the depression+anxiety group was most symptomatic, followed in order by the depression and anxiety groups. The depression+anxiety group reported significantly higher anxiety/mood (M=2.0 vs. M=1.3) and cognitive/fatigue (M=2.9 vs M=2.1) symptom severity compared to the anxiety group. Group differences on total symptom severity approached significance (F=2.83, p=.06). Conclusions The observed symptom profiles suggest that the acute-concussive response is similar in adolescents and young adults with history of depression and/or anxiety. Multiple premorbid conditions, such as depression and anxiety, appear to magnify overall symptom severity. Further research is warranted to understand the relationship between symptom burden and premorbid mental health factors.

Depression, anxiety, and attachment among women hospitalized on an antepartum unit

2019 ◽  
Vol 54 (6) ◽  
pp. 395-407 ◽  
Author(s):  
Sarah Nagle-Yang ◽  
MacKenzie Phillips ◽  
Avril Albaugh ◽  
Lulu Zhao ◽  
Jaina Amin ◽  
...  
Keyword(s):  
At Risk ◽  
Mental Health Treatment ◽  
Screening Tools ◽  
Depression And Anxiety ◽  
Maternal Fetal Attachment ◽  
Prevalence Of Depression ◽  
History Of ◽  
Fetal Attachment ◽  
Anxiety Depression ◽  
Risk For Depression

Objective To examine the prevalence of depression, anxiety, attachment issues, and associated factors among pregnant women hospitalized on an antepartum unit. Method Ninety-eight women hospitalized on an antepartum unit reported demographic and social information and were evaluated with screening tools for depression, anxiety, and maternal–fetal attachment. Data were analyzed using descriptive statistics and logistical regression analysis. Results Over one third (36%) of participants screened at risk for depression. Almost half (47%) reported elevated state anxiety and over one third (37%) reported elevated trait anxiety. Depression and anxiety were frequently comorbid. Positive screens for depression and anxiety were associated with decreased maternal-fetal attachment. Those who screened at risk for depression and anxiety in this sample often had a personal or family history of depression or anxiety or a history of intimate partner victimization. Substance use was common among those with elevated anxiety. Only a minority (15%) of at-risk participants had been referred to mental health treatment. Conclusions Women hospitalized on antepartum units had an elevated risk of depression and anxiety. Depression and anxiety were strongly comorbid in this population. Screening efforts to increase detection of perinatal depression and anxiety are recommended on obstetrical antepartum units.

scholarly journals A-01 Comparing State Anxiety Between Concussed Athletes with and without a History of Sport Related Concussion

2020 ◽  
Vol 35 (5) ◽  
pp. 597-597
Author(s):  
M Anderson ◽  
A J Zynda ◽  
K M Petit ◽  
C P Tomczyk ◽  
T Covassin
Keyword(s):  
Trait Anxiety ◽  
State Anxiety ◽  
Statistical Significance ◽  
The State ◽  
Cross Sectional ◽  
Significant Difference ◽  
History Of ◽  
Concussion History ◽  
Cross Sectional Design ◽  
The Moment

Abstract Objective To compare state anxiety between concussed athletes with and without a history of sport related concussion (SRC). Method This study utilized a cross-sectional design. The State Trait Anxiety Inventory (STAI) was administered to athletes within 72 hours of SRC diagnosis. The STAI is a subjective, 40-item inventory that assesses state and trait anxiety; however, this study only examined the state anxiety component. Participants reported how they were feeling at the moment of testing on a 4-point Likert scale ranging from 1 (not at all) to 4 (very much so). State anxiety scores range from 20–80, with higher scores indicating higher levels of state anxiety. An independent samples t-test was used to compare state anxiety between concussed athletes with and without a history of SRC. Statistical significance was set at p &lt; .05. Results A total of 104 (18.12 ± 2.5 years; male = 65, female = 39) high school (n = 36) and collegiate (n = 68) athletes completed the STAI within 72 hours of SRC. Fifty-nine (56.7%) concussed athletes had no history of SRC and 45 (43.3%) athletes had a history of one or more SRCs. There was no significant difference in state anxiety between concussed athletes with (37.64 ± 9.22) and without (38.47 ± 9.44) a history of SRC (p = .65). Conclusions This study suggests that concussion history does not affect state anxiety after SRC. However, clinicians should continue to assess emotional changes after SRC in order to best manage and treat SRC.

scholarly journals Case report: Manual therapies promote resolution of persistent post-concussion symptoms in a 24-year-old athlete

2021 ◽  
Vol 9 ◽  
pp. 2050313X2095222
Author(s):  
Susan Vaughan Kratz
Keyword(s):  
Case Report ◽  
Symptom Severity ◽  
Impact Test ◽  
Manual Therapies ◽  
Symptom Checklist ◽  
Post Concussion Syndrome ◽  
Persistent Symptoms ◽  
Short Period ◽  
History Of ◽  
Headache Impact

This case report illustrates the treatment outcomes of a collegiate athlete presenting with an 18-month history of post-concussion syndrome who received a series of mixed manual therapies in isolation of other therapy. Persistent symptoms were self-reported as debilitating, contributing to self-removal from participation in school, work, and leisure activities. Patient and parent interviews captured the history of multiple concussions and other sports-related injuries. Neurological screening and activities of daily living were baseline measured. Post-Concussion Symptom Checklist and Headache Impact Test-6™ were utilized to track symptom severity. Treatments applied included craniosacral therapy, manual lymphatic drainage, and glymphatic techniques. Eleven treatment sessions were administered over 3 months. Results indicated restoration of oxygen saturation, normalized pupil reactivity, and satisfactory sleep. Post-concussion syndrome symptom severity was reduced by 87% as reflected by accumulative Post-Concussion Symptom Checklist scores. Relief from chronic headaches was achieved, reflected by Headache Impact Test-6 scores. Restoration of mood and quality of life were reported. A 6-month follow-up revealed symptoms remained abated with full re-engagement of daily activities. The author hypothesized that post-concussion syndrome symptoms were related to compression of craniosacral system structures and lymphatic fluid stagnation that contributed to head pressure pain, severe sleep deprivation, and multiple neurological and psychological symptoms. Positive outcomes over a relatively short period of time without adverse effects suggest these therapies may offer viable options for the treatment of post-concussion syndrome.

scholarly journals The contribution of depressive ‘disorder characteristics’ to determinations of prognosis for adults with depression: an individual patient data meta-analysis

2021 ◽  
pp. 1-14
Author(s):  
Joshua E. J. Buckman ◽  
Rob Saunders ◽  
Zachary D. Cohen ◽  
Phoebe Barnett ◽  
Katherine Clarke ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Depressive Symptom ◽  
Panic Disorder ◽  
Symptom Severity ◽  
Individual Patient Data ◽  
Antidepressant Treatment ◽  
Patient Data ◽  
History Of ◽  
Depressive Symptom Severity

Abstract Background This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care. Methods We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted. Results Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3–4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3–4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions. Conclusions When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.

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