Abstract
The current study explored how affective disturbances, particularly concomitant anxiety and depressive symptoms, impact baseline symptom self-reporting on the Post-Concussion Symptoms Scale (PCSS) in college athletes. Athletes were separated into four groups (Healthy Control (HC) (n = 581), Depression Only (n = 136), Anxiety Only (n = 54), Concomitant Depression/Anxiety (n = 62)) based on their anxiety and depression scores. Groups were compared on Total PCSS Score as well as 5 PCSS Symptom Cluster scores (Cognitive, Physical, Affective, Sleep, and Headache). The three affective groups reported significantly greater symptomatology than HCs, with the Concomitant group showing the highest symptomatology scores across all clusters. The depressive symptoms only group also reported significantly elevated symptomatology, compared to HCs, on every symptom cluster except headache. The anxiety symptoms only group differed from HCs on only the cognitive symptoms cluster. Additionally, the Concomitant group reported significantly increased PCSS symptomatology, in terms of total scores and all 5 symptom clusters, compared to the depressive symptoms only and anxiety symptoms only groups. Our findings suggest that athletes experiencing concomitant depressive/anxiety symptoms report significantly greater levels of symptomatology across all 5 PCSS symptom clusters compared to HCs. Further, results suggest that athletes experiencing concomitant affective disturbance tend to report greater symptomatology than those with only one affective disturbance. These findings are important because, despite the absence of concussion, the concomitant group demonstrated significantly elevated symptomatology at baseline. Thus, future comparisons with post-concussion data should account for this increased symptomatology, as test results may be skewed by affective disturbances at baseline.
Highlights
Assessing self-reported symptomatology is an important aspect of concussion management as most clinicians will not allow athletes to return to play if they are still symptomatic, even if they are deemed “neurocognitively recovered.” For example, Arnett and colleagues (2016) laid out an empirically derived algorithm for determining neurocognitive recovery, yet progression to the steps following “recovery” is dependent upon an absence/reduction of symptoms as determined by self-report
Results revealed a significant effect of Group on Total Post-Concussion Symptoms Scale (PCSS) Score, F(3,829)= 45.38, p < .001, ηp2=.14.1 We found that, compared to Healthy Control (HC), the concomitant group reported significantly greater Total PCSS Scores, t(829)=11.25, p < .001, d = 1.02,2 as did the depressive symptoms only group, t(831)=4.58, p < .001, d =
The current paper examined the relationship between significant affective symptomatology and self-report symptomatology across 5 symptom clusters on the PCSS, as well as total number of symptoms
Summary
Assessing self-reported symptomatology is an important aspect of concussion management as most clinicians will not allow athletes to return to play if they are still symptomatic, even if they are deemed “neurocognitively recovered.” For example, Arnett and colleagues (2016) laid out an empirically derived algorithm for determining neurocognitive recovery, yet progression to the steps following “recovery” is dependent upon an absence/reduction of symptoms as determined by self-report. Iverson (2005) demonstrated that patients who were clinically diagnosed with a depressive disorder demonstrated elevated symptom reporting on the British Columbia Post-concussion Symptom Inventory such that approximately 90% of patients in this sample met “liberal self-report criteria” for post-concussion syndrome (PCS) while over 50% met conservative criteria for PCS despite not having sustained recent head injury. Snell and colleagues (2018) found that participants with chronic pain without history of mTBI reported elevated post-concussion-like symptoms scores. Taken together, these findings suggest that there are many factors other than concussion that may lead to increased scores on self-report symptom measures
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