4. Impact of Affective Symptoms on Baseline Neurocognitive Performance in High-School Athletes

Abstract

Research suggests that athletes with mental health treatment history (MH-Hx) have higher baseline affective symptom endorsement and are at risk for prolonged recovery trajectories after sport-related concussion. The present study examined the impact of these affective symptoms on baseline neurocognitive performance in high school athletes. Archival data was drawn from Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) records at a neuropsychology practice. Participants (N=6,205) were athletes ages 13-18 years (M=14.85; 54.6% male). Athletes were categorized into low (n=3,487) or high (n=2,718) affective symptom groups based on Post-Concussion Symptom Scale (PCSS). A subsample reported either no MH-Hx (n=2,616, 94.2%) or prior MH-Hx (n=162, 5.8%). Neurocognitive outcomes included ImPACT composite scores: Verbal Memory, Visual Memory, Visual Motor Speed, Reaction Time, and Impulse Control. A Mann-Whitney U test revealed that athletes with MH-Hx reported higher affective symptoms (p<.001) and weaker Reaction Time and Impulse Control performances (p's< .05), with no significant interaction effects between level of affective symptoms and MH-Hx status (p's> .05). Additional Mann-Whitney U and two-way ANOVAs demonstrated that, regardless of MH-Hx, higher affective symptom endorsement was associated with stronger Visual Motor Speed and Impulse Control performances (p's< .05). Findings suggest that relying only on PCSS affective symptom endorsement and self-reported MH-Hx may limit interpretation of baseline neurocognitive performance. Incorporating validated mood screeners at baseline and post-injury, along with a clinical interview, may enhance evaluation accuracy and better support adolescent athletes with affective symptoms or MH-Hx.