Examining the role of depression on the relationship between performance-based and self-reported cognitive functioning after sport-related concussion

Arch Clin Neuropsychol. 2024 Nov 22;39(8):1390-1397. doi: 10.1093/arclin/acae043.

Abstract

Objective: Little is known about the relationship between neuropsychological test performance, cognitive symptom reporting, and depressive symptoms after sport-related concussion. Accordingly, this cross-sectional study examined these relationships in collegiate athletes. It was hypothesized that depressive symptoms would moderate and mediate the relationship between performance-based and self-reported cognitive functioning after concussion.

Methods: After sustaining a sport-related concussion, 110 collegiate athletes completed a neuropsychological battery, the Post-Concussion Symptoms Scale, and the Beck Depression Inventory-Fast Screen. Neuropsychological test performance, depressive symptoms, and their interactions were entered into distinct hierarchical linear regression analyses with self-reported cognition as the dependent variable to assess moderation. Mediation was analyzed using the PROCESS macro with 5000 bootstrap samples and a 95% confidence interval.

Results: There was a significant interaction between the mean memory composite and depressive symptoms when predicting cognitive symptom reporting, p = 0.047. Simple effects tests revealed that for athletes who had a lower memory composite score, an increase in depressive symptoms led to an increase in self-reported cognitive dysfunction, p < 0.001, ηp2 = 0.11. Depressive symptoms partially mediated the relationship between the memory composite and cognitive symptom reporting, indirect effect = -0.26, 95%CI[-0.58,0.001], but this relationship was not found for any other neurocognitive domain.

Conclusions: For tests of memory, depressive symptoms moderated and partially mediated the relationship between performance-based and self-reported cognitive functioning after sport-related concussion. Athletes reporting high depressive symptoms and cognitive dysfunction may need more comprehensive evaluations to inform return-to-play decisions, and depression could be a treatment target for athletes who report high levels of cognitive dysfunction after concussion.

Keywords: College athletes; Concussion; Depressive symptoms; Mild; Post-concussion symptoms.

MeSH terms

  • Adolescent
  • Adult
  • Athletes / psychology
  • Athletic Injuries* / complications
  • Brain Concussion* / complications
  • Brain Concussion* / physiopathology
  • Brain Concussion* / psychology
  • Cognition / physiology
  • Cognitive Dysfunction / etiology
  • Cognitive Dysfunction / physiopathology
  • Cross-Sectional Studies
  • Depression* / diagnosis
  • Depression* / etiology
  • Female
  • Humans
  • Male
  • Neuropsychological Tests*
  • Post-Concussion Syndrome / diagnosis
  • Post-Concussion Syndrome / etiology
  • Post-Concussion Syndrome / psychology
  • Self Report*
  • Young Adult