Risk Factors Associated with the Development of Depression Following Sport-related Concussion

This is the authors' abstract. We don't add key points for this paper.

Introduction: Repeated concussive episodes are correlated with many sequelae, including psychiatric conditions. Reports have examined the association between concussion and the development of major depressive disorder (MDD). However, no reports have evaluated patient-specific factors and post-concussion symptoms correlated with the development of MDD following a sports-related concussion (SRC). Aims and Objectives: this study examined and reported the association of patient-specific factors and post-concussion symptoms with depression following sports-related concussions. Study Design: Retrospective Review. Setting: Institutional. Materials and Methods: A retrospective review identified all patients presenting for sports-related concussion between 2012 and 2014. Patients were included if they completed a Patient Health Questionnaire (PHQ-9). Statistics: Continuous and categorical variables were assessed using Student's ttest and chi-squared test, respectively. Logistic regression analysis was conducted to assess the effect of patient-specific factors and post-concussive symptoms on the development of MDD. Results: Out of 194 patients identified (mean age= 21.2 years), 86 met criteria for a diagnosis of MDD. The MDD cohort comprised of 64.0% women and 36.0% men, whereas the without MDD consisted of 71.3% women and 28.7% men (p=0.276). Patients with MDD were significantly older than patients without MDD (24.9 vs. 17.8 years, p<0.001). MDD was significantly higher after SRC among patients 18 years or older compared to patients under the age of 18 (56.9 vs. 36.9%, p=0.007). There was no demonstrable difference in time to presentation between patients that developed MDD and those that did not (43.9 vs. 41.9 days, p=0.864). There was no difference in race for patients that developed MDD (p=0.748). With regard to sport, there were no differences found between any of the different sports played at the time of sport-related concussion (p=0.973). Additionally, no significant difference was detected in cognitive disturbance (p=0.942). Irritability (50.4 vs. 49.6%, p=0.012) and sleep disturbances (52.2 vs. 47.8%, p=0.001) after sustaining SRC were significantly higher among patients that developed MDD. Fatigue was not significantly different in patients with MDD after SRC (p=0.163). After adjusting for confounders, logistic regression analysis demonstrated that patients 18 years old were associated with 2.12 times higher odds of developing MDD (adjusted Odds Ratio [aOR]=2.118, p=0.023) after suffering sports-related concussions. Patients with sleep disturbances after sustaining SRC had 2.57 times higher odds of developing MDD (aOR=2.568, p=0.009). Patients who experienced irritability following SRC had 1.98 higher odds of developing MDD; however, this trended towards statistical significance (p=0.054). Race (p=0.893), sex (p=0.601), sport (lacrosse: p=0.679; football: p=0.327; others: p=0.798), cognitive disturbance (p=0.884) and fatigue (p=0.392) were not independent predictors for the development of MDD after SRC. Conclusion: Our findings indicate that patients over the age of 18 and patients who experienced sleep disturbances after sustaining a SRC have a higher likelihood of developing MDD. These findings are vital in helping providers and patients recognize the early signs and symptoms in the development of depression, while it can be promptly treated to prevent further progression.