Prevalence and risk factors for depression, anxiety and suicidal ideation in youth with persistent post-concussive symptoms (PPCS).
Sara P D Chrisman, Bridget M Whelan, Douglas F Zatzick and 5 others
PMID 34841998WHAT IT FOUND
Among youth with persistent post-concussive symptoms, 40% had significant depressive symptoms, one-quarter had significant anxiety symptoms, 14% reported thoughts of death or self-harm, and 8% thoughts of suicide; history of depression and lower sleep quality were linked to greater risk.
Key findings
01In 200 parent-adolescent dyads, 40% reported significant depressive symptoms, one-quarter reported significant anxiety symptoms, 14% reported thoughts of death or self-harm, and 8% reported thoughts of suicide.
02A history of depression was associated with greater risk for thoughts of death or self-harm (RR 3.56) and suicidal ideation (RR 6.53).
03Better sleep quality was associated with lower risk for depression, anxiety, and thoughts of death or self-harm, but not suicidal ideation.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The analysis was cross-sectional, so it cannot show whether the emotional symptoms came before or after the concussion, or whether any risk factor caused them. Participants came from outpatient sports-medicine and rehabilitation-medicine clinics in one U.S. region, and most were white and from higher-income households, so the findings may not apply to all adolescents with persistent post-concussive symptoms. Youth with acute suicidal ideation requiring intervention were excluded, so the 8% rate of thoughts of suicide may not capture the highest-risk group. Of the eligible 390, 109 passively refused and 80 actively refused, leaving 200 parent-adolescent dyads; the final sample may not represent all eligible youth. The PHQ-9 includes sleep and fatigue items, which may make the association between poor sleep and depressive symptoms harder to interpret. Race and ethnicity findings had wide confidence intervals because few participants were nonwhite or Hispanic, so the 4-5x risk estimates should be read cautiously.
Declared interests
The authors reported no potential conflict of interest. The article is labelled as supported by NIH extramural research.
The easy way to misread this
Do not conclude that concussion caused the emotional distress or that improving sleep will reduce it. These data were collected at one time point, so they show associations, not cause or effect.