A Longitudinal Pilot Study of Depressive Symptoms in Concussed and Injured/Nonconcussed National Collegiate Athletic Association Division I Student-Athletes

CONTEXT: Depression, which affects millions of Americans each year, among them collegiate student-athletes, can be caused by a wide range of circumstances, including sport-related injuries. OBJECTIVE: To longitudinally examine the extent to which National Collegiate Athletic Association Division I student-athletes demonstrated postinjury depressive symptoms. DESIGN: Descriptive epidemiologic study. SETTING: National Collegiate Athletic Association Division I collegiate athletics. PATIENTS OR OTHER PARTICIPANTS: Concussed, injured/nonconcussed, and healthy Division I collegiate student-athletes (aged 18-22 years) competing in men's basketball, football, and wrestling and women's basketball, soccer, and volleyball. MAIN OUTCOME MEASURE(S): Participants completed the Center for Epidemiologic Studies Depression Scale at baseline and at 1 week, 1 month, and 3 months postinjury. We measured differences in depressive scores among concussed, injured/nonconcussed, and healthy participants. Longitudinal changes in postconcussion depressive symptoms were also examined. RESULTS: No differences in baseline depressive symptoms among subgroups were noted. After an increase between baseline and 1 week (4.3, 95% confidence interval [CI] = 0.41, 8.16, P = .02), depressive symptoms in the concussion group decreased between 1 week and 1 month (-2.7, 95% CI = -4.96, -0.47, P = .01) and between 1 week and 3 months (-4.0, 95% CI = -6.50, -1.49, P = .004). The injured/nonconcussed group showed differences between baseline and 1 week (4.6, 95% CI = 1.08, 8.17, P = .009) and between baseline and 1 month (3.2, 95% CI = -0.05, 6.30, P = .03). No significant differences were present in depressive symptoms between concussed participants and injured/nonconcussed participants at any of the postinjury time points. CONCLUSIONS: Depression may present as a postinjury sequela in Division I collegiate athletes. Athletes who sustain a concussion or other injury resulting in time lost from practice or competition need to be observed carefully for signs and symptoms that may indicate depression. Tools such as the Center for Epidemiologic Studies Depression Scale can be valuable in helping clinicians to recognize and manage depressive symptoms in these individuals.