Authors: Miriya Ogawa, Eli Snyder, Ryan Nakamura, Kaylin Bersamin, Edward Weldon, Julia Jahansooz, Anson Lee, Kyle Ishikawa, Janette Abramowitz, Enrique Carrazana, Jason Viereck, Kore Liow
Mentors: Janette Abramowitz
Insitution: Brigham Young University
Background: Post-Concussion Syndrome (PCS) describes symptoms persisting beyond the typical recovery time frame for mild traumatic brain injury (mTBI). Although there is a confirmed correlation between mTBI and depression risk, there is a paucity of literature investigating risk factors for depression in the context of PCS (DPCS). This study aims to assess patient demographics, concussion etiologies, clinical course, substance use, and medication use associated with DPCS risk.
Methods: This single-center, retrospective study included patients diagnosed with PCS between January 2020 and January 2023. Data comprised demographics, concussion etiology, loss of consciousness (LOC) following injury, PCS symptoms, Patient Health Questionnaire (PHQ)-2/PHQ-9 surveys, and substance use and CNS-active medications both pre- and post-PCS diagnosis. P-values were calculated using Fisher’s exact tests and Wilcoxon rank sum tests.
Results: Of the initial 297 patients, 82% received depression screening, and 31% were at risk of DPCS based on PHQ-2 scores. Patients with LOC of unspecified duration were at higher risk of developing DPCS (p=0.037). Patients with symptoms of confusion (p=0.014), insomnia (p=0.035), or memory loss (p=0.003) at PCS diagnosis had increased DPCS risk. Tobacco use pre-TBI (p=0.039) and marijuana use pre- (p=0.003) and post-TBI (p=0.009) were associated with increased risk of DPCS. Elevated DPCS risk was also seen in patients who used selective serotonin reuptake inhibitors (p=0.005), serotonin-norepinephrine reuptake inhibitors (p=0.010), atypical antidepressants (p=0.040), or mood stabilizers (0.022) pre-TBI or atypical antidepressants (p=0.005) post-TBI.
Conclusions: This study highlights several risk factors for DPCS which may inform improved PCS patient management and emphasizes the need to develop standardized screening protocols for DPCS.