Impact of Sex and Pubertal Development on Anxiety in Adolescents Following Concussion.

Concussion often results in psychological symptoms, including anxiety. Post-concussion anxiety has been well-documented, although much of this research has focused on collegiate athletes. The purpose of this study was to compare 1) anxiety symptoms in concussed and healthy controls over time, and 2) to explore sex differences in post-concussion anxiety within the context of pubertal development. Participants (N=126, mean age = 15.1 years old), including concussed (n=86) and healthy adolescents (n=40), completed the Pubertal Development Scale (PDS) and the Screen for Child Anxiety and Related Disorders (SCARED-C). The concussed groups completed SCARED-C at three visits (<10 days, 4 weeks, 3 months). Results of an ANCOVA and MANCOVA found concussed adolescents reported higher SCARED-C total, generalized, and panic anxiety scores than healthy controls, after controlling for sex, age, and PDSS. A three-way mixed ANCOVA examined the effects of sex, PDSS, time, and their interaction on SCARED-C total score in concussed adolescents while controlling for age. There was a significant three-way interaction between sex, age, and PDSS on SCARED-C total score while controlling for age. Overall, we observed increased anxiety in concussed adolescents, as compared to controls, as well as greater post-concussion anxiety reported by females as compared to males, including within PDSS groups. Concussion providers should be prepared to receive training to administer well-validated measures of psychopathology, and should consider that female adolescents, as compared to males, regardless of pubertal development, may be at greater risk for post-concussion anxiety.