The path from trait anxiety to post-concussion symptoms and posttraumatic stress symptoms in children with mTBI: the moderating role of alexithymia

Post-concussion symptoms (PCS) and posttraumatic stress symptoms (PTSS) are common after mild traumatic brain injuries (mTBI) in children. Psychological factors, especially pre-injury trait anxiety, are associated with the development of PCS and PTSS. However, the underlying mechanisms are understudied. The current study aimed to explore whether alexithymia (difficulty in identifying and describing emotions) moderates the associations between children's pre-injury trait anxiety and PCS, as well as PTSS in bothchildren and parents following mTBI. Participants were 53 children aged 8-16 with mTBI and their parents, recruited from the Emergency Department. Immediate mTBI symptoms were assessed by the Emergency Department physician within 24 hours post-injury. One-week post-injury, acute PTSS (children and parents), children's pre-injury trait anxiety, and alexithymia were measured using self-reported questionnaires. PCS were measured by symptom reports (including a baseline; reported by parents) and neuropsychological tests assessing cognitive functioning, including performance validity tests. PCS and cognitive functioning were assessed one-week and four-month post-injury. We found that alexithymia significantly moderated the associations between children's pre-injury trait anxiety and both PCS and PTSS in children and parents at one-week post-injury. Higher levels of alexithymia strengthened these associations. Alexithymia was found significantly associated with PCS at four-month post-injury. However, alexithymia did not moderate the association between pre-injury trait anxiety and PCS at four-month post-injury or cognitive functioning at one-week or four months. In conclusion, pre-injury trait anxiety and alexithymia are crucial in mTBI outcomes, being associated with PCS and PTSS development. Therefore, addressing emotional factors is important in TBI recovery.