Trajectory of Health-related Quality of Life Following Pediatric Concussion.

OBJECTIVES: To assess changes in health-related quality of life (HRQOL) across a 12-month period following pediatric concussion and to explore whether psychological factors (ie, pre-injury mental health history, current symptoms of anxiety and depression, sleep disturbance, or grit) were associated with HRQOL. STUDY DESIGN: Prospective cohort study design using data collected from patients presenting to a speciality care concussion program, with each patient followed for 12 months after initial presentation. Comparison data were collected from non-concussed controls recruited from the community. A total of 49 concussed patients (median=15.4 years of age) completed the Pediatric Quality of Life Inventory (PedsQL), Patient-Reported Outcome Measure Information Systems (PROMIS) Anxiety and Depressive Symptoms short forms, Pediatric Sleep Disturbance forms, and a Short Grit Scale. Mixed effects models explored change in HRQOL across time. RESULTS: Total HRQOL at initial clinic presentation was significantly lower for concussed adolescents (Peds QL Total Score mean=72 [SD=16 ]) compared with non-concussed controls (mean=88 [SD=11], p <.001). HRQOL improved in the patients with concussion over a 6-month period after initial assessment with no significant changes thereafter. Pre-injury history of anxiety (coefficient= -11.388, CI=-18.49 - -4.28, p<0.001), current depressive symptoms (coefficient= -0.317, CI= -0.62 - -0.01, p<0.01), and sleep disturbance (coefficient=-0.336, CI=-0.71 - 0.04, p<0.05) all predicted lower HRQOL. CONCLUSIONS: HRQOL is significantly lower in the acute phase of pediatric concussion and steadily improves over the following 6 months. Psychological factors are linked to lower HRQOL and may serve as important indicators of risk for poor outcome.

Mental Health in the Specialized Athlete.

PURPOSE OF REVIEW: The aim of this review is to interpret the existing evidence regarding the psychological aspects of sport specialization within the context of a developmental framework. RECENT FINDINGS: The growing trend toward early sport specialization is associated with increased risk for injury and burnout, both of which have significant implications for mental health. Mental health literacy programs designed to promote awareness, decrease stigma, and encourage help-seeking behaviors can be an effective way to increase resilience and early recognition of those in need. The trend toward early sport specialization is likely motivated in large part by the expectation that it will increase the likelihood of long-term athletic success. However, recent studies suggest that the majority of elite athletes delay specialization at least until mid to late adolescence. It is essential to consider the developmental psychology of children and adolescents and to avoid imposing expectations that are beyond their neurocognitive capabilities. In addition to depression, anxiety, and burnout, young athletes who are pressured to perform to excessively high standards are likely to internalize athletic failures as feelings of shame. This can lead to maladaptive perfectionistic traits and potentially overtraining, clinical eating disorders, or other harmful behaviors that will result in declines in performance, physical health, and overall wellbeing. Further work is needed to better inform sport-specific recommendations regarding sport specialization and to optimize the beneficial effects of sport participation while limiting the risks of harm.

Comparison of Anxiety and Depression Symptoms in Concussed and Nonconcussed Adolescents.

BACKGROUND: Few studies have examined psychiatric symptoms during the acute phase following a concussion in adolescents. Thus, this study compares anxiety and depression in acutely concussed and nonconcussed adolescents. HYPOTHESIS: Acutely concussed adolescents will report greater anxiety and depressive symptoms compared with nonconcussed adolescents. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Data were collected from 282 adolescents (111 concussed within 28 days of injury, 171 nonconcussed), 13 to 18 years of age, who completed Patient-Reported Outcome Measurement Information System (PROMIS) Anxiety and Depressive Symptoms measures. We calculated average T-scores for anxiety and depression across both groups and compared the proportion of those who scored above normal limits. Finally, we calculated risk ratios for anxiety and depression scores above normal limits. RESULTS: Average T-scores for anxiety did not differ in concussed versus nonconcussed adolescents (mean: 45.9 [SD 10.84] vs 45.2 [8.1], respectively, P = 0.54), whereas average T-scores for depression were significantly higher in concussed versus nonconcussed adolescents (46.0 [10.88] vs 42.8 [8.48], respectively, P < 0.01). The proportion of concussed adolescents above normal limits for depression was greater than nonconcussed adolescents (32.4% vs 20.5%, respectively, P = 0.02). Post hoc sensitivity analyses excluding those with a history of anxiety or depression demonstrated a 1.45 (95% CI, 0.97, 2.01) and 1.56 (95% CI, 0.95, 2.56) increased risk of an above-normal anxiety and depression score for concussed compared with nonconcussed adolescents, respectively, although both were nonsignificant. CONCLUSION: Although we found few significant differences between the 2 groups, the results highlight that many concussed adolescents met the threshold for above-average symptoms on the depression and anxiety PROMIS measures. CLINICAL RELEVANCE: In adolescents, there is increased risk for psychiatric sequalae in the acute period after a concussion. As such, we suggest that clinicians consider incorporating depression screening when caring for adolescents after a concussion.

A Pilot Study using the Compensatory Reserve Index to evaluate individuals with Postural Orthostatic Tachycardia syndrome.

PURPOSE: The diagnosis of Postural Orthostatic Tachycardia syndrome traditionally involves orthostatic vitals evaluation. The Compensatory Reserve Index is a non-invasive, FDA-cleared algorithm that analyses photoplethysmogram waveforms in real time to trend subtle waveform features associated with varying degrees of central volume loss, from normovolemia to decompensation. We hypothesised that patients who met physiologic criteria for Postural Orthostatic Tachycardia syndrome would have greater changes in Compensatory Reserve Index with orthostatic vitals. METHODS: Orthostatic vitals and Compensatory Reserve Index values were assessed in individuals previously diagnosed with Postural Orthostatic Tachycardia syndrome and healthy controls aged 12-21 years. Adolescents were grouped for comparison based on whether they met heart rate criteria for Postural Orthostatic Tachycardia syndrome (physiologic Postural Orthostatic Tachycardia syndrome). RESULTS: Sixty-one patients were included. Eighteen percent of patients with an existing Postural Orthostatic Tachycardia syndrome diagnosis met heart rate criteria, and these patients had significantly greater supine to standing change in Compensatory Reserve Index (0.67 vs. 0.51; p<0.001). The optimal change in Compensatory Reserve Index for physiologic Postural Orthostatic Tachycardia syndrome was 0.60. Patients with physiologic Postural Orthostatic Tachycardia syndrome were more likely to report previous diagnoses of anxiety or depression (p = 0.054, 0.042). CONCLUSION: An accurate diagnosis of Postural Orthostatic Tachycardia syndrome may be confounded by related comorbidities. Only 18% (8/44) of previously diagnosed Postural Orthostatic Tachycardia syndrome patients met heart rate criteria. Findings support the utility of objective physiologic measures, such as the Compensatory Reserve Index, to more accurately identify patients with true autonomic dysfunction.

Risky Interactions: Relational and Developmental Moderators of Substance Use and Dating Aggression.

Physical dating aggression is a prevalent and costly public health concern. A theoretical moderator model of substance use and dating aggression posits that associations between them are moderated by relational risk factors. To test these theoretical expectations, the current study examined seven waves of longitudinal data on a community-based sample of 100 male and 100 female participants in a Western U.S. city (M age Wave 1 = 15.83; 69.5% White non-Hispanic, 12.5% Hispanic, 11.5% African Americans, & 12.5% Hispanics). Multilevel models examined how links between substance use and dating aggression varied by relational risk and how these patterns changed developmentally. Main effects of relational risk and substance use emerged, particularly in adolescence. In young adulthood significant three-way interactions emerged such that substance use was more strongly associated with physical aggression when conflict and jealousy were higher. Thus, relational risk factors are integral to models of dating aggression, but their role changes developmentally.