Background:

There is growing awareness and clinical interest in athletes with affective symptoms after sport-related concussion (SRC), as these symptoms may contribute to overall symptoms and represent a modifiable risk factor of longer recovery. However, evidence of their effects on the entire return-to-play (RTP) trajectory, particularly among women and men, is limited.

Purpose/Hypothesis:

To examine the relationship between affective symptom reporting and RTP progression after SRC among a cohort of Division 1 student-athletes. We hypothesized that those endorsing affective symptoms, specifically nervous-anxious symptoms, spend more time in RTP progression and recovery.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Using SRC data from the Ivy League–Big Ten Epidemiology of Concussion Study among varsity athletes through February 2020, we identified the 4 affective symptoms from the Sport Concussion Assessment Tool symptom inventory. We modeled the relationship between a 4-category affective symptom variable and time to symptom resolution, RTP, and RTP progression, adjusting for nonaffective symptom prevalence and concussion history. Cox regressions were used to estimate hazard ratios for time to event outcomes, and linear regressions were used to evaluate mean differences for continuous outcomes.

Results:

Among 2077 student-athletes (men, 63.5%) with SRC symptoms, affective symptom prevalence was 47.6% and 44.3% in women and men, respectively, and nervous-anxious prevalence was 24.2% and 22.5%, respectively. When comparing women with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with affective symptoms, and women with nervous-anxious symptoms spent significantly longer in RTP progression. When comparing men with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with co-occurring affective symptoms, and affective symptoms were not associated with time in RTP progression.

Conclusion:

Student-athletes with affective symptoms and nervous-anxious symptoms exhibited delayed clinical recovery and RTP timelines, particularly for time in RTP. Symptom prevalence and concussion history contributed to this; however, unmeasured confounding remains, as indicated by the poor model fit. This study motivates future work to explore affective symptoms and RTP timelines, considering anxiety and risk/protective factors over time.

中文翻译：

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报告的情感症状和焦虑在运动相关脑震荡后恢复轨迹中的作用

背景：

人们对运动相关脑震荡 (SRC) 后出现情感症状的运动员的认识和临床兴趣越来越高，因为这些症状可能会导致整体症状，并代表一个可改变的延长恢复时间的风险因素。然而，它们对整个重返赛场 (RTP) 轨迹的影响的证据，特别是在女性和男性中，是有限的。

目的/假设：

在一组 1 级学生运动员中检查 SRC 后情感症状报告与 RTP 进展之间的关系。我们假设那些支持情感症状，特别是神经焦虑症状的人，在 RTP 进展和恢复上花费了更多时间。

学习规划：

队列研究；证据水平，3。

方法：

我们使用来自常春藤联盟的 SRC 数据——截至 2020 年 2 月在校运动员中进行的脑震荡十大流行病学研究，我们从运动脑震荡评估工具症状清单中确定了 4 种情感症状。我们模拟了 4 类情感症状变量与症状消退时间、RTP 和 RTP 进展之间的关系，并根据非情感症状患病率和脑震荡史进行了调整。Cox 回归用于估计时间到事件结果的风险比，线性回归用于评估连续结果的平均差异。

结果：

在有 SRC 症状的 2077 名学生运动员（男性，63.5%）中，女性和男性的情感症状患病率分别为 47.6% 和 44.3%，神经焦虑患病率分别为 24.2% 和 22.5%。在比较有和没有同时发生情感症状的女性时，有情感症状的女性症状缓解率和 RTP 显着降低，而有神经焦虑症状的女性在 RTP 进展中花费的时间明显更长。在比较有和没有同时发生情感症状的男性时，同时发生情感症状的男性症状缓解率和 RTP 显着降低，并且情感症状与 RTP 进展时间无关。

结论：

有情感症状和神经焦虑症状的学生运动员表现出延迟的临床恢复和 RTP 时间表，尤其是在 RTP 中的时间。症状患病率和脑震荡史促成了这一点；然而，如模型拟合不佳所表明的那样，仍然存在无法测量的混杂因素。这项研究激发了未来探索情感症状和 RTP 时间表的工作，同时考虑到焦虑和风险/保护因素。