Adolescent Sadness/hopelessness Is Associated With Substance/illicit Drug Use, But Not Concussion History

PURPOSE: Historical rates of adolescent depression during the COVID-19 pandemic has initiated investigation into potential contributors to poor youth mental health. Incidence of concussion is independently associated with adolescent reporting of anxiety and depression, though additional confounding factors (e.g., substance use/abuse) are important to consider. METHODS: A nationally representative Adolescent Behaviors and Experiences (ABES) Survey was administered to US high school students in 2020. Students self-reported for the previous year experiences of sadness and/or hopelessness, diagnosed concussion, substance use, and illicit drug use (Table). We tested univariable associations between sadness/hopelessness (outcome) and concussion history (predictor) and constructed a multivariable regression with concussion history, substance use, and illicit drug use as predictors. RESULTS: 7,181 high school-aged students (53% female) completed the survey. Sadness/hopelessness prevalence among US high school students was 44% (95% Confidence Interval [CI]: 41.6-46.8%) and rate of concussion was 9% (CI: 8.2-10.7%) in the prior year. In univariable analysis, concussion history was associated with self-reported sadness/hopelessness (OR: 1.3, CI: 1.1-1.5).Associations between concussion history and sadness/hopelessness were closer to the null (OR: 1.1, CI: 0.9-1.4) when adjusted for substance use/abuse (OR: 2.8, CI: 2.3-3.3), illicit drug use (OR: 2.5, CI: 2.0-3.1), and other relevant covariates (age, sex, etc.). CONCLUSION: Nearly half (44%) of high school students reported feeling sad/hopeless. Having sustained a concussion in the past year was independently associated with increased odds of feeling sad/hopeless. However, after adjusting for covariates, concussion incidence was no longer a significant predictor and substance/illicit drug use emerged as potentially more substantial contributors to adolescent sadness/hopelessness