P3.252: The Evolution and Interaction of Mental Health and Sleep Symptoms Following Adolescent Concussion

Background: Our purpose was to evaluate the development of psychological symptoms at three time points following adolescent concussion ( < 21 days post-injury, within a week of symptom resolution, and 8 weeks after symptom resolution) and their association with self-reported sleep quality. Overall, we sought to better elucidate the connection between the timeline of clinical concussion recovery and symptoms that may persist or change beyond that point.

Methods:

Methods:
This was a secondary analysis of an ongoing multisite randomized controlled trial investigating adolescent concussion recovery. Participants were enrolled within 21 days of sustaining a concussion. Participants reported concussion symptoms (Post-concussion Symptom Inventory), psychological health symptoms (Patient-Reported Measurement Information System (PROMIS) Pediatric Global 25 Anxiety and Depressive Symptom domains) and sleep quality [Pittsburgh Sleep Quality Index (PSQI)]. Data were collected at: Visit 1 (symptomatic phase; < 21days after concussion), Visit 2 (asymptomatic phase; assessed 1 week following symptom resolution;), and Visit 3 (8-week post-symptom-resolution follow-up;). Multivariable linear regressions examined associations between mean sleep quality (averaged across all visits) and mean PROMIS anxiety and mean PROMIS depressive symptom scores. Prevalence of poor sleep (PSQI >4) at Visits 1 or 2 was estimated, as well as the incidence of clinically relevant psychological symptoms at Visit 3 (PROMIS Anxiety or Depressive Symptoms >60 and/or a clinically meaningful worsening of ≥5 points in anxiety or depressive symptoms from Visit 2 to Visit 3).

Results:

Results:
PROMIS mental health domain scores and sleep quality improved across the three visits. On average, poor sleep quality was positively associated with higher levels of both depressive (p < 0.0001) and anxiety symptoms (p=0.0002) (Figure1, Table1). 72 participants, aged 13-18 years (average=15.5 years, 46% female, mean 49.0 days to symptom resolution) were enrolled in the study. The prevalence of poor sleep quality, PSQI >4 at Visit 1 or Visit 2, was 80.6% (95% CI: 71.4% to 89.7%) Clinically relevant psychological symptoms occurred in 22.2% (16/72, 95% CI: 12.6 to 31.8%) of participants at Visit 3 (8-weeks after symptom resolution). Among the 16 participants who developed elevated psychological symptoms at Visit 3, 0% (0/16) reported clinically relevant anxiety or depression symptoms at visit 2.

Conclusion:

Conclusion:
Poor sleep quality is common following concussion and is associated with worse mental health symptoms across recovery. Notably, clinically relevant psychological symptoms emerged or worsened after self-reported symptom resolution for a subset of participants. This could be related to injury or non-injury factors during recovery and resumption of full academic workload and athletic activity following medical clearance. Incorporating routine assessments of sleep and mental health—both during recovery and beyond as patients re-integrate into typical activities—may help clinicians identify at-risk patients earlier, provide timely interventions, and ultimately reduce the risk of prolonged or recurrent psychological distress in this vulnerable population.