Objective To examine relationship between pre-injury somatization and post-injury mental health on concussion recovery among adolescents.

Design Retrospective chart review.

Setting Multi-disciplinary sport concussion program.

Participants 153 patients (M = 78, F = 75), ages 12–18 years (M = 14.69, SD= 1.71) diagnosed with sport-related concussion (SRC) between May 2017 and March 2019.

Interventions/Assessment Patients completed the Post-Concussion Symptom Scale (PCSS), Somatic Symptom Scale (SSS-8), Generalized Anxiety Disorder (GAD-7), and Patient Health Questionnaire (PHQ-9) within two weeks of sustaining SRC. Patient demographics, injury characteristics and medical history were gathered at intake.

Outcome Measures Recovery was qualified as within expectations (<28 days) or protracted (≥ 28 days), measured from day of injury until meeting international criteria for return to play.

Main Results 37.9% of participants met criteria for protracted recovery. Female sex, concussion history, and elevated PCSS, SSS-8, PHQ-9, and GAD-7 scores were all independently correlated with protracted recovery (p < 0.05). Controlling for sex, concussion history, and PCSS, mental health scores did not have a significant main effect on protracted recovery. Anxiety significantly moderated the relationship between somatization and protracted recovery (p < 0.05). High pre-injury somatization and high post-injury anxiety were associated with decreased likelihood of protracted recovery. High pre-injury somatization and low post-injury anxiety were associated with increased likelihood of protracted recovery. For those who endorsed low pre-injury somatization, likelihood of protracted recovery increased as post-injury anxiety increased.

Conclusions Elevated levels of pre-injury somatization may be a protective factor for patients who experience elevated anxiety after SRC.