Influence Of Pre-existing Anxiety On Symptom Severity And Recovery Time After Adolescent Concussion

PURPOSE: Anxiety symptoms are common after adolescent concussion. Pre-existing anxiety diagnosis may exacerbate acute post-concussion anxiety symptoms, concussion symptom severity and recovery time. We investigated associations between anxiety diagnosis history, post-concussion anxiety severity, overall concussion symptom severity, and concussion symptom resolution time. METHODS: We assessed adolescents within 21 days of a diagnosed concussion. Participants reported demographics, medical history, current anxiety symptoms via the Patient Reported Outcome Measurement Information System (PROMIS) Pediatric Global 25, and pre- and post-concussion symptom severity via the Post-Concussion Symptom Inventory (PCSI). We monitored participants through symptom resolution. We used t-tests to compare PSCI score and PROMIS anxiety scores (standardized T scores: mean = 50, standard deviation = 10) for those with and without pre-existing anxiety diagnosis. A cox proportional hazard model was used to evaluate pre-existing anxiety diagnosis, post-concussion anxiety severity, and overall symptom severity as predictors of symptom resolution time. RESULTS: We enrolled 110 participants (age = 15.3 ± 1.7 years, 55% female, 9.1 ± 3.9 days post-concussion), of which 15% (n = 17) had pre-existing anxiety diagnosis. Those with and without pre-existing anxiety diagnosis were similar in age, biological sex, and history of concussion (p > 0.05). Post-concussion anxiety PROMIS T-scores were not significantly different between those with or without pre-existing anxiety (52.5 ± 10.4 vs. 47.1 ± 11.2; p = 0.07, Cohen’s d = 0.49). PSCI score was not significantly different between groups (37.5 ± 23.9 vs. 36.5 ± 24.2; p = 0.89, Cohen’s d = 0.04). Higher post-concussion symptom severity (hazard ratio = 0.986, 95% CI = 0.972, 0.998) was significantly associated with longer symptom resolution time, but pre-concussion anxiety diagnosis and post-concussion anxiety severity were not. CONCLUSIONS: In our study, pre-existing anxiety diagnosis was not associated with post-concussion anxiety symptoms, concussion symptom severity, or symptom resolution time. Further work is needed to clarify the relationship of pre-existing anxiety diagnosis and concussion recovery. MINDSOURCE Brain Injury Network, NIH (R01HD108133), Tai Foundation, and the Children's Hospital Colorado Pilot Grant Award Program