Concussion Management Defined

Validity of ImPACT Post-Concussion Symptom Scale (PCSS) Affective Symptom Cluster as a Screener for Depression in Collegiate Athletes

Arch Clin Neuropsychol. 2018 Nov;

[Epub ahead of print](12-Nov):.

Riegler, K. E., Guty, E. T. and Arnett, P. A..


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Objective: The relationship between depression and sports-related concussion is complex and has implications both pre- and post-injury. The current study established the construct validity, convergent and discriminant, of the affective symptom cluster of The Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) post-concussion symptom scale (PCSS) as a screening tool for depression.

Method: Nine hundred and thirty (M = 695, F = 235) college athletes were assessed at baseline using the ImPACT PCSS and Beck-Depression Inventory-Fast Screen (BDI-FS). Previous factor analysis identified four symptom clusters on the PCSS: affective, physical, cognitive, and sleep. Clinically significant depression was operationalized as a BDI-FS score >/=4. Receiver Operating Characteristic curves (ROC) were used to determine the ideal cutoff, Chi-square tests of independence were calculated to establish convergent validity, and Fisher’s r-to-z comparisons were used to establish discriminant validity of the affective symptom cluster.

Results: The 90th percentile cutoff yielded the highest sensitivity and specificity on the affective symptom cluster for males (4) and females (6). The correlation between BDI-FS and the 90th percentile cutoff was statistically significantly higher in females (phi = .96) than males (phi = .83), Z = 9.49, p < .001. When correlating the BDI-FS with each PCSS symptom cluster, the correlation with the affective symptom cluster was stronger than its correlation with cognitive, sleep, and physical clusters across gender.

Discussion: By utilizing a measure of depression within an existing and commonly used assessment, clinicians can easily screen for depression and identify athletes at risk for complicated recovery even in the absence of a supplemental depression assessment.

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