Depressive Symptoms in Concussed Youth Athletes: Factor Analysis of the Patient Health Questionnaire Modified for Adolescents (PHQ-A)

The presentation of depression symptoms in concussed youth athletes is not well understood. We examined the PHQ-A factor structure in concussed youth athletes. Five hundred and ninety-five youth athletes completed the PHQ-A and PCSS within 30 days of sport-related concussion. Factor analyses of the PHQ-A alone revealed a two-factor structure: cognitive-energy/sleep and emotional symptoms. When combined, only two PCSS items ("sadness," "more emotional") overlapped with PHQ-A symptoms. Over half (51.1%) of youth athletes endorsed symptoms consistent with mild-to-severe depression; athletes with preexisting anxiety or depression had a 1.6-3.2x greater likelihood of meeting depression criteria. The PHQ-A provides unique clinical information beyond standard post-concussion assessments.