Predictors and prevalence of postconcussion depression symptoms in collegiate athletes

Context: Depression is common after concussion and is associated with functional outcome and quality of life after injury. However, few baseline predictors of postconcussion depressive symptoms (PCDS) have been found. Objective: To describe the prevalence of depressive symptoms in a collegiate athlete sample at baseline and postconcussion, compare these levels of symptoms and change in symptoms with those of a control group with no reported concussions in the past year, and examine the baseline predictors for PCDS. Design: Case-control study. Setting: Undergraduate institution. Patients or Other Participants: Participants were 84 collegiate athletes (65 men, 19 women) with concussion and 42 individuals (23 men, 21 women) with no history of recent concussion who served as controls. Main Outcome Measure(s): The Beck Depression Inventory-Fast Screen was administered to the concussion group at baseline and postconcussion and to the control group at 2 time points. Results: Seventeen athletes (20%) showed a reliable increase in depression, and more athletes reported clinically important depression postconcussion than at baseline. Only 2 participants (5%) in the control group showed a reliable increase in depression. Concussed athletes were more likely to show a reliable increase in depression symptoms than control participants (χ² 1 = 5.2, P = .02). We also found several predictors of PCDS in the athletes, including baseline depression symptoms (r = 0.37, P < .001), baseline postconcussion symptoms (r = 0.25, P = .03), estimated premorbid intelligence (full-scale IQ; r = -0.29, P = .009), and age of first participation in organized sport (r = 0.34, P = .002). For the control group, predictors of depression symptoms at time 2 were number of previous head injuries (r = 0.31, P = .05) and baseline depression symptoms (r = 0.80, P < .001). Conclusions: A large proportion of athletes showed a reliable increase in depression after concussion, and we identified several baseline predictors. Given that depression affects quality of life and recovery from concussion, more research is necessary to better understand why certain athletes show an increase in PCDS and how these can be better predicted and prevented.