Effect of co-morbid anxiety and depression history on multidomain concussion clinical outcomes and recovery time.

IMPORTANCE: Extant evidence supports a history of psychological health diagnoses, such as anxiety and depression, as risk factors associated with greater symptom burden and prolonged recovery following concussion. However, researchers have yet to examine the combined effect of co-morbid anxiety and depression history on multidomain clinical outcomes and recovery time following concussion. OBJECTIVE: To examine the effect of co-morbid anxiety and depression history on multidomain concussion clinical outcomes including concussion symptoms, cognitive and vestibular/oculomotor functioning, and recovery time. DESIGN: Secondary analysis of combined prospective cohorts from research conducted between 2019 and 2024. SETTING: Concussion specialty clinic in the Mid-Atlantic region of the United States. PARTICIPANTS: 628 patients aged 9–68 years within 0–384 days of a diagnosed concussion. EXPOSURES: Participants represented three groups: 1) no anxiety or depression history (NONE), 2) either anxiety or depression history (EITHER), or 3) anxiety and depression history (BOTH). MAIN OUTCOMES AND MEASURES: Multidomain clinical outcomes at initial clinic visit including Concussion Clinical Profile Screen (CP Screen), Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Post-Concussion Symptom Scale (PCSS), and Vestibular/Ocular Motor Screen (VOMS), as well as recovery time (i.e., days from injury to medical clearance). RESULTS: 459 (73.09%) participants were in the NONE, 100 (15.92%) in the EITHER, and 69 (10.99%) in the BOTH group. Results of ANCOVA supported significant main effect for group on CP Screen total symptom severity scores (p < .001), all CP-screen profile scores (ps < .001-.012) except sleep (p = .506), ImPACT visual memory (p = .015), and PCSS total symptoms severity (p < .001), after controlling for sex and age. Specifically, the BOTH and EITHER groups reported more total symptoms (CP Screen total, p < .001; PCSS, p < .001) and more anxiety/mood symptoms (p < .001) than the NONE group. The BOTH group reported more cognitive/fatigue, post-traumatic migraine, and cervical symptoms (ps < .001-.004) and worse visual memory than the NONE group (p = .008). The BOTH group also reported more cervical complaints than the EITHER group (p < .001). The EITHER group reported more anxiety/mood, ocular, and vestibular symptoms (ps =  < .001-.005) and performed worse on visual motor speed (p = .026) than the NONE group. The Lastly, the BOTH group (49.06 ± 5.84 days) took significantly longer to recover than the NONE group (36.43 ± 1.85 days, p = 0.04). CONCLUSIONS AND RELEVANCE: The findings support the notion that pre-existing psychological factors such as anxiety and depression influence worse concussion outcomes and recovery. However, surprisingly, there was only minimal support for an additive effect for patients having both anxiety and depression. These findings highlight the importance of screening for pre-existing anxiety and depression in patients with concussion to inform more accurate prognosis, as well as timely management and treatment strategies to mitigate adverse outcomes in these at-risk patients.