Background In youth, anxiety is the most prevalent mental illness in the US, effecting 31.9% of adolescents. During concussion assessment, athletes may experience high levels of anxiety due to concerns such as the inability to perform in their sport. While it is commonly assumed lower socioeconomic (SES) adolescents are more resilient in handling anxiety, this has not been examined.

Objective Determine the effect of anxiety on neuropsychological testing in rural low SES adolescent athletes.

Design Cross-sectional between-groups cohort design.

Setting and Participants Rural low SES adolescent athletes (n=126) were recruited prior to their competitive season to establish anxiety levels during baseline concussion assessment.

Interventions Participants were given baseline tests including computerized neuropsychological test battery (ImPACT™) and the State Trait Anxiety Inventory (STAI-Y) to determine cognitive function and levels of anxiety, respectively. Participants were divided into groups based upon STAI-Y scores. Using SPSS, one-way ANOVAs were calculated on ImPACT composite scores, using an alpha level of .05 for all tests.

Main Outcome Measurements ImPACT composite scores.

Results 7% (n=9) and 17% (n=21) endorsed high state and trait anxiety respectively. Statistically significant differences existed between state anxiety groups on composite reaction time (F_(1,124) = 6.72, p=0.011, eta squared = .03), composite impulse control F_(1,124) = 8.49, p= 0.004, eta squared = .01), and total symptoms (F_(1,124) = 7.09, p<0.001, eta squared =.01), with high state anxiety athletes performing worse and reporting more symptoms.

Conclusions Rural low SES athletes endorsed lower levels of anxiety than the general population, however those with high state anxiety endorsed more symptoms and performed worse on measures of impulsivity. This study provides initial evidence that anxiety may influence cognitive test scores in this population. Future research should examine the influence of anxiety during post-concussion assessment when stakes may be higher in this underrepresented population.