It is estimated that around 4.5 sport-related concussions occur per 10,000 athlete exposures in college athletics each year (Zuckerman et al., 2015). Sport-related concussions are associated with deficits in numerous domains of cognition as well as increased symptom reporting on postconcussion symptom scales. This said, research also shows that co-occurring depression and anxiety negatively affect cognitive performance and are associated with increased symptom reporting at baseline (i.e., prior to a concussive event). Therefore, it is possible that the presence of co-occurring depression and anxiety may have a significant secondary influence on cognitive performance and symptom reporting, which may skew neuropsychological interpretations and may complicate return-to-play (RTP) decisions. As such, it is important that the magnitude and the ways in which secondary factors, such as co-occurring depression and anxiety, affect athletes and their neuropsychological test performance be understood so that these factors may be better accounted for in concussion management.
A study recently published in Translational Issues in Psychological Scienceopens in new window compared athletes with affective comorbidity (i.e., co-occurring depression and anxiety) at baseline with athletes without mood disturbance who had experienced concussion. This approach allowed the researchers to directly compare the effects of affective disturbance with the effects of concussion to better understand whether the neuropsychological profiles of these groups differ.
One hundred nineteen athletes (27% of them women) participated in this study. Athletes were separated into two groups on the basis of their depression and anxiety scores and the time point of testing (i.e., baseline or postconcussion). For the first group, athletes were included if they reported elevated symptoms of depression and anxiety at baseline (n = 61). For the second group, athletes were included if they denied experiencing elevated affective symptomatology postconcussion (n = 58). Groups were compared on measures of neurocognitive performance as well as symptom reporting using the Post-Concussion Symptom Scale.
The researchers found that athletes reporting co-occurring depression and anxiety at baseline performed comparably to athletes who recently sustained a concussion, as there were no group differences in cognitive performance. However, athletes in the baseline affective comorbidity group reported greater overall symptomatology on the Post-Concussion Symptom Scale compared with athletes who had recently sustained a concussion.
These findings highlight the nonspecificity of common concussion symptoms, which can make it difficult to discern whether symptoms are related to concussion, affective disturbance, or something else entirely. Further, the results show that co-occurring depression and anxiety can have neurocognitive effects similar to those of concussion in terms of performance on testing. As such, it is important to screen for depression and anxiety in college athletes and to account for affective factors in concussion management, especially when making RTP decisions. If these effects are unaccounted for, athletes may inadvertently be cleared to RTP too quickly or held out of play too long, and both scenarios could have negative consequences.
Overall, these results highlight the magnitude of the effects that depression and anxiety can have on college athletes. This work is important for advancing individualized approaches to concussion management. Although serial testing (i.e., baseline testing followed by future postconcussion assessments) has limitations, these results suggest that athletes with preexisting conditions that may be comorbid with concussion, such as depression and anxiety, should complete baseline testing to have more accurate data for future comparisons should they sustain a concussion while participating in their sport. Athletes should be routinely screened for depression and anxiety during preseason evaluations so that appropriate recommendations and referrals may be provided and, ultimately, the best evidence-based RTP decisions made.
This article is in the Basic/Experimental Psychology topic area. View more articles in the Basic/Experimental Psychology topic area.