{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:59:13Z","timestamp":1792799953593,"version":"4.5.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T00:00:00Z","timestamp":1707782400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["5 T R01 Act NS097549 Project 06 Year"],"award-info":[{"award-number":["5 T R01 Act NS097549 Project 06 Year"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["1K23NS124986-01"],"award-info":[{"award-number":["1K23NS124986-01"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"publisher","award":["1K23NS128275-01"],"award-info":[{"award-number":["1K23NS128275-01"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Children\u2019s Hospital of Philadelphia Frontier Program","id":[{"id":"https:\/\/ror.org\/01z7r7q48","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sports Health: A Multidisciplinary Approach"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Pre-existing mental health diagnoses may contribute to greater emotional symptom burden and prolonged recovery after concussion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis:<\/jats:title>\n                    <jats:p>Youth with pre-existing mental health diagnoses will have greater emotional symptom burden, greater risk for delayed return to exercise, and more prolonged recovery from concussion than those without those diagnoses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Prospective cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A prospective registry of youth concussion was examined for differences in emotional symptom burden after injury to develop a predictive risk model for prolonged recovery. The impact of individual and total number of pre-existing mental health diagnoses (0, 1, 2, and 3+) was assessed, and multivariable logistic regression was performed to identify factors associated with prolonged recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among a cohort of 3105 youth with concussion, those with a history of mental health diagnoses, in a dose-response fashion, had greater postinjury emotional symptom burden (7 emotional symptoms vs 4; P &lt; 0.01), visio-vestibular dysfunction (65% abnormal vs 56% abnormal; P &lt; 0.01), later return to symptom-limited exercise (23 vs 21 days; P &lt; 0.01), and overall longer concussion recovery (38 days, interquartile range [IQR] 18, 80) versus 25 days (IQR 13, 54; P &lt; 0.01). Boys with prolonged recovery after concussion had greater emotional symptom burden than girls (5 emotional symptoms vs 3; P &lt; 0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Pre-existing mental health diagnoses are associated with greater postinjury emotional symptom burden and longer concussion recovery in a dose-response fashion. Visiovestibular deficits and delayed return to exercise are also associated with pre-existing mental health diagnoses and prolonged recovery. Boys with prolonged recovery from concussion experience greater emotional symptom burden than girls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>Addressing pre-existing mental health diagnoses is essential to concussion management. Boys with prolonged recovery from concussion may particularly benefit from interventions to address their higher emotional symptom burden. Interventions, including a home visio-vestibular exercise program and symptom-limited exercise, may contribute to improving time to concussion recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19417381241228870","type":"journal-article","created":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T07:09:22Z","timestamp":1707808162000},"page":"254-268","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Dose-Response Effect of Mental Health Diagnoses on Concussion Recovery in Children and Adolescents"],"prefix":"10.1177","volume":"16","author":[{"given":"Christina L.","family":"Master","sequence":"first","affiliation":[{"name":"Sports Medicine and Performance Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Center for Injury Research and Prevention, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Corwin","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Center for Injury Research and Prevention, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, Division of Emergency Medicine, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Fedonni","sequence":"additional","affiliation":[{"name":"Center for Injury Research and Prevention, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, Department of Biomedical and Health Informatics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven B.","family":"Ampah","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Health Informatics, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn C.","family":"Housel","sequence":"additional","affiliation":[{"name":"Center for Injury Research and Prevention, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"McDonald","sequence":"additional","affiliation":[{"name":"Center for Injury Research and Prevention, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristy B.","family":"Arbogast","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, Center for Injury Research and Prevention, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, Division of Emergency Medicine, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew F.","family":"Grady","sequence":"additional","affiliation":[{"name":"Sports Medicine and Performance Center, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, 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