Poster #63 - Associations Between Post-Concussive Symptom Severity/Chronicity, Mental Health Status, and Participation in Intervention Services

• In Event: Poster Session 12

Abstract

The presence of mental health problems prior to concussion confers risk for prolonged recovery and worse outcomes following injury (Iverson et al., 2020). Further, children and adolescents who have sustained a concussion are at a higher risk for new onset mental health problems following concussion (Ledoux et al., 2022). A range of physical (e.g., fatigue, headaches, vision changes), cognitive (e.g., slowed processing speed, difficulties sustaining attention and holding information in mind), and emotional symptoms (e.g., irritability, lability, sadness, anxiety) are commonly endorsed following concussion. Interdisciplinary concussion clinics involving clinical interview with child and parent, physical and neuro examination, and brief neuropsychological screening can help parse apart overlapping symptoms to best identify key areas for intervention and rehabilitation efforts, as needed. Given the high incidence of anxiety and depression symptoms pre- and post- injury in pediatric concussion populations, the screening of symptoms during joint clinic visits can facilitate access to mental health services by means of psychoeducation during clinic visits and referrals placed to mental health providers for ongoing psychotherapy.

Among a sample of children and adolescents who were seen in an outpatient mild traumatic brain injury (mTBI)/ concussion program, the current study proposes to examine rates of pre-injury mental health problems, current participation in therapy services, and number of new referrals placed for therapy services. Associations between post-concussive symptom severity/chronicity and participation in intervention services will be investigated. Data collection began in June of 2017 and remains active, with a current sample size of 947 (see Table 1 for preliminary descriptives). Eligibility criteria included: 1) evaluated for a mTBI (GCS ≥ 13) and 2) 5 through 17 years of age. Families self-reported on child/adolescent pre-injury mental health diagnoses, history of therapy, and current therapy status. Children/adolescents self-reported on their experience of physical, cognitive, emotional, and fatigue symptoms at baseline as well as at the time of visit 1 and visit 2 using the Post-Concussive Symptom Inventory (Sandy, Vaughan, & Gioia, 2014). Controlling for endorsement of symptoms at baseline and time since injury, children/adolescents with a pre-injury history of mental health problems are expected to report more severe and chronic post-concussive symptoms compared to those without a pre-injury history of mental health problems. Using a subset of the sample who were not cleared at visit 1 and scheduled to return for a follow-up visit, intervention status at time of visit 1 (e.g., active therapy participation) is hypothesized to be associated with greater reduction in post-concussive symptomatology from visit 1 to visit 2.

Initial descriptive analyses indicate a prevalence rate of 20.7% for anxiety and 10.8% for depression among the current sample. National rates of anxiety and depression among children 3-17 are estimated to be 9.4% and 4.4%, respectively (CDC; Bitsko et al., 2022), highlighting the comparatively higher rate of pre-injury mental health problems in the current sample. Advancing our understanding of effective assessment, prevention, and intervention of mental health status is essential to concussion recovery.

Authors

• Laura K. Winstone-Weide, University of Texas at Austin
  Presenting Author

• Cynthia A. Austin, University of Texas at Austin Dell Medical School

• Kelly Gettig, Dell Children's Medical Center

• Kimberly Mooney, Dell Children's Medical Center