7. Baseline Cognition and Symptom Reporting in Elite Athletes with Low and High Mental Health Symptoms

Abstract

Athletes who experience mental health (MH) symptoms tend to endorse other symptoms that resemble those commonly reported post-concussion. These associations suggest pre-existing MH symptoms may bias baseline symptom reporting, raising concerns regarding its utility and interpretation in post-concussion management decisions. This study examined the possible influence of MH symptoms on baseline cognitive testing and symptom reporting in a sample of elite Canadian athletes. Participants were 70 elite/international-level athletes without a concussion history (age: M=21.95, SD=3.82; 34 females) from a Canadian national sport institute who completed baseline testing using the SCAT-5 and the Vienna Test System (VTS), a computerized cognitive battery. Participants were divided into high and low MH symptom groups based on endorsement of emotional symptoms on the SCAT-5. Compared to the low MH group, the high MH group captured all athletes who reported a prior MH diagnosis. Independent-samples t tests revealed the high MH group reported significantly higher total symptom severity, t(64)=-5.76, p<.001, d=-1.17, and total number of symptoms endorsed, t(52)=-6.97, p< .001, d=-1.50, on the SCAT-5. When controlling for the emotional symptoms used to define group membership, the high MH group still reported significantly higher symptom severity, t(51)=-4.09, p<.001, d=0.92. The groups did not significantly differ in performance on the VTS. Groups did not differ in terms of cognitive performance, however, the high MH group endorsed significantly more symptoms on the SCAT-5 even when controlling for emotional symptoms. These findings highlight the importance of tracking MH symptoms for concussion management in elite athletes.