{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T23:26:06Z","timestamp":1769124366168,"version":"3.49.0"},"reference-count":38,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2025,1,11]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the association between concussion history and depressive symptoms after adjusting for physical activity, substance use, and illicit drug use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analysed data from the Adolescent Behaviour and Experiences Survey, a nationally representative survey of adolescents in the USA. Our independent variables were history of concussion in the 12 months preceding survey completion; self-reported weekly physical activity (days per week with &gt;60\u2009min of physical activity, 0\u20137 scale); substance use over the past 30 days (yes vs no) and illicit drug use throughout lifetime (yes vs no). Our dependent variable was participant-reported sadness\/hopelessness over the past 12\u2009months (yes vs no).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 7499 adolescents (9th\u201312th grade, 50.4% female), reporting one or more concussions over the past year was not associated with the odds of depressive symptoms (OR: 1.13, 95%\u2009CI: 0.93 to 1.37, p=0.21). Each additional day of physical activity per week was associated with a lower odds of depressive symptoms (OR: 0.91; 95%\u2009CI: 0.89 to 0.94; p&lt;0.0001). Illicit drug use (OR ever vs never: 2.48; 95%\u2009CI: 1.96 to 3.13; p&lt;0.0001) and substance use (OR yes vs no: 2.77; 95%\u2009CI: 2.34 to 3.29; p&lt;0.001) were associated with a higher odds of depressive symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Adjusting for physical activity, substance use and illicit drug use, concussion was not significantly associated with depressive symptoms. This novel discovery informs clinicians as they counsel adolescents with concussion; future research should examine physical activity and avoidance of substance\/illicit drug use as postinjury recommendations in an effort to lower the risk of depressive symptoms.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjsports-2024-109029","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T07:15:20Z","timestamp":1737443720000},"page":"249-256","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Concussion and depressive symptoms in high school students: impact of physical activity and substance use"],"prefix":"10.1136","volume":"59","author":[{"given":"Mathew J","family":"Wingerson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Carry","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebekah","family":"Mannix","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Meier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine L","family":"Smulligan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie C","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2955-0191","authenticated-orcid":false,"given":"David R","family":"Howell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,20]]},"reference":[{"key":"2025020607100870000_59.4.249.1","unstructured":"Surendran S , Fainaru-Wada M . 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