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. 2022 Sep 19;10(9):23259671221123581.
doi: 10.1177/23259671221123581. eCollection 2022 Sep.

Association of Preexisting Mental Health Conditions With Increased Initial Symptom Count and Severity Score on SCAT5 When Assessing Concussion

Kathryn J Schulze  1 , Michael Robinson  2 , Heather M MacKenzie  3   4 , James P Dickey  1
Affiliations

Association of Preexisting Mental Health Conditions With Increased Initial Symptom Count and Severity Score on SCAT5 When Assessing Concussion

Kathryn J Schulze et al. Orthop J Sports Med. .

Abstract

Background: Mental health conditions, such as depression, anxiety, and learning disabilities, are associated with symptoms that can overlap with those seen in persons with concussion. While concussion screening tools such as the Sport Concussion Assessment Tool-5th Edition (SCAT5) quantify the number of symptoms and symptom severity, it is not known whether these outcomes differ among individuals with concurrent mental health conditions compared with those without them.

Purpose: To determine whether, during initial concussion assessment, individuals with a self-reported mental health condition have a significantly different number of self-reported concussion symptoms or symptom severity compared with those without a self-reported mental health condition (controls).

Study design: Cohort study; Level of evidence, 3.

Methods: A retrospective chart review was performed on consecutive patients aged ≥13 years who underwent post-concussion assessment at the Fowler Kennedy Sport Medicine Clinic between May 2018 and March 2020 (N = 765). Most participants did not self-report a mental health condition (n = 606; 79.2%). Participants with a self-reported mental health condition (n = 159) were classified as having a learning disability (n = 14; 8.8%), anxiety (n = 62; 39.0%), depression (n = 20; 12.6%), or multiple conditions (≥2 conditions: n = 63; 39.6%). Each participant with a mental health condition was matched with 2 control participants (overall pool, n = 318) based on age, sex, student status, and sport-related risk. Mann-Whitney U tests were used to determine the statistical significance of differences between each subgroup and their matched controls for the self-reported number of concussion symptoms and symptom severity as measured using the SCAT5.

Results: The anxiety and multiple-conditions subgroups had a significantly greater number of reported symptoms than their corresponding control subgroups (median, 17 vs 15 [P = .004] and 18 vs 14.5 [P < .001], respectively). Additionally, the SCAT5 symptom severity score was significantly greater in the anxiety and multiple-conditions subgroups than their corresponding controls (median, 49 vs 34.5 [P = .018] and 62 vs 32 [P < .001], respectively).

Conclusion: During initial concussion assessment, both the number of concussion-related symptoms and the symptom severity were greater in study participants with anxiety and multiple mental health conditions than participants without these conditions.

Keywords: SCAT5; anxiety; depression; head injury/concussion.

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Conflict of interest statement

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram illustrating the grouping of participants.
Figure 2.
Figure 2.
Box-and-whisker plots illustrating (A) Sport Concussion Assessment Tool–5th Edition (SCAT5) symptom severity scores and (B) number of SCAT5 symptoms for the mental health condition subgroups and their corresponding control subgroups. The bars illustrate the medians, the boxes illustrate the interquartile range (IQR), the whiskers extend 1.5 times the length of the IQR, and the triangles illustrate outliers.
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References

    1. Ali A, Caplan PJ, Fagnant R. Gender stereotypes in diagnostic criteria. In: Chrisler JC, McCreary DR, eds. Handbook of Gender Research in Psychology. Springer New York; 2010:91–109. doi:10.1007/978-1-4419-1465
    1. Alpert JE, Maddocks A, Nierenberg AA, et al. Attention deficit hyperactivity disorder in childhood among adults with major depression. Psychiatry Res. 1996;62(3):213–219. doi:10.1016/0165-1781(96)02912-5 - PubMed
    1. Alsalaheen B, Li Y, Almeida A, et al. Factor structure for the Sport Concussion Assessment Tool Symptom Scale in adolescents after concussion. Clin J Sport Med. 2022;32(4):400–407. - PubMed
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013. doi:10.1176/appi.books.9780890425596
    1. Anderson M, Petit KM, Bretzin AC, Elbin RJ, Stephenson KL, Covassin T. Sport Concussion Assessment Tool Symptom Inventory: healthy and acute postconcussion symptom factor structures. J Athl Train. 2020;55(10):1046–1053. doi:10.4085/1062-6050-393-19 - PMC - PubMed

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