Symptomatic and Functional Recovery Following Concussion in Adolescents With and Without a History of Psychiatric Disorder
Kiersten Mangold1, Jacob Kay2, Alexander Wagner2, Jeffrey Holloway2, R. Davis Moore1
1Department of Exercise Science, University of South Carolina, 2Department of Pediatrics, Prisma Health Children's Hospital
Objective:
Our study aimed to examine whether symptomatic and functional recovery post-concussion varies between adolescents with and without a history of psychiatric disorder.
Background:
Pre-existing comorbidities can exacerbate impairments following concussion. Psychiatric disorders are associated with emotional symptoms and altered cognition, and similar outcomes are frequently observed post-concussion. Thus, it is possible that a history of psychiatric disorder may be associated with poorer concussion outcomes.
Design/Methods:
We conducted a retrospective analysis of data from a pediatric concussion clinic. Adolescents who had sustained a concussion completed initial (~2 weeks) and follow-up (~5 weeks) post-injury assessments. Assessments included questionnaires regarding concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire—RPQ), depressive symptoms (Beck Depression Inventory-Youth—BDI), parent-reported executive function (Behavior Rating Inventory of Executive Function—BRIEF), and a modified CogState testing battery. Groups were categorized as adolescents with a parent-reported history of psychiatric disorder (PD+; n = 13) and those reporting no history (PD-; n = 26).
Results:
The PD+ group reported greater severity of RPQ—somatic, RPQ—emotional, and BDI symptoms across timepoints and had poorer BRIEF—behavioral regulation scores at follow-up (p’s < .05). Compared to PD-, the PD+ group also had greater improvements in accuracy on a two-back working memory task from initial to follow-up evaluations, with higher accuracy at follow-up specifically (p’s < .05).
Conclusions:
Adolescents with a history of psychiatric disorder exhibit more severe concussive and depressive symptoms and poorer behavioral regulation post-concussion than adolescents with no such history. They also display greater increase in working memory accuracy over time; however, this may be attributable to poorer initial performance and a larger subsequent improvement by follow-up. These findings demonstrate a discrepancy between adolescent behavior and parent observations, highlighting the importance of acknowledging psychiatric comorbidities in concussion recovery and incorporating the perspective of both parent and child.