Preinjury somatization symptoms contribute to clinical recovery after sport-related concussion

Neurology. 2016 May 17;86(20):1856-63. doi: 10.1212/WNL.0000000000002679. Epub 2016 Apr 20.


Objective: To determine the degree to which preinjury and acute postinjury psychosocial and injury-related variables predict symptom duration following sport-related concussion.

Methods: A total of 2,055 high school and collegiate athletes completed preseason evaluations. Concussed athletes (n = 127) repeated assessments serially (<24 hours and days 8, 15, and 45) postinjury. Cox proportional hazard modeling was used to predict concussive symptom duration (in days). Predictors considered included demographic and history variables; baseline psychological, neurocognitive, and balance functioning; acute injury characteristics; and postinjury clinical measures.

Results: Preinjury somatic symptom score (Brief Symptom Inventory-18 somatization scale) was the strongest premorbid predictor of symptom duration. Acute (24-hour) postconcussive symptom burden (Sport Concussion Assessment Tool-3 symptom severity) was the best injury-related predictor of recovery. These 2 predictors were moderately correlated (r = 0.51). Path analyses indicated that the relationship between preinjury somatization symptoms and symptom recovery was mediated by postinjury concussive symptoms.

Conclusions: Preinjury somatization symptoms contribute to reported postconcussive symptom recovery via their influence on acute postconcussive symptoms. The findings highlight the relevance of premorbid psychological factors in postconcussive recovery, even in a healthy athlete sample relatively free of psychopathology or medical comorbidities. Future research should elucidate the neurobiopsychosocial mechanisms that explain the role of this individual difference variable in outcome following concussive injury.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Anxiety / epidemiology
  • Athletic Injuries / complications
  • Athletic Injuries / epidemiology
  • Athletic Injuries / psychology*
  • Athletic Injuries / therapy*
  • Depression / epidemiology
  • Female
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Models, Biological
  • Multivariate Analysis
  • Post-Concussion Syndrome / epidemiology
  • Post-Concussion Syndrome / etiology
  • Post-Concussion Syndrome / psychology*
  • Post-Concussion Syndrome / therapy*
  • Proportional Hazards Models
  • Psychiatric Status Rating Scales
  • Regression Analysis
  • Schools
  • Self Report
  • Somatoform Disorders / complications
  • Somatoform Disorders / epidemiology
  • Somatoform Disorders / psychology*
  • Time Factors
  • Treatment Outcome
  • Universities