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. 2024 Sep 18;38(11):869-879.
doi: 10.1080/02699052.2024.2347552. Epub 2024 May 10.

Effects of mTBI with loss of consciousness on neurobehavioral symptoms, depression, and insomnia in former collegiate and NFL football athletes

Sarah Laskowitz  1 , C Lexi Baird  1 , Ashley Huggins  2 , Nino Nadareishvili  3 , Jessica Bride  3 , H Ryan Wagner  4 , Melvin Briggs  1 , Rajendra A Morey  4 , Robert W Turner  5
Affiliations

Effects of mTBI with loss of consciousness on neurobehavioral symptoms, depression, and insomnia in former collegiate and NFL football athletes

Sarah Laskowitz et al. Brain Inj. .

Abstract

Objective: Considering that diagnostic decisions about mTBI are often predicated on clinical symptom criteria, it is imperative to determine which initial presentation features of mTBI have prognostic significance for identifying those at high risk for long-term functional impairment.

Setting: Zoom interview Participants: Male, former NCAA Division I, and professional-level National Football League (NFL) athletes (n = 177) between the ages of 27 and 85 (M = 54.1, SD = 14.7).

Design: Cross-sectional case-control. Main Measures: History of mild TBI, history of loss of consciousness (LOC), depression symptoms, insomnia, neurobehavioral symptoms.

Results: Number of mTBI exposures did not predict neurobehavioral symptoms (B = 0.21, SE = 0.18, p = 0.23), but number of mTBI + LOC events did (B = 2.27, SE = 0.64, p = <.001). Further analysis revealed that the number of mTBI + LOC events predicted neurobehavioral symptoms indirectly through both depression (B = 0.85, 95% CI = [0.27, 1.52) and insomnia (B = 0.81, 95% CI = [0.3, 1.4]). Further, the direct effect of mTBI + LOC events on neurobehavioral symptoms became non-significant when depression and insomnia were added to the model (B = 0.78, SE = 0.45, p = 0.08).

Conclusions: Findings support LOC at time of injury as an important predictor of long-term outcomes. Additionally, results suggest depression and insomnia as potential mediators in the association between mTBI + LOC and neurobehavioral symptoms. These findings provide justification for early depression and insomnia symptom monitoring following mTBI + LOC.

Keywords: American Football; Mild traumatic brain injury; depression; insomnia; loss of consciousness; neurobehavioral symptoms.

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Figures

Figure 1.
Figure 1.
mTBI+LOC significantly predicts total neurobehavioral symptoms indirectly through depression (B = 0.85, 95% CI= [0.27, 1.52) and insomnia (B= 0.81, 95% CI = [0.3, 1.4]).
Figure 2.
Figure 2.
mTBI+LOC significantly predicts affective symptoms indirectly through depression (B = 0.39, 95% CI= [0.15, 0.65]) and insomnia (B=0.44, 95% CI = [0.17, 0.71]).
Figure 3.
Figure 3.
mTBI+LOC significantly predicts somatic/sensory symptoms indirectly through insomnia (B = 0.25, 95% CI= [0.06, 0.49]), but not depression (B= 0.12, 95% CI = [−0.04, 0.34]).
Figure 4.
Figure 4.
mTBI+LOC significantly predicts cognitive symptoms, indirectly through depression (B = 0.33, 95% CI= [0.09, 0.65]) and insomnia (B= 0.13, 95% CI = [0.04, 0.25]).
See this image and copyright information in PMC

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