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Cited by 51Traumatic Brain Injury ResearchLong-Term Effects of COVID-19Posttraumatic Stress Disorder Research

Depressive Symptoms in Individuals With Persistent Postconcussion Symptoms: A Systematic Review and Meta-Analysis

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Lambert, Maude, Sheldrake, Elena, Deneault, Audrey-Ann, Wheeler, Anne, Burke, Matthew, Scratch, Shannon·2022·JAMA Network Open
DOI 10.1001/jamanetworkopen.2022.48453PMC PMC9857135
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Abstract

Importance: Approximately 15% to 30% of individuals with a history of concussion present with persistent postconcussion symptoms (PPCS). Individuals with PPCS are at greater risk of experiencing depressive symptoms. Objective: To synthesize the association between depressive symptoms and PPCS in children, adolescents, and adults via meta-analysis and to investigate potential moderators of that association. Data Sources: Systematic search of Ovid Medline, CINAHL, PsycInfo, and Embase from 1995 to January 2022 was performed. Additionally, references from included studies were hand-searched to ensure relevant articles were captured in the search. Study Selection: Studies that involved participants who experienced PPCS and quantified depressive symptoms were included. The definition of PPCS was limited to physician-diagnosed or self-reported concussion, with symptoms lasting for a minimum of 4 weeks postinjury. Two authors independently screened all articles to determine study eligibility. Data Extraction and Synthesis: Study characteristics were extracted independently by 2 trained investigators. Study data were meta-analyzed using a random-effects meta-analysis. Exposure: PPCS. Main Outcomes and Measures: The the primary outcome was depressive symptoms. Results: Data were extracted from 18 studies with a total of 9101 participants. Of the 18 studies, all were cohort studies, and 13 (72%) comprised adult populations. The mean (SD) time since concussion was 21.3 (18.7) weeks. After accounting for potential publication bias, the random-effects meta-analysis found a significant positive association between PPCS and depressive symptoms, (odds ratio, 4.56; 95% CI, 2.82-7.37; P < .001). There were no significant moderators, likely due to the small number of studies included. Conclusions and Relevance: In this meta-analysis, experiencing PPCS was associated with a higher risk of experiencing depressive symptoms. There are several important clinical and health policy implications of the findings. Most notably, the development of strategies for effective prevention and earlier intervention to optimize mental health recovery following a concussion should be supported.

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  • A recent review reported prevalence rates of depression and anxiety in adults with PPCS of 44% and 24%, respectively.

    “a recent review reported prevalence rates of depression and anxiety in adults with PPCS of 44% and 24%, respectively.”

    From Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study (2025) · cites this paper as [25]

    The Results (Meta-Analytical Results) report an association between PPCS and depressive symptoms, not prevalence rates. The Methods (Study Selection) say studies measuring anxiety without depression were excluded. Searches for the claimed 44% depression and 24% anxiety rates found neither estimate in our copy. (LLM, conf=0.76)

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1 of the 62 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [13]Marshall S, Bayley M, McCullagh S,. Guideline for concussion/mild traumatic brain injury and persistent symptoms: 3rd Edition (for Adults 18+ Years of Age). Ontario Neurotrauma Foundation; 2018.

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Authors
Lambert, M., Sheldrake, E., Deneault, A.-A., Wheeler, A., Burke, M., & Scratch, S.
Affiliations
  • University of Ottawa (CA)
  • University of Toronto (CA)
  • University of Calgary (CA)
  • Sunnybrook Health Science Centre (CA)
Corresponding author
Scratch, Shannon
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2022-12-27
Volume
5
Issue
12
Pages
e2248453
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2022.48453
PMC
PMC9857135
OpenAlex
W4313257186
Cited by
51
References
62
Citations by year
2026: 14 · 2025: 21 · 2024: 11 · 2023: 5
FWCI
1.47
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Keywords
depressive symptoms, concussion, mood disorders, mental health recovery, children and adolescents, adults, risk factors
MeSH terms
Adolescent, Adult, Brain Concussion, Child, Depression, Humans, Cohort Studies, Post-Concussion Syndrome

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