Prevalence and Risk of Anxiety and Depression after Concussion: A TRANSCENDENT Study

Anxiety and depression are associated with high symptom burden, functional limitations, and poor quality-of-life. Understanding the prevalence and risk factors for mental health symptoms after concussion is essential for early identification and targeted treatment. The objective of this study was to estimate the prevalence and risk factors associated with moderate-to-severe anxiety (msANX) symptoms and depression (msDEP) symptoms after concussion. This prospective observational study recruited participants from three specialty concussion clinics within the TRANSCENDENT Concussion Research Program. Adolescents and adults aged 13 years and older diagnosed with a physician-confirmed concussion who presented for routine care within a learning health system were eligible if they completed mental health measures at intake assessment between April 2024 and July 2025. Primary outcomes were msANX (Generalized Anxiety Disorder-7 [GAD-7] ≥10) and msDEP (Patient Health Questionnaire-9 [PHQ-9] ≥10) symptoms at intake assessment. Multivariable logistic regression assessed the association between symptoms and patient-related and injury-related factors. Models were adjusted for known predictors. Of 1,639 participants (n = 1,051 [64%] female; median [interquartile range, IQR] age, 28 [17-45] years; median [IQR], 21 [12, 42] days since injury), 45.2% (95% confidence intervals, CI, 42.8-47.7) had msANX (median [IQR] score, (15 [12-18]) and 60.7% (95% CI, 58.3-63.0) had msDEP (median [IQR] score, (16 [12-19]). Risk factors included injury setting (motor vehicle collision [msANX: OR, 3.68; 95% CI: 2.56-5.30; p < 0.001; msDEP: OR, 3.15; 95% CI: 2.11-4.74; p < 0.001], workplace [msANX: OR, 2.85; 95% CI: 1.90-4.30; p < 0.001; msDEP: OR, 2.73; 95% CI: 1.74-4.35; p < 0.001], and assault [msANX: OR, 2.24; 95% CI: 1.07-4.82; p = 0.03] compared with playing sports, having preinjury anxiety (msANX: OR, 1.97; 95% CI, 1.41-2.75; p < 0.001; msDEP: OR, 1.87; 95% CI: 1.31-2.70; p < 0.001), sleep difficulties (msANX: OR, 1.44; 95% CI: 1.36-1.52; p < 0.001; msDEP: OR, 1.62; 95% CI: 1.53-1.73; p < 0.001), being female (msANX: OR, 1.38; 95% CI: 1.08-1.77; p = 0.01; msDEP: OR, 1.34; 95% CI: 1.04-1.72; p = 0.03), and time since injury (msANX: OR, 1.16; 95% CI: 1.07-1.26; p < 0.001; msDEP: OR,1.10; 95% CI: 1.01-1.20; p = 0.03). Leveraging data collected during routine care, this study suggests that existing prevalence estimates likely underestimate the high levels of anxiety and depression symptoms at specialty clinic intake that warrant active treatment. Clinicians should routinely screen for mental health conditions and prioritize higher-risk patients for closer monitoring, including those injured in a motor vehicle collision or at work, female patients, and those with preinjury anxiety or postinjury sleep difficulties. Timely referral to mental health professionals is needed to prevent chronic mental health problems and optimize recovery.