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Editorial
Why psychological factors are still being sidelined in sport-related concussion treatment and what we can do about it
  1. Kate N Jochimsen1,2,
  2. Jeffrey G Caron3,4,
  3. Ana-Maria Vranceanu1,2,
  4. Jonathan Greenberg1,2
  1. 1 Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2 Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
  3. 3 School of Kinesiology and Physical Activity Sciences, Université de Montréal, Montréal, Quebec, Canada
  4. 4 Center for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Quebec, Canada
  1. Correspondence to Dr Kate N Jochimsen; kjochimsen{at}mgh.harvard.edu

https://doi.org/10.1136/bjsports-2024-108090

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    Growing research supports the central role of psychological factors, including anxiety and depression, in recovery from sport-related concussion (SRC).1 Indeed, mental health is among the most robust predictors of concussion outcomes, including SRC.1 This is reflected in the recent Consensus Statement on Concussion in Sport,2 which explicitly recommends consideration of anxiety, depression and psychological response to injury in assessment and treatment, including referrals for psychological evaluation as needed.

    However, these recommendations often fail to trickle down to clinical practice. Psychological factors remain under-addressed,3 and programmes specifically addressing psychological factors after SRC (eg, dealing with anxiety, teaching coping skills) remain scarce. In this commentary, we identify four challenges impeding the integration of psychological care into the treatment of SRC, and we propose strategies to ‘tackle’ these challenges.

    Challenge 1: the importance of assessing psychological needs following SRC

    Despite considerable support for a biopsychosocial approach in SRC assessment and treatment as well as recommendations to monitor and address anxiety and depression symptoms in concussion treatment guidelines (eg, Ontario Living Concussion Guidelines),4 the majority of SRC measures neither require robust psychological health screening nor typically include metrics to assess coping skills. The most highly recommended screening and assessment tools, including the most recent Consensus Statement on Concussion in Sport, the Sport Concussion Assessment Tool 6, the Sport Concussion Office Assessment Tool (SCOAT6), Post-Concussion Symptom Scale and the Rivermead Post Concussion Symptoms Questionnaire, are limited to a gross and non-specific assessment of psychological factors.2 5–8 The recently released SCOAT6 covers more psychological factors than previous measures, yet these are classified as ‘optional’. Despite acknowledging psychological factors, these tools and recommendations remain discordant with the mounting evidence supporting the importance and prognostic value of psychological factors in recovery from SRC.1 9 This likely results in under-identifying emotional and psychological needs important …

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    Footnotes

    • X @katejoch

    • Contributors KNJ led the conceptional design, prepared the manuscript and critically reviewed the manuscript. JG assisted with the conceptional design, manuscript preparation and critically reviewed the manuscript. JC and A-MV assisted with manuscript preparation and critically reviewed the manuscript. All authors are the guarantors, accepting full responsibility for the finished work and approving the final manuscript.

    • Funding This study was supported by National Center for Complementary and Integrative Health (K23AT01065301A1, K23AT01192201A1).

    • Competing interests KNJ and JG report funding from the NCCIH (K23AT01192201A1 and K23AT01065301A1) and JC reports funding from the Social Sciences and Humanities Research Council of Canada, Canadian Institutes of Health Research and Fonds de recherche du Québec – Société et culture and royalties/licences from Routledge.

    • Provenance and peer review Not commissioned; externally peer reviewed.