{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T15:40:04Z","timestamp":1794238804581,"version":"4.9.0"},"reference-count":48,"publisher":"SAGE Publications","issue":"15-16","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100008914","name":"Ontario Brain Institute","doi-asserted-by":"crossref","award":["OBI funding for period 2023-2026"],"award-info":[{"award-number":["OBI funding for period 2023-2026"]}],"id":[{"id":"10.13039\/100008914","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Canada First Research Excellence Fund for the Brain-Heart Interconnectome","award":["CFREF-2022-00007"],"award-info":[{"award-number":["CFREF-2022-00007"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:p>\n                    Anxiety and depression are associated with high symptom burden, functional limitations, and poor quality-of-life. Understanding the prevalence and risk factors for mental health symptoms after concussion is essential for early identification and targeted treatment. The objective of this study was to estimate the prevalence and risk factors associated with moderate-to-severe anxiety (msANX) symptoms and depression (msDEP) symptoms after concussion. This prospective observational study recruited participants from three specialty concussion clinics within the TRANSCENDENT Concussion Research Program. Adolescents and adults aged 13 years and older diagnosed with a physician-confirmed concussion who presented for routine care within a learning health system were eligible if they completed mental health measures at intake assessment between April 2024 and July 2025. Primary outcomes were msANX (Generalized Anxiety Disorder-7 [GAD-7] \u226510) and msDEP (Patient Health Questionnaire-9 [PHQ-9] \u226510) symptoms at intake assessment. Multivariable logistic regression assessed the association between symptoms and patient-related and injury-related factors. Models were adjusted for known predictors. Of 1,639 participants (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    = 1,051 [64%] female; median [interquartile range, IQR] age, 28 [17\u201345] years; median [IQR], 21 [12, 42] days since injury), 45.2% (95% confidence intervals, CI, 42.8\u201347.7) had msANX (median [IQR] score, (15 [12\u201318]) and 60.7% (95% CI, 58.3\u201363.0) had msDEP (median [IQR] score, (16 [12\u201319]). Risk factors included injury setting (motor vehicle collision [msANX: OR, 3.68; 95% CI: 2.56\u20135.30;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001; msDEP: OR, 3.15; 95% CI: 2.11\u20134.74;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001], workplace [msANX: OR, 2.85; 95% CI: 1.90\u20134.30;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001; msDEP: OR, 2.73; 95% CI: 1.74\u20134.35;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001], and assault [msANX: OR, 2.24; 95% CI: 1.07\u20134.82;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.03] compared with playing sports, having preinjury anxiety (msANX: OR, 1.97; 95% CI, 1.41\u20132.75;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001; msDEP: OR, 1.87; 95% CI: 1.31\u20132.70;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001), sleep difficulties (msANX: OR, 1.44; 95% CI: 1.36\u20131.52;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001; msDEP: OR, 1.62; 95% CI: 1.53\u20131.73;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001), being female (msANX: OR, 1.38; 95% CI: 1.08\u20131.77;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.01; msDEP: OR, 1.34; 95% CI: 1.04\u20131.72;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.03), and time since injury (msANX: OR, 1.16; 95% CI: 1.07\u20131.26;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001; msDEP: OR,1.10; 95% CI: 1.01\u20131.20;\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = 0.03). Leveraging data collected during routine care, this study suggests that existing prevalence estimates likely underestimate the high levels of anxiety and depression symptoms at specialty clinic intake that warrant active treatment. Clinicians should routinely screen for mental health conditions and prioritize higher-risk patients for closer monitoring, including those injured in a motor vehicle collision or at work, female patients, and those with preinjury anxiety or postinjury sleep difficulties. Timely referral to mental health professionals is needed to prevent chronic mental health problems and optimize recovery.\n                  <\/jats:p>","DOI":"10.1177\/08977151261416446","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T04:51:29Z","timestamp":1770007889000},"page":"1259-1270","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Prevalence and Risk of Anxiety and Depression after Concussion: A TRANSCENDENT Study"],"prefix":"10.1177","volume":"43","author":[{"given":"Jacqueline J.","family":"van Ierssel","sequence":"first","affiliation":[{"name":"Children\u2019s Hospital of Eastern Ontario Research Institute, Ottawa, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen A.","family":"Kutcher","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Eastern Ontario Research Institute, Ottawa, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada."},{"name":"Institut du Savoir Montfort, Ottawa, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nguyen Khoi","family":"Pham","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Eastern Ontario Research Institute, Ottawa, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Lamoureux","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Eastern Ontario Research Institute, Ottawa, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew B.","family":"Dodd","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Eastern Ontario Research Institute, Ottawa, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly","family":"Mullan","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Eastern Ontario Research Institute, Ottawa, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith Owen","family":"Yeates","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Calgary, Calgary, Alberta, Canada."},{"name":"Alberta Children\u2019s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada."},{"name":"Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9e-Anne","family":"Ledoux","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Eastern Ontario Research Institute, Ottawa, Canada."},{"name":"Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian C.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Lalonde","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioural Sciences, McMaster University, Hamilton, Ontario, Canada."},{"name":"Homewood Health Centre, Guelph, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina L.","family":"Master","sequence":"additional","affiliation":[{"name":"The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA."},{"name":"University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Howell","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA."},{"name":"Sports Medicine Center, Children\u2019s Hospital Colorado, Aurora, Colorado, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Araba","family":"Chintoh","sequence":"additional","affiliation":[{"name":"Alberta Children\u2019s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada."},{"name":"Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Mikoli\u0107","sequence":"additional","affiliation":[{"name":"Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam H.","family":"Beauchamp","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada."},{"name":"Azrieli Research Center, CHU Sainte-Justine, Montreal, Quebec, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah D.","family":"Silverberg","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada."},{"name":"Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada."},{"name":"Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger","family":"Zemek","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Eastern Ontario Research Institute, Ottawa, Canada."},{"name":"Departments of Pediatrics and Emergency Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for 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