Concussions in youth sports comprise an estimated 1.6–3.8 million annual injuries in the US. Sex, age, and attention-deficit hyperactivity disorder (ADHD) have been identified as salient risk factors for concussion. This study seeks to evaluate the role of premorbid depression or anxiety (DA), with or without antidepressant use, on the incidence of concussion and the recovery of symptoms and neurocognitive dysfunction after concussion.

Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) was administered to 7453 youth athletes at baseline. Throughout the season, concussions were examined by physicians and athletic trainers, followed by readministration of ImPACT postinjury (PI) and again at follow-up, a median of 7 days PI. Individuals were divided into three categories: 1) unmedicated athletes with DA (DA-only, n = 315), athletes taking antidepressants (DA-meds, n = 81), and those without DA or antidepressant use (non-DA, n = 7039). Concussion incidence was calculated as the total number of concussions per total number of patient-years. The recovery of neurocognitive measures PI was calculated as standardized deviations from baseline to PI and then follow-up in the 5 composite ImPACT scores: symptom score, verbal memory, visual memory, visual motor skills, and reaction time. Univariate results were confirmed with multivariate analysis.

There was no difference in concussion incidence between the DA-only cohort and the non-DA group. However, the DA-meds group had a significantly greater incidence of concussion than both the DA-only group (OR 2.67, 95% CI 1.88–7.18, p = 0.0001) and the non-DA group (OR 2.19, 95% CI 1.16–4.12, p = 0.02). Deviation from baseline in PI symptom scores was greater among the DA-meds group as compared to the non-DA group (OR 1.14, 95% CI 1.01–1.28, p = 0.03). At follow-up, the deviation from baseline in symptom scores remained elevated among the DA-meds group as compared to the non-DA group (OR 1.62, 95% CI 1.20–2.20, p = 0.002) and the DA-only group (OR 1.87, 95% CI 1.12–3.10, p = 0.02). Deviation from baseline in follow-up verbal memory was also greater among the DA-meds group as compared to both the non-DA group (OR 1.57, 95% CI 1.08–2.27, p = 0.02) and the DA-only group (OR 1.66, 95% CI 1.03–2.69, p = 0.04).

Premorbid DA itself does not seem to affect the incidence of concussion or the recovery of symptoms and neurocognitive dysfunction PI. However, antidepressant use for DA is associated with 1) increased concussion incidence and 2) elevated symptom scores and verbal memory scores up to 7 days after concussion, suggesting impaired symptomatic and neurocognitive recovery on ImPACT.

在美国，青少年运动中的脑震荡估计每年有 1.6-380 万人受伤。性别、年龄和注意力缺陷多动障碍 (ADHD) 已被确定为脑震荡的显着危险因素。本研究旨在评估使用或不使用抗抑郁药的病前抑郁或焦虑 (DA) 对脑震荡发生率以及脑震荡后症状和神经认知功能障碍的恢复的作用。

在基线时对 7453 名青年运动员进行了即时脑震荡后评估和认知测试 (ImPACT)。在整个赛季中，医生和运动教练对脑震荡进行了检查，随后再次接受了 ImPACT 伤后 (PI)，并再次进行了随访，平均 PI 为 7 天。个人分为三类：1）未服用药物的 DA 运动员（仅 DA，n = 315），服用抗抑郁药的运动员（DA-meds，n = 81），以及未服用 DA 或抗抑郁药的运动员（非 DA，n = 7039）。脑震荡发生率计算为每患者年总数的脑震荡总数。神经认知测量 PI 的恢复计算为从基线到 PI 的标准化偏差，然后在 5 个复合 ImPACT 评分中进行随访：症状评分、语言记忆、视觉记忆、视觉运动技能、和反应时间。单变量结果通过多变量分析得到证实。

仅 DA 组和非 DA 组之间的脑震荡发生率没有差异。然而，DA-meds 组的脑震荡发生率显着高于仅 DA 组（OR 2.67，95% CI 1.88–7.18，p = 0.0001）和非 DA 组（OR 2.19，95% CI 1.16） –4.12，p = 0.02）。与非 DA 组相比，DA 药物组的 PI 症状评分偏离基线更大（OR 1.14，95% CI 1.01–1.28，p = 0.03）。在随访中，与非 DA 组（OR 1.62，95% CI 1.20–2.20，p = 0.002）和仅 DA 组（ OR 1.87, 95% CI 1.12–3.10, p = 0.02)。与非 DA 组相比，DA 药物组的随访言语记忆与基线的偏差也更大（OR 1.57，95% CI 1.08-2.27，p = 0.

病前 DA 本身似乎不影响脑震荡的发生率或症状的恢复和神经认知功能障碍 PI。然而，DA 抗抑郁药的使用与 1) 脑震荡发生率增加和 2) 脑震荡后长达 7 天的症状评分和语言记忆评分升高有关，这表明 ImPACT 的症状和神经认知恢复受损。