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CARE Consortium: How mental health and concussion history influence baseline performance

Study suggests athletes with history of concussion may be more prone to anxiety, depression

No two student-athletes are the same, so there is no reason to expect that they would all perform the same on baseline concussion tests. But what factors influence the baseline results that clinicians use to help diagnose concussions and evaluate recovery after injury? Michelle Weber, a doctoral candidate at the University of Georgia Concussion Research Laboratory, and a team of researchers examined data from the NCAA-Department of Defense Concussion Assessment, Research and Education Consortium to determine whether a history of anxiety or depression or a student-athlete’s current psychological state could affect performance on baseline concussion tests. Their results were published in the American Journal of Sports Medicine.

What did the study find?

Weber and her team examined baseline tests from 8,652 student-athletes participating in the NCAA-Department of Defense CARE Consortium study, finding that those who had suffered anxiety, depression or both reported more symptoms and heightened symptom severity at baseline. Additionally, anxiety and depression were more prevalent among student-athletes who reported a history of more concussions. That effect was particularly pronounced among athletes who reported having suffered at least four concussions. 

“This indicates that student-athletes with extensive concussion histories may need to be monitored for psychological distress,” the paper said. “Clinicians should take this into consideration when caring for student-athletes with a concussion history.”

What are the implications?

This could have an immediate impact in the clinical setting. Student-athletes who have a history of anxiety and depression may report more symptoms and manifest with greater symptom severity at baseline. Additionally, the data suggests those who are taking baseline tests while under great psychological stress are more likely to underperform.

“While baseline assessments are suggested to compare a pre-injured state to a post-injured state, concussion evaluation often occurs in the absence of baseline assessments, requiring the clinician to rely on normative data,” the authors said. “Clinicians may be holding patients to post-injury standards that they may never be able to achieve if comparing a person with anxiety, depression, or anxiety with depression to normative data.”

What’s next?

To build on this work, Weber and her co-authors encouraged future research on the prevalence and severity of psychological distress in those who had suffered multiple concussions, which could help better articulate the need for mental health monitoring and treatment among those who have experienced such injuries. Future work also could account for limitations in this study, including recording or accounting for medication use for anxiety or depression at the time of the baseline tests.