Post-concussion symptom severity phenotypes predict risk of depression after concussion in adults
By Zoe Marquis. This article was initially published in the 12/18/25 Edition of our Concussion Update newsletter; please consider subscribing.
A recent study published in BMC Psychiatry found that post-concussion symptom severity, injury severity, and psychological resilience can predict the risk of post-concussion depression in adults. Using 249 patient responses to the Rivermead Post-Concussion Questionnaire, Researchers Hung-Ju Chen et al. identified three statistically distinct clusters (or “phenotypes”) of symptom severity: mild, moderate, and severe. The researchers then used these phenotypes (as well as a measure of participants’ psychological resilience and their Glasgow Coma Scale score at time of injury) to build a model that predicted post-concussion depression. The model showed that participants in the “moderate” cluster were 5 times more likely to experience post-concussion depression than those in the “mild” cluster, and participants in the “severe” cluster were 17 times more likely to experience post-concussion depression than those in the “mild” cluster. Higher Glasgow Coma Scale and resilience scores were protective factors, meaning that they reduced the risk of post-concussion depression.
Overall, the model was able to correctly discriminate between patients who developed post-concussion depression and those who did not 88% of the time, which is excellent for this kind of model. These findings provide a way to identify patients with a higher risk of post-concussion depression, allowing for targeted intervention and helping focus the limited resources available for mental health care where they are needed most. The authors recommend that clinicians “integrate both symptom severity clustering and resilience assessments into routine post-mTBI evaluation.”
The researchers collected data from 249 adults who had been diagnosed with a concussion in the past six months. They assessed participants’ depression levels, resilience, and symptom severity using existing assessment tools. They also recorded participants’ documented Glasgow Coma Scale score at the time of their injury. Patients with prior depression or a history of psychological hospitalization were excluded. Interestingly, the researchers found that patients in the “severe” symptom cluster experienced vision disturbances (such as light sensitivity and double vision) more often than patients in the mild and moderate clusters; They also had the greatest headache burden. The researchers suggest that screening for these symptoms early may help identify patients with the greatest risk for secondary depression, allowing for timely assessment and interventions. The researchers note that their study is limited in its generalizability due to being conducted at a single hospital in Taiwan. Specifically, they mention that attitudes towards mental health, as well as available support structures, differ by region. The researchers also note that stigma towards mental health may have influenced self-reports for the depression and resilience assessments.
