Increased number and severity of concussion symptoms related to preexisting mental health conditions

By Henry Petrini. This article was initially published in our Concussion Update newsletter; please consider subscribing.

A study published in the Orthopaedic Journal of Sports Medicine found that self-reported preexisting mental health conditions were associated with a higher number and severity of concussion-related symptoms as identified in an initial SCAT5 concussion assessment (Sport Concussion Assessment Tool-5th Edition). Kathryn J Schulze et al. found that self-reported preexisting anxiety or multiple mental health conditions–but not depression or learning disability–were associated with increased number and severity of concussion symptoms.

Schulze et al. performed a retrospective chart review of 765 patients (age ≥13 years) who were given a post-concussion assessment at a sports medicine clinic over a two-year period. The researchers identified 159 participants with self-reported preexisting mental health conditions–classified as learning disabilities, depression, anxiety, or multiple conditions; each of these participants was matched with two control participants. Participants younger than 13 were excluded from the study due to differences in SCAT5 application for young and older people. Participants screened with SCAT5 that played sports were classified into groups depending on the relative safety of their sport with respect to the likelihood of concussion or mTBI (mild traumatic brain injury). 

Participants who self-reported preexisting conditions for anxiety or multiple mental health conditions had significantly higher symptom severity scores and numbers of symptoms than the control group. However, the authors observe no significant differences in symptom count or severity compared to controls for participants with preexisting depression or learning disability.

The study was limited by not including a control group with non-concussed participants, which would allow the authors to compare concussed and non-concussed participants with mental health conditions. Additionally, physician confirmation of preexisting mental health conditions, as opposed to solely self-reported conditions, would give a participant pool whose symptoms are more supported by clinical evidence. 

The study argues that comprehensive medical histories should be taken of each patient before SCAT5 assessment to account for higher symptom count and severity. It also contends that normative data (standard data compared to the majority of SCAT5 takers to gauge symptom count and severity) should be used with caution with people with preexisting mental health conditions.