Longitudinal trajectories of post-concussive and depressive symptoms in adolescents with prolonged recovery from concussion.
Elizabeth Stein, Waylon Howard, Ali Rowhani-Rahbar and 3 others
PMID 29115868WHAT IT FOUND
Adolescents with persistent concussion symptoms and depression had lower symptom scores over six months.
Higher concussion scores predicted faster depression improvement. Initial depression did not predict faster concussion improvement. The two symptom sets changed together.
Key findings
01Post-concussive symptom scores and depressive symptom scores both decreased over the study period.
02Decreases in post-concussive symptoms were strongly related to decreases in depressive symptoms.
03Higher post-concussive symptom scores at enrollment predicted greater decrease in depressive symptoms over time, while initial depressive symptoms did not predict change in post-concussive symptoms.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The sample was small, with 49 adolescents, and the analysis was a secondary report from a randomized trial rather than a direct test of the intervention. Participants were treatment-seeking adolescents recruited from rehabilitation and sports medicine clinics, so the observed decline may partly reflect receiving care rather than natural recovery. The study was not powered to examine results separately for collaborative care and usual care groups. Time since injury at enrollment was not standardized, so participants were not all at the same point in recovery. The depression questionnaire includes sleep, fatigue, and concentration items that also appear in the concussion symptom inventory, so the two scores may partly overlap. The study cannot determine whether depression causes persistent post-concussive symptoms or whether treating depression improves post-concussive symptoms. The sample was 65.3% female and 64.6% white, so the trajectories may not represent all adolescents with prolonged concussion recovery.
Declared interests
The authors reported no potential conflicts of interest to disclose. The supplied text does not state a funding source.
The easy way to misread this
Do not read the six-month improvement as proof that collaborative care or depression treatment caused it. This was a secondary analysis of a small treatment-seeking sample, and the paper did not test which treatment components produced the decline.