- Greater initial symptom burden predicted higher long-term neurobehavioural and depressive symptoms approximately 8.5 years after sport-related concussion.
- Post-injury amnesia independently predicted increased anxiety symptoms at follow-up, indicating specific acute features carry prognostic value.
- Findings are preliminary and limited by small sample size, potential selection bias, and absence of pre-injury baseline symptom data.
Brain Inj. 2026 May 21:1-8. doi: 10.1080/02699052.2026.2675398. Online ahead of print.
ABSTRACT
OBJECTIVE: To examine whether initial concussion symptom severity predicts long-term neurobehavioral, anxiety, and depressive symptoms in adolescents with sport-related concussion (SRC).
METHODS: This cross-sectional study surveyed athletes treated for SRC between 2010 and 2017 who completed follow-up at least 5 years post-injury. Initial concussion data were obtained via chart review. Primary outcomes included the Neurobehavioral Symptom Inventory (NSI), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Multivariable regression analyzed whether initial Post-Concussion Symptom Scale (PCSS) scores predicted long-term outcomes.
RESULTS: The cohort included 76 participants (current age 24.1 ± 2.5 years; 8.5 ± 1.5 years follow-up). At follow-up, 26.3% and 30.3% had clinically significant depressive (PHQ-9 ≥ 10) and anxiety (GAD-7 ≥ 10) symptoms, respectively. Amnesia at injury was associated with higher NSI (U = 612.0, p = 0.040) and GAD-7 (U = 554.0, p = 0.003). In multivariable regressions, higher initial PCSS at the time of injury was significantly associated with greater neurobehavioral (B = 0.227, p = 0.015) and depression symptoms (B = 0.083, p = 0.017). Amnesia after an initial injury independently predicted worse anxiety symptoms (B = 4.087, p = 0.009). However, these associations should be interpreted in light of the small sample size, potential selection bias, and the absence of pre-injury baseline symptom data.
CONCLUSIONS: Initial concussion symptom burden and amnesia at injury were associated with elevated neurobehavioral, depressive, and anxiety symptoms approximately 8.5 years post-concussion. These preliminary findings suggest that early symptom severity may be relevant to long-term prognosis, though the causal mechanism remains unclear: the small sample, potential selection bias, and absence of baseline data limit the strength of these conclusions.
PMID:42165680 | DOI:10.1080/02699052.2026.2675398
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