Sawlani, Sabrina P.Goldman, Joshua T.Babikian, TalinMcArthur, David L.Polster, DouglasMcCrea, MichaelMcAllister, ThomasGiza, Christopher C.CARE ConsortiumCARE Consortium InvestigatorsOrtega, Justus D.Port, NicholasPutukian, MargotMcDevitt, JaneGiza, Christopher C.Goldman, Joshua T.Benjamin, Holly J.Buckley, ThomasKaminski, Thomas W.Clugston, James R.Feigenbaum, Luis A.Eckner, James T.Mihalik, Jason P.Anderson, ScottMaster, Christina L.Kontos, Anthony P.Chrisman, Sara P. O.Cameron, KennethDuma, StefanMiles, Christopher M.2024-12-122024-12-122024-06-04Sawlani SP, Goldman JT, Babikian T, et al. Association of Premorbid Anxiety and Depression Symptoms in Concussion Recovery in Collegiate Student-Athletes. Sports Health. Published online June 4, 2024. doi:10.1177/19417381241255308https://hdl.handle.net/1805/44978Background: Mental health disorders are linked to prolonged concussion symptoms. However, the association of premorbid anxiety/depression symptoms with postconcussion return-to-play timelines and total symptom burden is unclear. Objective: To examine the association of self-reported premorbid anxiety/depression symptoms in collegiate student-athletes with (1) recovery times until asymptomatic, (2) return-to-play, and (3) postconcussion symptom burden. Study design: Athletes in the Concussion Assessment, Research and Education Consortium completed baseline concussion assessments (Sport Concussion Assessment Tool [SCAT3] and Brief Symptom Inventory-18 [BSI-18]). Athletes were tested postinjury at <6 hours, 24 to 48 hours, time of asymptomatic and start of return-to-play protocol, unrestricted return-to-play, and 6 months after injury. Injured athletes were categorized into 4 groups based on BSI-18 scores: (1) B-ANX, elevated anxiety symptoms only; (2) B-DEP, elevated depression symptoms only; (3) B-ANX&DEP, elevated anxiety and depression symptoms; and (4) B-NEITHER, no elevated anxiety or depression symptoms. Relationship between age, sex, BSI-18 group, SCAT3 total symptom and severity scores, and time to asymptomatic status and return-to-play was assessed with Pearson's chi-squared test and robust analysis of variance. Level of evidence: Level 3. Results: Among 1329 athletes with 1352 concussions, no respondents had a self-reported premorbid diagnosis of anxiety/depression. There was no difference in time until asymptomatic or time until return-to-play between BSI-18 groups (P = 0.15 and P = 0.11, respectively). B-ANX, B-DEP, and B-ANX&DEP groups did not have higher total symptom or severity scores postinjury compared with the B-NEITHER group. Conclusion: Baseline anxiety/depression symptoms in collegiate student-athletes without a mental health diagnosis are not associated with longer recovery times until asymptomatic, longer time to return-to-play, or higher postconcussion total symptom and severity scores compared with athletes without baseline symptoms. Clinical relevance: Anxiety and depression symptoms without a clear mental health diagnosis should be considered differently from other comorbidities when discussing prolonged recovery in collegiate student-athletes.en-USPublisher PolicyAnxietyConcussionDepressionMental healthArticle