Objective Determine post-concussive affective symptoms among university student-athletes in the context of the COVID-19 pandemic.

Design Ivy League−Big Ten Epidemiology of Concussion Study surveillance and prospective cohort study. Student-athletes consent and enroll.

Setting 19 universities; two athletic conferences in the United States, years 2017/18–2021/22.

Participants Women, men varsity/club-sport athletes (age: med=20[IQR:19,21years]) with concussion reporting ≥1symptom(s) via the SCAT symptom inventory.

Assessment of Risk Factors Affective symptom domain (emotional, irritability, sadness, nervous-anxious), academic year (pre-[2017–19]/during-[2020–22]COVID-19 pandemic), gender (women/men), setting (sport-related concussion[SRC]/non-SRC), contact-level (contact/non-contact).

Outcome Measures Prevalence of affective symptoms pre-/during-pandemic.

Main Results Among 1,563 concussions (women, n=738[47.3%]; SRC, n=1,306[83.3%]; contact, n=1,085[69.4%]), women had median=12(IQR:8,17) total symptoms, men, median=11(IQR:7,16). The four affective symptoms were strongly correlated (women, α=0.82; men, α=0.85). Over five years, 50% athletes endorsed affective symptoms; highest prevalence during 2020–21 academic year (59.1%). Affective symptom prevalence differed by gender (χ2=23.26, p<0.001), SRC/non-SRC (χ2=14.71, p<0.001), contact-level (χ2=4.50, p=0.03). Among women, proportion of athletes reporting affective symptoms was slightly higher after the COVID-19 pandemic began (59.9% vs 55.9%), not significantly (χ2=0.83, p=0.36). Athletes most commonly endorsed the nervous-anxious symptom with other affective symptoms (25.0%).

Conclusions Post-concussive affective symptom prevalence differed by gender, SRC/non-SRC, contact-level, but not pre-/during-COVID-19, suggesting management could remain the same. Previously, we observed affective symptoms association with persistent clinical recovery; this relationship during the pandemic remains unclear and will be investigated here.