Persistent postconcussion symptoms tied to depressive symptom risk

By Rebecca Jenkins

People who are experiencing a prolonged recovery from concussion are at an increased risk of depressive symptoms, a systematic review and meta-analysis finds.

Approximately 15 to 30% of people with a history of concussion experience persistent postconcussion symptoms (PPCS), the study authors wrote in JAMA Network Open.

Symptoms varied but could include headaches, fatigue, dizziness, cognitive difficulties, and emotional changes.

Throughout the past decade, the association between PPCS and mental health outcomes had also emerged as an area of interest, with multiple studies finding bidirectional associations between depressive symptoms and PPCS, the authors wrote.

In their systematic review and meta-analysis of 18 studies and 9101 participants, the authors found the odds of depressive symptoms were increased fourfold among people who experienced PPCS.

The meta-analysis included studies where participants had experienced PPCS and quantified depressive symptoms, with PPCS symptoms lasting for a minimum of four weeks.

All included studies were cohort studies, mainly comprising adult populations, with a mean time since concussion of 21.3 weeks.

‘There are several important clinical and health policy implications of the findings,’ the authors concluded.

‘Most notably, the development of strategies for effective prevention and earlier intervention to optimize mental health recovery following a concussion should be supported.’

They noted that although the study highlighted the strong association between PPCS and postinjury depressive symptoms, it did not answer the question about the directionality of the association.

‘Longitudinal studies are essential to gain further insight into temporal patterns and directionality of the association,’ they wrote.

Professor Jennie Ponsford, Director of the Monash Epworth Rehabilitation Research Centre, Melbourne, said the study confirmed other research showing depressive symptoms were often associated with mild traumatic brain injury, adding that the association was ‘very much bidirectional’.

‘The most common predictor of PPCS is a history of mental health problems – so individuals with a history of depression or anxiety are more likely to develop PPCS and depression,’ she told Medicine Today.

Professor Ponsford agreed with the authors that there was a lack of guidelines to direct management of depressive symptoms following concussion.

‘There are limited guidelines available for managing PPCS including but not just confined to depression,’ she said. ‘There is a need to recognise the multiple factors associated with PPCS including mental health issues.’

JAMA Netw Open 2022; doi: 10.1001/jamanetworkopen.2022.48453.