INS NYC 2024 Program

Poster	Poster Session 10 Program Schedule 02/17/2024 09:00 am - 10:15 am Room: Majestic Complex (Posters 61-120) Poster Session 10: Neurodevelopmental \| Congenital Conditions Final Abstract #68 The Influence of Symptom Severity and Depression or Anxiety Diagnosis on Self Efficacy after Concussion in Adolescents Katerina Nastea, Children's National Hospital, Washington D.C., United States Dean Allen, Children's National Hosptial, Washington D.C., United States Christopher Vaughan, Children's National Hospital, Washington D.C., United States Gerard Gioia, Children's National Hosptial, Washington D.C., United States Category: Concussion/Mild TBI (Child) Keyword 1: depression Keyword 2: pediatric neuropsychology Keyword 3: self-esteem Objective: A history of depression or anxiety is a risk factor for higher symptom levels following a concussion in adolescents (Solomon et al, 2015 and Kent et al, 2022). In contrast, greater self-efficacy (SE) to manage their concussion recovery is a resilience factor. Limited research has examined the relationships among premorbid depression or anxiety (A/D), post-concussion symptoms, and self-efficacy. We hypothesized that adolescents with a diagnosis of A/D and high levels of symptoms would have the lowest self-efficacy, while those without A/D and with low levels of symptoms would have the highest self-efficacy during the initial visit at a concussion clinic. Participants and Methods: Participants were 282 adolescents (52% female) with a concussion, ages 13-18, either with (A/D+) or without (A/D-) a pre-injury diagnosis of anxiety or depression. The Progressive Activities of Controlled Exertion – Self Efficacy (PACE-SE) scale (Ramsey et al, 2021) and Post-Concussion Symptom Inventory (PCSI) were administered within 30 days of injury in a concussion clinic. Four risk groups were created based on the PCSI RAPID Total Severity Score Classification Level (low vs. high) and presence or absence of A/D diagnosis, resulting in A/D+ with high symptoms (n=46), A/D- with high symptoms (n=85), A/D+ with low symptoms (n=21), and A/D- with low symptoms (n=130). A 4x2 ANOVA (IV = risk group, sex, and their interaction term) was performed to examine differences in SE after concussion. All analyses were performed with α=0.05. Results: Symptom severity risk groups demonstrated significantly different levels of SE based on Total Symptoms and anxiety or depression history (F = 45.00, p <.001, Partial Eta = .330). There were no statistically significant sex differences in SE (F = 3.404, p = 0.066, Partial Eta = .012). There were no significant differences in SE based on risk group by sex interactions (p > .05). As predicted, mean levels of SE were lowest for A/D+ / high initial symptoms (highest risk), then A/D- / high symptoms (medium high risk), then AD+ / low symptoms (medium low risk), and then A/D- / low symptoms (low risk). However, there were no statistically significant post-hoc differences between those with high total symptom levels and AD+ or AD-, and no significant differences between those with low total symptom levels and AD+ or AD-. Conclusions: Concussion symptomatology combined with a history of pre-injury anxiety or depression diagnoses has a significant effect on reported self-efficacy in adolescents. However, individuals with higher symptom levels had lower self-efficacy regardless of a prior diagnosis of depression or anxiety. Individuals with both high symptom levels and A/D+ are at the highest risk for low self-efficacy. A study limitation was the smaller sample size of the high risk/low self-efficacy group, which may impact generalizability. Pre-injury history and symptom burden, and sex, are associated with an individual’s self-efficacy to facilitate recovery after a concussion.

Poster

02/17/2024
09:00 am - 10:15 am
Room: Majestic Complex (Posters 61-120)

Poster Session 10: Neurodevelopmental | Congenital Conditions

Final Abstract #68

The Influence of Symptom Severity and Depression or Anxiety Diagnosis on Self Efficacy after Concussion in Adolescents

Katerina Nastea, Children's National Hospital, Washington D.C., United States
Dean Allen, Children's National Hosptial, Washington D.C., United States
Christopher Vaughan, Children's National Hospital, Washington D.C., United States
Gerard Gioia, Children's National Hosptial, Washington D.C., United States

Category: Concussion/Mild TBI (Child)

Keyword 1: depression
Keyword 2: pediatric neuropsychology
Keyword 3: self-esteem

Objective:

A history of depression or anxiety is a risk factor for higher symptom levels following a concussion in adolescents (Solomon et al, 2015 and Kent et al, 2022). In contrast, greater self-efficacy (SE) to manage their concussion recovery is a resilience factor. Limited research has examined the relationships among premorbid depression or anxiety (A/D), post-concussion symptoms, and self-efficacy. We hypothesized that adolescents with a diagnosis of A/D and high levels of symptoms would have the lowest self-efficacy, while those without A/D and with low levels of symptoms would have the highest self-efficacy during the initial visit at a concussion clinic.

Participants and Methods:

Participants were 282 adolescents (52% female) with a concussion, ages 13-18, either with (A/D+) or without (A/D-) a pre-injury diagnosis of anxiety or depression. The Progressive Activities of Controlled Exertion – Self Efficacy (PACE-SE) scale (Ramsey et al, 2021) and Post-Concussion Symptom Inventory (PCSI) were administered within 30 days of injury in a concussion clinic. Four risk groups were created based on the PCSI RAPID Total Severity Score Classification Level (low vs. high) and presence or absence of A/D diagnosis, resulting in A/D+ with high symptoms (n=46), A/D- with high symptoms (n=85), A/D+ with low symptoms (n=21), and A/D- with low symptoms (n=130). A 4x2 ANOVA (IV = risk group, sex, and their interaction term) was performed to examine differences in SE after concussion. All analyses were performed with α=0.05.

Results:

Symptom severity risk groups demonstrated significantly different levels of SE based on Total Symptoms and anxiety or depression history (F = 45.00, p <.001, Partial Eta = .330). There were no statistically significant sex differences in SE (F = 3.404, p = 0.066, Partial Eta = .012). There were no significant differences in SE based on risk group by sex interactions (p > .05). As predicted, mean levels of SE were lowest for A/D+ / high initial symptoms (highest risk), then A/D- / high symptoms (medium high risk), then AD+ / low symptoms (medium low risk), and then A/D- / low symptoms (low risk). However, there were no statistically significant post-hoc differences between those with high total symptom levels and AD+ or AD-, and no significant differences between those with low total symptom levels and AD+ or AD-.

Conclusions:

Concussion symptomatology combined with a history of pre-injury anxiety or depression diagnoses has a significant effect on reported self-efficacy in adolescents. However, individuals with higher symptom levels had lower self-efficacy regardless of a prior diagnosis of depression or anxiety. Individuals with both high symptom levels and A/D+ are at the highest risk for low self-efficacy. A study limitation was the smaller sample size of the high risk/low self-efficacy group, which may impact generalizability. Pre-injury history and symptom burden, and sex, are associated with an individual’s self-efficacy to facilitate recovery after a concussion.