Objective Investigate association of history of depression and emotional symptoms at time of initial evaluation with symptoms of post-traumatic stress reported during recovery from a sport-related concussion (SRC) in adolescent athletes.

Design Prospective longitudinal.

Setting Four North Texas concussion clinics.

Participants Athletes aged 13–18 (N=129; Female 64, Male 65) who sustained an SRC within one month of initial evaluation.

Interventions (or Assessment of Risk Factors) History of treatment for depression, Patient Health Questionnaire-8 (PHQ-8), and Sport Concussion Assessment Tool-5 (SCAT-5) emotional symptoms (More Emotional, Irritability, Sadness, and Nervous or Anxious) at initial visit. Return to normal physical activity at three-month follow-up.

Outcome Measures Three-month follow-up score of PTSD Checklist for DSM-5 (PCL-5).

Main Results A multiple regression model predicting participants’ total three-month follow-up PCL-5 score (R²=0.516, p<0.001) included history of treatment for depression (β=0.253, p< 0.001), higher initial PHQ-8 scores (β=0.423, p< 0.001), and greater severity of initial SCAT-5 emotional symptoms (β=0.287, p< 0.001).

Independent sample t-tests indicated participants who had not returned to normal physical activity by three-month follow-up had higher PCL-5 scores (n=18, M=6.38, SD=3.13) than those who had returned (n=111, M=1.55, SD=2.47, 95% CI: 2.52–6.48, p=0.001).

Conclusions History of treatment for depression and higher level of emotional symptoms at time of initial evaluation appear associated with greater symptoms of post-traumatic stress in concussed adolescents. Concussed individuals who did not return to normal physical activity also endorsed higher levels of post-traumatic stress. Consideration of initial SCAT-5 emotional symptoms by clinicians may be important in effectively addressing symptoms of post-traumatic stress during concussion recovery.