Brain InjuriesTraumatic Brain InjuryDepressive Symptoms In Individuals With Persistent Postconcussion Symptoms: A Systematic Review And Meta-analysis

April 28, 20230

Concussion, or mild traumatic brain injury (mTBI), can cause symptoms that persist for months or even years, which is referred to as persistent postconcussion symptoms (PPCS). PPCS can have a significant impact on an individual’s daily functioning and mental health. While there have been several studies on the association between PPCS and mental health outcomes, the strength and robustness of that had not been conducted.

Researchers recently conducted a systematic review and meta-analysis to investigate the association between PPCS and depressive symptoms. They searched multiple databases for articles published since 1995, focusing on studies measuring depressive symptoms using a validated measure of depression. After screening the articles, they included 18 studies in their meta-analysis. They assessed the strength of the association between PPCS and depressive symptoms, investigated potential moderators of the association, and examined publication bias and heterogeneity between studies.

  • The meta-analysis showed a significant positive association and a large effect size between PPCS and post-injury depressive symptoms.
  • The most frequently used questionnaires to assess PPCS was the Rivermead Post-Concussion Symptoms Questionnaire, and the most frequently used questionnaires to assess depressive symptoms were the Patient Health Questionnaire and the Beck Depression Inventory-II.
  • There was high heterogeneity between studies, but the researchers found the studies to be low quality primarily due to the use of self-reported measures and the lack of randomized control trials.
  • The analysis failed to identify significant moderators.

The researchers recommended the inclusion of health care professionals with strong clinical training in mental health conditions in specialized concussion care programs. The study also highlighted the need for additional studies on the management of post-concussion mental health difficulties, given the strong association between concussion and negative long-term outcomes such as suicidality. To date, research has been limited by heterogeneity in the methods used to study PPCS, inconsistency across studies, and the lack of understanding about the directionality of the relationship between PPCS and depressive symptoms.

Lambert M, Sheldrake E, Deneault A, Wheeler A, Burke M, Scratch S. Depressive Symptoms in Individuals With Persistent Postconcussion Symptoms: A Systematic Review and Meta-Analysis. JAMA Network Open. (2022).