Date of Graduation

5-2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Health, Sport and Exercise Science (PhD)

Degree Level

Graduate

Department

Health, Human Performance and Recreation

Advisor/Mentor

Elbin, R.J.

Committee Member

McDermott, Brendon

Second Committee Member

Leen-Feldner, Ellen

Third Committee Member

Hickey, Erin Howie

Keywords

concussion; symptom-based anxiety disorder

Abstract

Background: Anxiety is common following a concussion, arising from both psychosocial and physiological changes, and can manifest in diverse ways. Despite its complexity and association with worse outcomes, post-concussion anxiety is often assessed as a single construct. Characterizing anxiety presentations following injury may improve the identification of clinically meaningful symptoms and help inform future targeted interventions that can improve concussion outcomes. Purpose: The primary purpose was to determine if symptom-based anxiety disorders occur in adults with concussion and identify pre- and post-injury predictors associated with these disorders. Additionally, the clinical utility and predictive abilities of symptom-based anxiety disorders and variability of disorders across stages of recovery were explored. Study Design: A cross-sectional observational study design was employed. Methods: 101 adults between 18-40 years (M=27.55+6.35) completed the Screen for Adult Anxiety Related Disorders (SCAARED) following their first clinical evaluation for a diagnosed concussion. SCAARED was completed by participants either remotely (n=39) or in-person (n=62). Scores were calculated for each of the four anxiety domains (panic disorder or significant somatic symptoms: PA/SSS, generalized anxiety disorder: GAD, separation anxiety disorder: SEP, and social phobia disorder: SOC), and established cutoff scores were used to indicate the presence or absence of elevated symptoms within each anxiety disorder. Pre- and post-injury factors, clinical profile assignment at initial evaluation, recovery duration, and phase of recovery at the time of the first visit were examined in relation to disorders. Results: Symptom-based anxiety disorders were frequently observed following concussion, with PD/SSS (81%) being the most frequent and SOC (37%) being the least. Distinct and unique pre- and post-injury factors were associated with specific anxiety disorders. Symptom-based anxiety disorders demonstrated differential associations with having an anxiety/mood clinical profile at initial evaluation but were not associated with protracted recovery. Finally, proportions of patients with each anxiety disorder did not significantly change across recovery phases, but descriptively, PD/SSS and GAD were highest acutely, while SEP and SOC peaked in the chronic phase. Conclusions: Post-concussion anxiety presents through distinct symptom-based disorders with unique predictors, supporting more individualized assessment approaches and informing future research aimed at improving identification, management, and outcomes during concussion recovery.

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