Anxiety, Depression, and Quality of Life: A Long-Term Follow-up Study of Patients with Persisting Concussion Symptoms.
2020
Persisting concussion symptoms (PCS) can last for months, years, or indefinitely and affect a considerable number of concussion patients. The objectives of this study were to evaluate the prevalence of clinical symptoms of anxiety and depression and the relationship between PCS and quality of life in patients examined at the Canadian Concussion Centre. The Depression and Anxiety Stress Scale (DASS-42) and the WHO Quality of Life Assessment (WHOQOL-Bref) were sent to 526 adult patients diagnosed with PCS. The median with interquartile range (IQR) follow-up time was 5 (4-7) years. Of the 105 respondents, 35.2% displayed mild or greater symptoms of anxiety, depression or both. Importantly, the number of previous concussions was correlated with elevations on the DASS-42 Anxiety (p=0.030) and Depression (p=0.018) sub-scale scores, suggesting an acquired cause of symptoms. Patients with clinical elevations of depression, anxiety, or both exhibited poorer mean WHOQOL-Bref scores in each domain (p<0.001) compared to those who scored in the normal range on the DASS-42. These findings indicate that, depression and anxiety in PCS can endure for years and are associated with diminished quality of life. Consequently, depression and anxiety should be identified and treated early in PCS populations in order to optimize recovery. While the underlying etiology of depression and anxiety cannot be ascertained with certainty in the present study, the association between depression and anxiety and the number of concussions may indicate an organic explanation. In the future, quality of life measures should be incorporated into the treatment and research in PCS to improve intervention strategies and enhance understanding of the trajectory of recovery in this population.
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