Temporal Changes in Depression and Neurocognitive Performance in Collegiate Student-Athletes: A Repeated Measures Evaluation Pre- and Post-Concussion Injury

Abstract

The study had three purposes: 1.) examine the temporal change in depression symptoms among collegiate student-athletes throughout a fall athletic season, 2.) identify the course of depression in student-athletes pre- and post-concussion injury, and 3.) examine the relationship between neurocognitive performance and depression at baseline and post-concussion injury. Depression symptoms were measured every two weeks, beginning at pre-season baseline, until the end of the athletic season using the Patient Health Questionnaire-9 (PHQ-9). The Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) exam was used to measure neurocognitive performance at baseline and post-concussion. A total of 593 (92.1%) participants were used in the depression analyses. On average, nearly a third of the athletes endorsed minimal levels of depression symptoms across the fall athletic season. Across the entire athletic season, 3.7% of student-athletes had their PHQ-9s red-flag for moderate to severe depression symptoms. Significant differences were found in depression symptoms across time, and by sex. At pre-season baseline, higher depression symptoms were significantly correlated with decreased scores on Visual Memory, Visual Motor Speed, and Total Symptom Score, and increased Reaction Time. A total of 27 concussed athletes were used in the concussion and depression analyses. No significant differences were found between depression symptoms pre-concussion and any of the post-concussion time intervals. At 1 week post-concussion, elevated depression symptoms were significantly correlated with slower Reaction Time and higher Total Symptom Scores at 1 week post-concussion, and increased Impulse Control and Total Symptom Scores at 3-5 months post-concussion. These results demonstrate the need to evaluate depression symptoms at pre-season baseline, across the athletic season, and post-concussion in collegiate student-athletes.