The Association Between Persisting Symptoms after Concussion (PSaC) and Symptoms of Depression and/or Anxiety in the Athletic Population: A Scoping Review.

Background: The association between persisting symptoms after concussion (PSaC) and symptoms of depression and/or anxiety is a growing concern in athlete populations. However, the evidence base is complex and inconsistent, creating significant diagnostic challenges and uncertainty regarding appropriate screening protocols. This scoping review maps the literature from the past five years to examine the evidence for this association in adult athletes and to identify the screening tools employed. Objectives: The objectives of this scoping review were: (1) to systematically map the extent, range, and nature of the empirical literature on the association between PSaC and symptoms of depression and/or anxiety in adult athletic populations; (2) to identify and categorize the screening tools used to assess symptoms of depression and/or anxiety; and (3) to identify gaps and limitations in the existing body of research to provide direction for future investigations. This review was guided by the following questions: 1) What is the nature of the reported association between PSaC and symptoms of depression and/or anxiety in adult athletes? 2) What screening tools are most frequently utilized in the literature to assess symptoms of depression and/or anxiety in this population? Methods: This scoping review followed the Joanna Briggs Institute (JBI) methodology, incorporating the framework by Arksey and O'Malley and subsequent JBI refinements. A systematic search of English-language literature was conducted in the PubMed, Scopus, and Google Scholar databases. Studies were included if they: (1) involved adult populations (≥18 years); (2) focused on sport-related concussion (SRC) as a mechanism of injury; (3) assessed symptoms persisting for four weeks or more (i.e., PSaC); and (4) explored the association between PSaC and symptoms of depression and/or anxiety. Results: The review identified 14 studies. A majority (n=9) reported a positive association between PSaC and symptoms of depression and anxiety. However, the overall evidence base was marked by significant methodological heterogeneity, including a wide range of study designs, participant numbers (ranging from single case reports to large surveys (n = 1-3406), populations (from active to retired athletes), and time since injury (28 days to 55 years). There was a lack of consensus in assessment methods, with an inconsistent collection of 13 different screening tools used across the included studies to measure symptoms of depression and/or anxiety. Furthermore, a foundational challenge identified was the inconsistent terminology used across studies to describe persisting symptoms. Conclusion: While the evidence suggests a link between PSaC and symptoms of depression and/or anxiety in athletes, a lack of consensus on terminology and screening tools severely limits the comparability of research and the development of clear clinical guidelines. This highlights a potential need for standardisation to improve the quality of research and, ultimately, the clinical care and well-being of athletes with PSaC.