Variability in baseline concussion symptom burden and symptom reporting among UK student-athletes with neurodevelopmental, psychological, or mental health conditions

Aims

To examine variability in baseline concussion symptom burden and symptom reporting among UK university student athletes (SA) with preexisting neurodevelopmental, psychological, or mental health (NP/MH) conditions, with/without concussion history (CH), to inform clinical interpretation and best practice.

Methods

A total of 404 SA (male = 188, female = 216) from the University of Chichester, across 12 sports, completed baseline screening using the Sports Concussion Assessment Tool (SCAT) 22‑item symptom checklist (severity scored 0 = none to 6 = severe; total severity score range 0–132) prior to participation over three university sports seasons. Symptom distributions were summarized using medians and interquartile ranges (IQR). Prevalence of ≥1 symptom was compared using χ2 tests, with differences in symptom burden between concussion groups within NP/MH conditions assessed using Mann–Whitney U tests. Hierarchical linear regression analyses examined variance in symptom burden determined by NP/MH diagnosis and CH.

Results

SA with NP/MH diagnosis reported a higher overall symptom burden than those without. SA without NP/MH diagnosis but with CH had a greater symptom count (p < .001) and severity (p < .002). Hierarchical regression indicated that NP/MH explained 12% of variance in symptom count (R2 = .12) and 16% in symptom severity (R2 = .16), with previous concussion and depression/anxiety adding significant incremental variance (p < .001). Chi-square analysis showed that SA with NP/MH and CH were more likely to report ≥1 symptom (χ2 (1) = 9.96, p < .001). Symptom pattern analysis revealed difficulty concentrating, fatigue/low energy, and trouble sleeping as the most frequent baseline symptoms, with females reporting consistent prevalence.

Conclusion

Preexisting NP/MH conditions and CH can substantially influence baseline symptom reporting in UK SA. Clinicians should consider these factors when interpreting SCAT symptom checklists, as variability is expected, and the management of SA return to sport is often determined by baseline values.