Long-term neurobehavioral and mental health outcomes in young athletes following sport-related concussion: the role of initial symptom severity

OBJECTIVE: To examine whether initial concussion symptom severity predicts long-term neurobehavioral, anxiety, and depressive symptoms in adolescents with sport-related concussion (SRC). METHODS: This cross-sectional study surveyed athletes treated for SRC between 2010 and 2017 who completed follow-up at least 5 years post-injury. Initial concussion data were obtained via chart review. Primary outcomes included the Neurobehavioral Symptom Inventory (NSI), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Multivariable regression analyzed whether initial Post-Concussion Symptom Scale (PCSS) scores predicted long-term outcomes. RESULTS: = 0.009). However, these associations should be interpreted in light of the small sample size, potential selection bias, and the absence of pre-injury baseline symptom data. CONCLUSIONS: Initial concussion symptom burden and amnesia at injury were associated with elevated neurobehavioral, depressive, and anxiety symptoms approximately 8.5 years post-concussion. These preliminary findings suggest that early symptom severity may be relevant to long-term prognosis, though the causal mechanism remains unclear: the small sample, potential selection bias, and absence of baseline data limit the strength of these conclusions.