The Effect of Anxiety on Baseline Concussion Assessment in Adolescent Females

Background: Anxiety occurs in approximately 15-20% of adolescent females. The potential for the interaction between anxiety and impaired cognition commonly assessed by concussion batteries require clinicians and researchers to examine the effect of anxiety on baseline concussion test scores.

Purpose: Examine the effects of trait anxiety on concussion baseline testing in adolescent female athletes.

Methods: Prior to their competitive season, 35 adolescent female athletes ranging from 13-18 years of age (mean age: 15.66 ± 1.28) were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) and the State Trait Anxiety Inventory during baseline testing. Participants were divided into groups, based off a previously validated T-Anxiety cutoff score of 35, which was derived from the literature (low n=18, high n=17). ImPACT composite scores served as dependent variables. Multiple one-way ANOVAs were calculated to examine group differences on ImPACT composite scores. All statistical analyses were conducted using SPSS 23.0 (IBM, Armonk, NY). Significance level was set a priori at 0.05 with a Bonferroni correction (p<.008).

Results: Significant differences were found between high and low trait anxiety groups for total symptom score (F (1, 33) = 9.58, p= .004; High: 12.30 ± 10.57, Low: 4.12 ± 5.57), and composite visual motor speed (F (1, 33) = 10.11, p= .003; High: 37.31 ± 4.96, Low: 40.31 ± 5.82). Athletes with high trait anxiety reported more symptoms and performed slower on visual motor speed. No statistical differences existed for composite: verbal memory, visual memory, reaction time and impulse control (p>0.05).

Conclusion: This study provides preliminary evidence that adolescent females with high trait anxiety during baseline concussion assessment present with higher symptoms and slower visual motor speed. In order to subscribe to a holistic approach of concussion management, anxiety needs to be incorporated into the clinical decision process. Without examining adolescent levels of anxiety the clinician may be vulnerable to making inaccurate interpretations of baseline test scores.