The role of family and personal psychiatric history in postconcussion syndrome following sport-related concussion: a story of compounding risk
The role of family and personal psychiatric history in postconcussion syndrome following sport-related concussion: a story of compounding risk
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DOI：
10.3171/2018.3.peds1850
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发表时间：
2018-09-01
影响因子：
1.9
通讯作者：
Zuckerman, Scott L.
中科院分区：
文献类型：
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作者：
Legarreta, Andrew D.;Brett, Benjamin L.;Zuckerman, Scott L.
目的运动相关脑震荡（SRC）已成为一个主要的公共卫生问题。SRC后恢复时间延长，称为脑震荡后综合征（PCS），与几个生物心理社会因素有关，但家庭和个人精神病史的作用需要调查。在一个队列的脑震荡高中运动员，作者研究的作用（S）的家庭和个人精神病史的风险发展PCS.METHODS的回顾性队列研究154名高中运动员与完整的文件脑震荡后症状的解决或持久性在6周进行。PCS定义为SRC后6周出现3种或3种以上症状。定义了三个组：1）阳性家族精神病史和个人精神病史（FPH/PPH），2）仅阳性FPH，和3）阴性家族和个人精神病史（对照）。进行了三项双变量回归分析：FPH/PPH与对照组，FPH与对照组，FPH/PPH与FPH。事后双变量回归分析检查了特定的FPH病理和PCS.Results与对照组相比，FPH/PPH运动员有PCS的风险增加（卡方（2）= 8.90，p = 0.018; OR 5.06，95%CI 1.71-14.99）。与对照组相比，仅患有FPH的运动员也有PCS风险增加（卡方2 = 6.04，p = 0.03; OR 2.52，95%CI 1.20-5.30）。将FPH/PPH的运动员与仅FPH的运动员进行比较，未发现PCS风险增加（卡方2 = 1.64，p = 0.247; OR 2.01，95%CI 0.68-5.94）。在各种FPH诊断中，焦虑（chi（2）= 7.48，p = 0.021; OR 2.99，95% CI 1.36-6.49）和双相情感障碍（chi（2）= 5.13，p = 0.036; OR 2.74，95%CI 1.14-6.67）与PCS的存在显著相关。PPH患者发生PCS的可能性是对照组的5倍以上。只有FPH的运动员比对照组患PCS的可能性高2.5倍。那些患有焦虑或双相情感障碍的FPH的人患PCS的风险特别高。这些结果表明，不仅是FPH/PPH的运动员在SRC后恢复较慢的风险，但那些只有FPH-特别是焦虑或双相情感障碍-也可能处于危险之中。总体而言，本研究支持在SRC的管理中采取详细的FPH和PPH。
OBJECTIVE Sport-related concussion (SRC) has become a major public health concern. Prolonged recovery after SRC, named postconcussion syndrome (PCS), has been associated with several biopsychosocial factors, yet the role of both family and personal psychiatric histories requires investigation. In a cohort of concussed high school athletes, the authors examined the role(s) of family and personal psychiatric histories in the risk of developing PCS.METHODS A retrospective cohort study of 154 high school athletes with complete documentation of postconcussion symptom resolution or persistence at 6 weeks was conducted. PCS was defined as 3 or more symptoms present 6 weeks after SRC. Three groups were defined: 1) positive family psychiatric history and personal psychiatric history (FPH/PPH), 2) positive FPH only, and 3) negative family and personal psychiatric histories (controls). Three bivariate regression analyses were conducted: FPH/PPH to controls, FPH only to controls, and FPH/PPH to FPH. Post hoc bivariate regression analyses examined specific FPH pathologies and PCS.RESULTS Athletes with FPH/PPH compared with controls had an increased risk of PCS (chi(2) = 8.90, p = 0.018; OR 5.06, 95% CI 1.71-14.99). Athletes with FPH only compared with controls also had an increased risk of PCS (chi(2) = 6.04, p = 0.03; OR 2.52, 95% CI 1.20-5.30). Comparing athletes with FPH/PPH to athletes with FPH only, no added PCS risk was noted (chi(2) = 1.64, p = 0.247; OR 2.01, 95% CI 0.68-5.94). Among various FPH diagnoses, anxiety (chi(2) = 7.48, p = 0.021; OR 2.99, 95% CI 1.36-6.49) and bipolar disorder (chi(2) = 5.13, p = 0.036; OR 2.74, 95% CI 1.14-6.67) were significantly associated with the presence of PCS.CONCLUSIONS Concussed high school athletes with FPH/PPH were greater than 5 times more likely to develop PCS than controls. Athletes with only FPH were over 2.5 times more likely to develop PCS than controls. Those with an FPH of anxiety or bipolar disorder are specifically at increased risk of PCS. These results suggest that not only are athletes with FPH/PPH at risk for slower recovery after SRC, but those with an FPH only-especially anxiety or bipolar disorder-may also be at risk. Overall, this study supports taking a detailed FPH and PPH in the management of SRC.