Objective Pre-injury mental health problems are associated with worse clinical outcome following sport-related concussion. Greater acute symptoms, measured in the first 72 hours post injury, are also a risk factor for longer recovery. This study examines symptom reporting in acutely injured student athletes stratified by pre-injury mental health problems.

Design Cross-sectional, observational study.

Setting Adolescent student athletes from schools in Maine, USA.

Participants Pre-season baseline and post-injury data were available for 879 athletes 0–3 days following injury. Adolescents were divided into two groups: (i) no psychiatric history and (ii) self-reported history of treatment for a psychiatric disorder (n=75, 8.5%).

Assessment of Risk Factors Demographic information, health history, and pre-injury symptoms.

Outcome Measures Post-Concussion Symptom Scale (PCSS) total score and factor scores.

Main Results During preseason baseline testing, youth with a history of treatment for a psychiatric disorder endorsed a significantly greater severity of affective (Cohen’s d=0.38), cognitive (d=0.34), physical (d=0.35), and sleep-arousal (d=0.31) symptoms compared to those with no mental health history. Both groups showed a very large increase in symptom reporting following concussion for the physical (d=2.07–2.25), cognitive (d=1.99–1.69), and sleep-arousal (d=1.11–1.13) factors—and a medium increase on the affective factor for the group with no pre-injury psychiatric history (d=0.49). There was no statistically significant increase on the affective factor following concussion for the youth with a pre-injury psychiatric history.

Conclusions These results are a first step in the direction of developing more personalized precision rehabilitation for youth with a pre-injury history of mental health problems.