Mood Disorders Linked to Lingering Concussion Effect in Kids

Neil Osterweil

October 24, 2014

BOSTON — After a sports-related concussion, preteens and adolescents with a personal or family history of mood disorders appear to be at significantly greater risk than their peers for post-concussion syndrome (PCS), investigators say.

Results of a retrospective study comparing characteristics of student athletes who sustained concussions with symptoms lasting for at least 3 months with those of athletes who recovered within 3 weeks suggest a 17-fold increase in risk for chronic symptoms among athletes with preinjury anxiety or depression, reported Scott L. Zuckerman, MD, a neurologic surgery resident at Vanderbilt University Medical Center in Nashville, Tennessee.

The investigators also found that a family history of mood disorders and delayed onset of symptoms (hours after the original injury) were also associated with elevated risk for PCS.

"Our results highlight the importance of concussion history and behavioral psychiatric history. Probably the most important point from our study is our new finding of a family history," Dr Zuckerman said here at the Congress of Neurological Surgeons (CNS) 2014 annual meeting.

Case-Control Study

Although healthy young brains are generally plastic and recover well from a mild concussion, an estimated 10% to 15% will go on to develop PCS. The syndrome is characterized by one or more nonspecific symptoms, such as headache, dizziness, fatigue, irritability, sleep disturbances, problems with memory or concentration, and mood disorders.

The authors conducted a retrospective case-control study to identify risk factors for PCS among patients in a pediatric, sports-related concussion group. They identified 40 patients with PCS (mean age, 14.9 years) and paired each one with two age- and sex-matched controls with documented recovery from concussion within 2 weeks of the original injury.

They assessed potential predictive factors within four areas:

  • Demographic variables;

  • Medical, psychiatric, and family histories;

  • Acute postinjury phase (0 to 24 hours); and

  • Subacute postinjury phase (0 to 2 weeks).

The analysis also looked at symptom clusters within somatic, cognitive, sleep, and emotional domains.

When they compared the groups, they found that the PCS group had more previous concussions, a more extensive history of personal and family mood and psychiatric disorders, and more significant stressors (eg, parents' divorce or family death) than controls.

Groups did not differ for race, loss of consciousness, amnesia, acute or subacute symptoms, or type of sport played.

In logistic regression, significant independent predictors of PCS after sports-related concussions were previous concussion (odds ratio [OR], 1.8; P = .017), preinjury depression or anxiety (OR, 17.3; P = .003), family history of depression or anxiety (OR, 2.9; P = .045), and family history of migraine (OR, 3.9; P = .004).

As noted before, delayed symptoms were also associated with increased risk for PCS (OR not shown, expressed as Exp[β] 20.69, 95% confidence interval, 3.24 - 131.97; P = .001).

A researcher who studies sports-related concussions in young athletes but was not involved in the study tells Medscape Medical News that the findings corroborate his observations in the clinic.

"We certainly find in our concussion clinics that patients with either personal or family histories of these comorbid conditions (mood lability/disorders, migraine) and prior concussions tend to have prolonged recoveries," commented Peter K. Kriz, MD, assistant professor of clinical orthopedics and pediatrics at Brown University in Providence, Rhode Island.

An emergency medicine specialist who treats children and adolescents in the acute phase of concussions suggested in an interview that there may be a degree of self-selection among youths who have lingering symptoms of concussion.

"The neuropsychologist that I have collaborated with on my last few projects and I are both starting to think that a lot of the postconcussion syndrome that we see is probably more related to patients who have underlying issues that cause them to report their symptoms more persistently rather than the head injury itself," said Joe Grubenhoff, MD, assistant professor of pediatrics at the University of Colorado in Aurora.

He and his colleagues are analyzing data on children with pre-existing conditions, such as depression or bipolar disorder, to determine whether they report symptoms more frequently after concussion than children without those comorbidities.

"We think that kids who in general view their injury as anxiety-provoking, or who have a general tendency to somaticize, meaning that they tend to experience more physical symptoms when they are sick or injured, are more likely then to go on to have postconcussion symptoms, because that's just kind of how they're wired," he said.

The work was supported by the Vanderbilt Sports Concussion Center. Dr Zuckerman, Dr Kriz, and Dr Grubenhoff have disclosed no relevant financial relationships.

Congress of Neurological Surgeons (CNS) 2014 Annual Meeting: Abstract 114 Presented October 19, 2014.


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