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Mental health implications and consequences following sport-related concussion
  1. Anthony P Kontos,
  2. Jamie McAllister Deitrick,
  3. Erin Reynolds
  1. Department of Orthopaedic Surgery/UPMC Sports Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Anthony P Kontos, UPMC Center for Sports Medicine, 3200 South Water St, Pittsburgh, PA 15203, USA; akontos{at}pitt.edu

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Concussion is a heterogeneous injury involving a myriad of physical (eg, dizziness, headache), cognitive (eg, memory problems, difficulty concentrating), sleep-related and affective (eg, depression, anxiety) symptoms, and impairment (eg, cognitive, vestibular, oculomotor). Consequently, clinical researchers have advocated for a more comprehensive and targeted approach to assessing and treating sport-related concussion (SRC).1 Some athletes experience mood-related consequences including anxiety and depression following SRC.2 In the extreme, these consequences if ignored or improperly managed can lead to clinical depression, anxiety, and even suicidal ideation and intent. As such, it is important to assess mood-related changes following SRC in all athletes and to properly treat those athletes who may be experiencing more pervasive affective symptoms.

In this paper, we aim to highlight the current research on the mental health consequences of SRC and explore their implications for assessment and treatment of SRC. We also discuss potential directions for future research on mental health-related outcomes following SRC.

Current research

Affective symptoms (eg, depression, anxiety) following traumatic brain injuries including concussion are common.2 However, it is estimated that only 6% of patients experience some form of depression following the concussion.3 Recent consensus statements on SRC have called for more research exploring the emotional sequelae that may accompany SRC as well as appropriate assessment and treatment approaches.2 ,4 Researchers have indicated that affective responses, particularly depression, are common following concussion.5–9 However, it is important to note that most affective responses occur at a subclinical level that does not meet diagnostic criteria for a clinical disorder. Additionally, it is important for the clinician to be aware of any pre-existing psychological conditions that may affect the emotional responses following SRC.

Both psychosocial and neurobiological factors may help to explain affective responses following SRC. For example, individuals with clinical depression have been found …

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