Pre- and post-concussion anxiety both contribute to risk of more intense and persistent symptoms

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

A study by Grant Iverson et al. found connections between pre-injury anxiety, post-injury anxiety, and persistent post-concussion symptoms. Dr. William Barr (NYU Langone Health) notably tweeted about the study, commenting: “assessment of anxiety is important among adolescents presenting for concussion care and delivery of evidence-supported treatments for anxiety are important considerations for treatment planning for these youth.” 

This study, published in Frontiers in Neurology, included 158 young adults treated at a multidisciplinary concussion clinic at a median of 29 days post-injury (range 7-349 days). Investigators ran various tests on the data regarding pre-injury and post-injury anxiety. Researchers accounted for numerous confounding variables, including gender and a history of migraine, depression, and ADHD.

Investigators found that almost all (97%) patients with post-injury anxiety experienced more intense physical, cognitive, and emotional symptoms and met the criteria for persistent post-concussion symptoms. A large majority (87%) of patients treated for anxiety before the injury also showed persistent post-concussion symptoms. 

Limitations of this study consist of strictly self-reported data, a lack of details regarding pre-injury anxiety, and limitations due to the information recorded at the time of injury and during recovery—which was before Iverson et al. used this data for the study. Further research could account for these limitations through symptom validity and response bias measures. The implications of this study can provide a context in which providers can offer better care for concussion recovery patients who had pre-injury or have post-injury anxiety.