49. Influences of Anxiety and Depression on Baseline Sway Balance and Cognitive Test Performance

Abstract

Anxiety and depression have been associated with worse performance on baseline balance and neurocognitive testing, and increased symptom reporting, using the SCAT, ImPACT, and BESS. This study replicated these findings using the Sway Sports+ Battery. A sample of 10,885 middle/high school, and collegiate athletes, ages 13-22, completed a pre-season baseline assessment. The Sway Sports+ Battery contains a Balance module and yields Reaction Time, Inspection Time, Impulse Control, and Memory scores. Total Symptom scores were documented as well as Total Symptoms without Emotion (removing “Sadness”, “More Emotional”, “Irritability” and “Nervous or Anxious”). Athletes also completed a Patient Health Questionnaire (PHQ9) and Generalized Anxiety Disorder assessment (GAD7), and were assigned to groups based on their PHQ9 and GAD7 scores (Minimal: 0-4; Mild 5-9; Moderate-to-Severe 10+). 12.0% of athletes obtained GAD7 scores consistent with mild and 4.5% with moderate-to-severe anxiety; 13.3% of athletes obtained PHQ9 scores consistent with mild and 5.6% with moderate-to-severe depression. Athletes with moderate-to-severe anxiety scored significantly worse on Impulse Control (p<.001, Effect Size (ES)=.01) and Inspection Time (p<.001; ES=.01), and the three groups were significantly different with respect to endorsement of Total Symptoms (p<.001; ES=.20) and Total Symptoms without Emotion (p<.001; ES=.16), with small effect sizes. A similar pattern was obtained for PHQ9 scores, although Memory scores were also significant (p<.001; ES=.01). There were no significant differences on Balance performance. Anxiety and depression is not related to decreased balance performance, but athletes with anxiety and depression perform worse on baseline cognitive testing using Sway, and endorse significantly more concussion-related symptoms. Exercise intolerance, defined as the exacerbation of neurobehavioral symptoms during physical exertion, is commonly associated with the acute recovery phase after a mild traumatic brain injury (mTBI). However, Repetitive Head Trauma-Associated Persistent Exercise Intolerance (RHT-PEI) in individuals with remote, repetitive mTBIs has not been characterized.