Cited by 106Traumatic Brain Injury ResearchHeart Rate Variability and Autonomic ControlSports injuries and prevention

Psychological and Physiological Markers of Stress in Concussed Athletes Across Recovery Milestones

Hutchison, Michael G., Mainwaring, Lynda, Senthinathan, Arrani, Churchill, Nathan, Thomas, Scott, Richards, Doug·2017·Journal of Head Trauma Rehabilitation

Abstract

Background: Sport-related concussions are associated with a range of physical, cognitive, and behavioral disturbances that are highly variable across individuals. Much remains unknown about the effects of sport concussion, and changes in markers of psychological and physiological stress over the recovery timeline. Objective: To examine psychological (mood, stress, sleep quality, and symptoms) and physiological (heart rate variability and salivary cortisol) measures in concussed athletes over clinical recovery milestones. Setting: University athletic program, sport medicine clinic, Canada. Participants: A sample of 52 interuniversity athletes (32 male and 20 female), 26 with concussion and 26 healthy controls. Design: Case-control repeated measures study at 3 time points of the clinical recovery process. Measures were administered to a matched control sample of uninjured athletes as well. Main Measures: Physiological measures were heart rate variability and salivary cortisol; psychological measures were mood, perceived stress, and quality of sleep. Results: Psychological measures were significantly worse for concussed athletes relative to controls at the symptomatic phase (acute injury), but significantly better at return-to-play (RTP). Multivariate analysis of heart rate variability identified main effects of sex and concussion, with reduced high-frequency heart rate variability for females and concussed athletes extending into the post-RTP phase. An interaction effect was also observed, showing the cardiac response of female athletes was more sensitive to concussion compared with males. Conversely, male athletes showed greater suppression of low-frequency heart rate variability associated with mood disturbances. Conclusion: This integrated study of psychological and physiological markers in concussed athletes confirmed the resolution of mood disturbances, symptoms, and sleep quality by RTP, but identified autonomic nervous system disturbances, as measured by depressed heart rate variability beyond RTP.

Integrity signals

Registry

Crossref · 10.1097/htr.0000000000000252

Cites

57 of 57 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Sex-related differences in fMRI activity, heart rate variability, edema, and intracranial hypertension were reported even in the absence of differences in cognition, post-concussive symptoms, duration of recovery, and GOS.

    “Indeed, sex-related differences in functional magnetic resonance imaging (fMRI) activity, heart rate variability, edema, and intracranial hypertension were reported even in the absence of differences in cognition, post-concussive symptoms, duration of recovery, and GOS. 13,55,56”

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Hutchison, M. G., Mainwaring, L., Senthinathan, A., Churchill, N., Thomas, S., & Richards, D.
Affiliations
  • St. Michael's Hospital (CA)
  • University of Toronto (CA)
Venue
Journal of Head Trauma Rehabilitation
Published
2017-05
Volume
32
Issue
3
Pages
E38-E48
ISSN
0885-9701 (ISSN-L)
OpenAlex
W2513771625
Cited by
106
References
57
Citations by year
2026: 6 · 2025: 8 · 2024: 10 · 2023: 10 · 2022: 12 · 2021: 18 · 2020: 13 · 2019: 8 · 2018: 13 · 2017: 8
FWCI
9.06
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Head Trauma Rehabilitation (publishedVersion)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research (2012-ABI-CAT1-971)
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
Keywords
sports-related concussion, athletes, return to sport, heart rate variability, salivary cortisol, stress, mood disturbance, sleep quality, autonomic nervous system, sex differences
MeSH terms
Adult, Age Factors, Athletic Injuries, Brain Concussion, Canada, Female, Follow-Up Studies, Heart Rate, Humans, Hydrocortisone, Male, Neuropsychological Tests, Prognosis, Saliva, Sex Factors, Sleep Wake Disorders, Sports Medicine, Stress, Psychological, Biomarkers, Multivariate Analysis, Logistic Models, Case-Control Studies, Risk Assessment, Mood Disorders, Recovery of Function, Young Adult, Self Report

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review