Baseline Concussion Symptom Reporting As A Possible Screening Method For Generalized Anxiety Disorder

Abstract

Athletes with previous diagnosis of a psychiatric condition, such as depression or anxiety, have been shown to experience a larger overall concussion symptom score compared to those without a previous psychiatric treatment. Anxiety rates in college students is high (42%) with student-athletes only slightly lower (37%) compared to the general the population (18%). PURPOSE: The purpose of this study was to compare concussion-related anxiety symptoms and validated anxiety disorder screeners to see if baseline concussion symptoms could be used as a screening tool for follow-up mental health assessments. METHODS: 254 club level collegiate student-athletes (18.2±1.4yrs, 150 female, 104 male) completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) including the 22-item Post-Concussion Symptom Scale (PCSS), the Patient Reported Outcome Measurement Information System (PROMIS-29), and the Depression Anxiety Stress Scales (DASS-21). DSM-5 Anxiety symptoms were compared to the PCSS symptoms and an anxiety-related concussion symptom score was calculated. These along with the anxiety sub-scales for both the DASS-21 and PROMIS-29 were used for analysis. RESULTS: Participants were divided into 4 anxiety level groups based on norms from the DASS-21 (normal=36; mild=76; moderate=87; severe=28). There was a significant correlation (p<0.001) between Anxiety Cluster PCSS symptom score and DASS-21 anxiety subscale (r=.41) and PROMIS-29 Anxiety Sub-score (r=.44). The DASS-21 and PROMIS-29 were also significantly correlated (r=.64, p<0.001). There were significant group differences across the 4 DASS-21 anxiety levels for Anxiety Symptom Cluster (F(4, 226)=9.27, p<0.001) and the PROMIS-29 Anxiety subscale (F(4,223)=31.01, p<0.001). CONCLUSIONS: The significance from this data shows that the proposed symptom clusters that potentially pertain to anxiety symptoms are meaningfully related to higher scores on the DASS-21 and the PROMIS-29 anxiety related questions. Participants that demonstrated a higher overall concussion-related anxiety symptom score were more likely to exhibit more severe levels of anxiety suggesting that this cluster score could potentially screen individuals at risk for anxiety disorders thus providing a pathway to refer and provide resources and support.