How Do Depression and Anxiety Affect Concussion Recovery?

| By Dr. Jennifer Hunnicutt

Recent study using PHQ-9 and GAD-7 shows depression and anxiety symptoms predict longer concussion recovery.

We all know that depression and anxiety affect general health and well-being. But how do depression and anxiety affect concussion recovery?

We have previously talked about mental health on the HEADCHECK blog here. And we know that it takes a team, including mental health professionals, to manage concussions.

But how exactly do depression and anxiety affect time to concussion recovery?

The symptoms of depression and anxiety are closely connected to some of the symptoms of concussion and head injury. Therefore, it is plausible that those individuals with depression and/or anxiety may struggle with concussion recovery more than those without mental health conditions.

Concussion Checklist For Parents and Athletes

Recent Research on Depression and Anxiety Symptoms Following a Concussion

Dr. Narducci and his fellow researchers sought to determine if scores on depression and anxiety questionnaires could be used to predict time to concussion recovery. (1)

They conducted a retrospective review of medical charts of 503 patients who visited a university-based concussion center. The average age of the patients was 23 years. The majority of the concussions (43%) were sport-related.

To quantify symptoms of depression, they used the Patient Health Questionnaire-9 (PHQ-9). To quantify symptoms of anxiety, they used the General Anxiety Disorder-7 (GAD-7).

The PHQ-9 is a nine-item questionnaire used to quantify depression symptoms and monitor severity. The GAD-7 is a seven-item questionnaire used to quickly screen for clinically significant anxiety disorder.

Importantly, these questionnaires shouldn’t be solely used to diagnose depression or anxiety. But rather, they aid clinicians in determining symptoms of depression or anxiety and monitoring them over time.

Through this study, the researchers first determined optimal cutoff points for the questionnaires: PHQ-9 > 6 and GAD-7 > 4. In other words, researchers were able to determine that patients with these scores recovered at slower rates.

Depression and Anxiety Symptoms Predict Concussion Recovery Time

Patients with symptoms of depression and anxiety did have a longer concussion recovery time, as evidenced by the following findings:

  • Depression Symptoms
    • Patients with PHQ-9 > 6 recovered in 33 days versus patients with PHQ-9 ≤ 6 recovered in 17 days.
    • Patients with a PHQ-9 > 6 are 48% less likely to recover.
  • Anxiety Symptoms
    • Patients with GAD-7 > 4 recovered in 32 days versus patients with GAD-7 ≤ 4 recovered in 19 days.
    • Patients with GAD-7 > 4 are 45% less likely to recover from a concussion.

They also found that patients with a history of depression or anxiety are 50% less likely to recover from a concussion.


These results that depression and anxiety symptoms predict longer concussion recovery are extremely eye-opening. The PHQ-9 and GAD-7 could be used as screening tools to identify symptoms of depression and anxiety, respectively. They could be used to identify those patients at risk for longer concussion recovery. And more importantly, they could be used to identify patients that may need early psychological intervention post-concussion.

It should be noted that this was a retrospective study on previous medical chart information. Thus, prospective studies are needed to support these findings. Future prospective research should develop effective interventions for patients with or at risk for depression and anxiety.

It is encouraging to see mental health concerns related to concussion being researched and talked about more and more!

PHQ-9 is included as part of the HEADCHECK test suite. Contact us to learn more.


  1. Narducci DM, Moran B, Coris E, Tsalatsanis A, Graulich I, Del Rossi G. Predicting Concussion Recovery with PHQ-9 and GAD-7. South Med J. 2021 Dec;114(12):760-765. doi: 10.14423/SMJ.0000000000001336. PMID: 34853851.
Dr. Jennifer Hunnicutt

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