Are There Differences in Reported Symptoms and Outcomes Between Pediatric Patients with and Without Obsessive Compulsive Disorder After a Concussion?

Background: Much attention has been given to the role of certain mental health conditions in concussions. However, despite Obsessive Compulsive Disorder (OCD) comprising an estimated in 1-3% of the pediatric population, there is limited research on OCD and concussions. This study aims to evaluate differences in symptoms and outcomes in participants with self-reported, pre-existing OCD versus those without OCD following a concussion.

Methods: Data were prospectively gathered from participants aged 11-21 enrolled in the North Texas Concussion Network Registry (ConTex) who were diagnosed with a concussion. Each participant with self-reported history of OCD was matched to 2 controls without OCD in terms of sex, age (+/- 1 year), mechanism of concussion (MVAs versus grouping of sports, hits, and falls), and history of psychological disorders, anxiety and depression. Demographics, medical history, clinical measures, including SCAT-5 Symptom Evaluation, Generalized Anxiety Disorder (GAD-7) scale, Patient Health Questionnaire (PHQ-8), and outcomes associated with prolonged symptom resolution (≤30, >30 days) and return-to-play (RTP) were evaluated. For statistical analysis, Chi-square or Fisher’s exact tests were used for categorical variables and the Mann-Whitney test was used for continuous variables.

Results: 39 participants were included, 13 with OCD and 26 without OCD. Within the OCD cohort, 5 participants reported a history of anxiety, 1 reported depression, and 6 reported both anxiety and depression. There were no significant differences in ethnicity, race, or previous concussion history. At the initial visit and 3-months post-enrollment, the OCD group did not show significant differences in Symptom Severity, GAD-7, and PHQ-8 scores (Table 1).

While the OCD group reported lower back to normal percentages (75.60% vs 89.84%, p=0.16) and took longer to initiate RTP at the 3-month mark (57.10± 61.51 vs 36.07± 36.73 days, p=0.57), these differences were not significant. Additionally, there was no difference between the OCD and non-OCD group in terms of the number of school days missed (1.50 ± 0.71 versus 1.25 ± 0.64, p=0.29) or prolonged symptoms (28.57% versus 30.77%, p=1.00). However, at 3-months, the OCD group did report significantly higher symptom scores for trouble concentrating (p=0.03), feeling irritable (p=0.02), and feeling more emotional than usual (p=0.01).

Conclusion: When controlling for other psychological disorders, age, sex, and mechanism of injury, OCD did not affect important markers of concussion presentation and recovery including symptom scores, symptom resolution, and return-to-play. Further research with larger samples is necessary to understand the influence of OCD on concussion recovery.