Anxiety Is Associated With Diverse Physical and Cognitive Symptoms in Youth Presenting to a Multidisciplinary Concussion Clinic

Introduction: Pre-injury and post-injury anxiety are prevalent and important to consider in the medical management of concussions in youth. We examined the association between anxiety and other physical, cognitive, and emotional symptoms in injured adolescents and young adults undergoing an initial...

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Bibliographic Details
Main Authors: Cook, N.E (Author), Greenberg, J. (Author), Iverson, G.L (Author)
Format: Article
Language:English
Published: Frontiers Media S.A. 2022
Subjects:
Online Access:View Fulltext in Publisher
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245 1 0 |a Anxiety Is Associated With Diverse Physical and Cognitive Symptoms in Youth Presenting to a Multidisciplinary Concussion Clinic 
260 0 |b Frontiers Media S.A.  |c 2022 
856 |z View Fulltext in Publisher  |u https://doi.org/10.3389/fneur.2021.811462 
520 3 |a Introduction: Pre-injury and post-injury anxiety are prevalent and important to consider in the medical management of concussions in youth. We examined the association between anxiety and other physical, cognitive, and emotional symptoms in injured adolescents and young adults undergoing an initial evaluation in a specialty concussion clinic. Methods: Participants were 158 adolescents and young adults presenting to a multidisciplinary concussion clinic for evaluation and treatment (54.4% girls and women; mean age = 17.3 years; SD = 2.9). Their median days post injury was 29 (interquartile range = 14–49; range = 7–349). They were divided into binary groups based on whether they had a pre-injury history of anxiety diagnosis or treatment and whether they were experiencing current anxiety in the week prior to the evaluation, and then compared on the Post-Concussion Symptom Scale. Results: Youth with a pre-injury history of anxiety reported greater post-concussion symptoms (Md total score = 36.0, IQR = 21.5–53.0) compared to youth with no pre-injury history of anxiety (Md total score = 20.5, IQR = 6.0–36.0; MW U = 1,520.00 p = 0.001, r = 0.26, small-medium effect size). They reported significantly worse headaches, nausea, balance difficulty, dizziness, vision problems, fatigue, concentration difficulty, irritability, nervousness, sadness, feeling more emotional, trouble falling asleep, and sleeping more than usual. Youth with high post-injury anxiety reported greater post-concussion symptoms (Md total score = 55.0, IQR = 33.0–62.5) compared to youth with low post-injury anxiety (Md total score = 19.0, IQR = 6.0–35.0; MW U = 681.00, p < 0.001, r = 0.49, large effect size). They reported significantly worse headaches, nausea, vomiting, dizziness, vision problems, fatigue, sensitivity to light, feeling mentally foggy, feeling slowed down, concentration difficulty, memory difficulty, irritability, sadness, feeling more emotional, drowsiness, trouble falling asleep, sleeping less than usual, and sleeping more than usual. Logistic regressions revealed that both pre-injury and post-injury anxiety were strong predictors of persistent post-concussion symptoms, with high post-injury anxiety presenting the strongest independent predictor, while attention-deficit hyperactivity disorder and pre-injury migraines were not significant predictors. Essentially all adolescents with high post-injury anxiety (97.1%) and nearly 9 of 10 adolescents with pre-injury treatment for anxiety (87.8%) met criteria for persistent post-concussion symptoms. Discussion: Pre-injury and post-injury anxiety are important risk factors for greater post-concussion symptoms among adolescents and young adults. Elevated post-injury anxiety was the strongest predictor of persistent post-concussion symptoms. Assessment of anxiety is important among adolescents presenting for concussion care and delivery of evidence-supported treatments for anxiety are important considerations for treatment planning for these youth. Copyright © 2022 Iverson, Greenberg and Cook. 
650 0 4 |a adolescent 
650 0 4 |a adolescents 
650 0 4 |a anxiety 
650 0 4 |a anxiety disorder 
650 0 4 |a Article 
650 0 4 |a attention deficit hyperactivity disorder 
650 0 4 |a balance impairment 
650 0 4 |a clouding of consciousness 
650 0 4 |a cognitive defect 
650 0 4 |a cohort analysis 
650 0 4 |a concussion 
650 0 4 |a controlled study 
650 0 4 |a disease association 
650 0 4 |a dizziness 
650 0 4 |a drowsiness 
650 0 4 |a effect size 
650 0 4 |a emotional disorder 
650 0 4 |a fatigue 
650 0 4 |a female 
650 0 4 |a head injury 
650 0 4 |a headache 
650 0 4 |a health care facility 
650 0 4 |a human 
650 0 4 |a ICD-10 
650 0 4 |a irritability 
650 0 4 |a major clinical study 
650 0 4 |a male 
650 0 4 |a medical assessment 
650 0 4 |a medical history 
650 0 4 |a memory disorder 
650 0 4 |a nausea 
650 0 4 |a nervousness 
650 0 4 |a patient participation 
650 0 4 |a physical disease 
650 0 4 |a postconcussion syndrome 
650 0 4 |a prediction 
650 0 4 |a retrospective study 
650 0 4 |a sadness 
650 0 4 |a sleep disorder 
650 0 4 |a sports 
650 0 4 |a traumatic brain injury 
650 0 4 |a visual disorder 
650 0 4 |a vomiting 
700 1 0 |a Cook, N.E.  |e author 
700 1 0 |a Greenberg, J.  |e author 
700 1 0 |a Iverson, G.L.  |e author 
773 |t Frontiers in Neurology