Preliminary Evidence for a Relationship Between Anxiety, Anger, and Impulsivity in Collegiate Athletes With Sport-Related Concussion

in Journal of Clinical Sport Psychology
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  • 1 Georgia Southern University
  • | 2 University of Pittsburgh
  • | 3 West Virginia University
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This study used an exploratory mixed-method sequential design to examine anger, impulsivity, and anxiety following sport-related concussions (SRC). Ten college athletes (M = 20.10 years, SD = 2.92) completed four measures 1–10 days postconcussion (Visit 1) and 11–20 days postconcussion (Visit 2). At return to play or 30 days postconcussion, the athletes completed a semistructured interview (follow-up) to assess their lived experiences of the emotional sequelae of concussions. All participants indicated experiencing some level of anxiety at Visit 1, with half the participants scoring above the measure’s threshold for probable clinical diagnosis of anxiety. The results found a significant decrease in symptoms and anxiety at Visit 2. Inductive coding revealed frustration, irritability, impulsive behavior, and fear of the unknown as themes pertaining to athletes’ experiences. The findings highlight the need for sports medicine and sport psychology professionals to provide athletes with information to normalize their emotional responses during recovery.

Byrd is with the Health Sciences and Kinesiology, Georgia Southern University, Statesboro, GA, USA. Kontos and Eagle are with the Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. Zizzi is with West Virginia University, Morgantown, WV, USA.

Byrd (mmbyrd@georgiasouthern.edu) is corresponding author.
  • Arvinen-Barrow, M., Massey, W.V., & Hemmings, B. (2014). Role of sport medicine professionals in addressing psychosocial aspects of sport-injury rehabilitation: Professional athletes’ views. Journal of Athletic Training, 49(6), 764772. PubMed ID: 25243737 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bailie, J.M., Cole, W.R., Ivins, B., Boyd, C., Lewis, S., Neff, J., & Schwab, K. (2015). The experience, expression, and control of anger following traumatic brain injury in a military setting. Journal of Head Trauma and Rehabilitation, 30(1), 1220. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bartlett, M.L., Abrams, M., Byrd, M., Treankler, A., & Houston-Norton, R. (2018). Advancing the assessment of anger in sports: Gender differences and the STAXI-2 normative data for college athletes. Journal of Clinical Sport Psychology, 12(2), 114128. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., & Sammudt, S. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of Affective Disorders, 173(1), 9096. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bloom, G.A., Horton, A.S., McCrory, P., & Johnston, K.M. (2004). Sport psychology and concussion: New impacts to explore. British Journal of Sports Medicine, 38(5), 519521. PubMed ID: 15388529 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Braun, V., & Clarke, V. (2016). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77101.

  • Braun, V., Clarke, V., & Weate, P. (2016). Using thematic analysis in sport and exercise research. In  Smith, B., Sparkes, A.C. (Eds.), Routledge handbook of qualitative research in sport and exercise (pp. 191205). London: Routledge.

    • Search Google Scholar
    • Export Citation
  • Broshek, D.K., De Marco, A.P., & Freeman, J.R. (2015). A review of post-concussion syndrome and psychological factors associated with concussion. Brain Injury, 29(2), 228237. PubMed ID: 25383595 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cattran, C., Oddy, M., & Wood, R. (2011). The development of a measure of emotional regulation following acquired brain injury. Journal of Clinical and Experimental Neuropsychology, 33(6), 672679. PubMed ID: 21416425 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chen, J.K., Johnston, K.M., Petrides, M., & Ptito, A. (2008). Neural substrates of symptoms of depression following a concussion in male athletes with persisting post-concussion symptoms. Archives of General Psychiatry, 65(1), 8189. PubMed ID: 18180432 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Collins, M.W, Kontos, A.P., Reynolds, E., Murawski, C.D., & Fu, F.H. (2014). A comprehensive, targeted approach to the clinical care of athletes following sports-related concussion. Knee Surgery, Sports Traumatology, Arthroscopy, 22(2), 235246. PubMed ID: 24337463 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Covassin, T., Crutcher, B., Bleeker, A., Heiden, E.O., Dailey, A., & Yang, J. (2014). Post-injury anxiety and social support among collegiate athletes: A comparison between orthopedic injuries and concussions. Journal of Athletic Training, 49(4), 462468. PubMed ID: 24673237 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Daruna, J., & Barnes, P. (1993). A neurodevelopmental view of impulsivity. In  McCown, W.G., Johnson, J.L., Shure, M.B. (Eds.), The impulsive client: Theory, research, and treatment. (pp. 2337). Washington, DC: American Psychological Association.

    • Search Google Scholar
    • Export Citation
  • Dickman, S.J. (1990). Functional and dysfunctional impulsivity: Personality and cognitive correlates. Journal of Personality and Social Psychology, 58(1), 95102. PubMed ID: 2308076 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Driscoll, D.L., Appiah-Yeboah, A., Salib, P., & Rupert, D.J. (2007). Merging qualitative and quantitative data in mixed methods research: How to and why not. Ecological and Environmental Anthropology, 3(1), 1928.

    • Search Google Scholar
    • Export Citation
  • Etkin, A. (2012). Neurobiology of anxiety: From neural circuits to novel solutions? Depression & Anxiety, 29(5), 355358. PubMed ID: 22553005 doi:

  • Goswami, R., Dufort, P., Tartaglia, M.C., Green, R.E., Crawley, A., Tator, C.H., . . . Davis, K. (2016). Frontotemporal correlates of impulsivity and machine learning in retired professional athletes with a history of multiple concussions. Brain Structure and Function, 221(4), 19111925. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Greve, K.W., Sherwin, E., Stanford, M., Mathias, C., Love, J., & Ramzinski, P. (2001). Brain Injury, 15(3), 255262.

  • Hammond, F., Davis, C., Cook, J.R., Philbrick, P., & Hirsch, M. (2016). A conceptual model of irritability following traumatic brain injury: A qualitative, participatory research study. Journal of Head Trauma & Rehabilitation, 31(2), E1E11. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hutchison, M., Mainwaring, L.M., Comper, P., Richards, D.W., & Bisschop, S.M. (2009). Differential emotional responses of varsity athletes to concussion and musculoskeletal injuries. Clinical Journal of Sports Medicine, 19(1), 1319. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Iverson, G.L., Brooks, B.L., Collins, M.W., & Lovell, M.R. (2006). Tracking neuropsychological recovery following concussion in sport. Brain Injury, 20(3), 245252.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kay, M.C., & Kucera, K.L. (2018). Mixed methods designs for sports medicine research. Clinics in Sports Medicine, 37(3), 401412. PubMed ID: 29903382 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kontos, A.P., Covassin, T., Elbin, R.J., & Parker, T. (2012). Depression and neurocognitive performance after concussion among male and female high school and collegiate athletes. Archives of Physical Medicine and Rehabilitation, 93(10), 17511756. PubMed ID: 22503738 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lassiter, G.H. (2009). Impulsivity: Causes: Control and disorder. New York: Nova Biomedical Books.

  • Lievaart, M., Franken, I., H., A., & Hovens, J.E. (2016). Anger assessment in clinical and nonclinical populations: Further validation of the state-trait anger expression inventory-2. Journal of Clinical Psychology, 72(3), 263278. PubMed ID: 26766132 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lincoln, A.E., Caswell, S.V., Almquist, J.L., Dunn, R.E., Norris, J.B., & Hinton, R.Y. (2011). Trends in concussion incidence in high school sports. The American Journal of Sports Medicine, 39(5), 958963. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Llewellyn, T., Burdette, G.T., Joyner, A.B., & Buckley, T.A. (2014). Concussion reporting rates at the conclusion of an intercollegiate athletic career. Clinical Journal of Sports Medicine, 24(1), 7679. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lovell, M.R., & Collins, M.W. (1998). Neuropsychological assessment of the college football player. Journal of Head Trauma Rehabilitation, 13(2), 926.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lovell, M.R., Collins, M.W., Podell, K., Powell, J., & Maroon, J. (2000). ImPACT: Immediate post-concussion assessment and cognitive testing. Pittsburgh, PA: NeuroHealth Systems, LLC.

    • Search Google Scholar
    • Export Citation
  • McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, R., . . . Vos, P. (2017). Consensus statement on concussion in sport—The 5th international conference on concussion in sport held in Berlin, October 2016. Behavioral Journal of Sports Medicine, 51, 838847.

    • Search Google Scholar
    • Export Citation
  • Merritt, V.C., Bradson, M.L., Meyer, J.E., & Arnett, P.A. (2018). Evaluating the test–retest reliability of symptom indices associated with the ImPACT post-concussion symptom scale. Journal of Clinical and Experimental Neuropsychology, 40(4), 377388. PubMed ID: 28728465 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Monteiro, S., Bártolo, A, Torres, A., & Pereira, A. (2017). (Re)examining the factoral structure of the generalized anxiety disorder-7 in a college student sample. European Psychiatry, 41, S109. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Moore, E., Terryberry-Spohr, L., & Hope, D.A. (2006). Mild traumatic brain injury and anxiety sequelae: A review of the literature. Brain Injury, 20(2), 117132. PubMed ID: 16421060 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Patton, J.H., Stanford, M.S., & Barratt, E.S. (1995). Factor structure of the Barratt impulsiveness scale. Journal of Clinical Psychology, 51(6), 768774. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • O'Rourke, D.J., Smith, R.E., Punt, S., Coppel, D.B., & Brieger, D. (2017). Psychosocial correlates of young athletes’ self-reported concussion symptoms during the course of recovery. Sport, Exercise, and Performance Psychology, 6(3), 262276. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rice, S.M., Gwyther, K., Santesteban-Echarri, O., Baron, D., Gorcynski, P., Gouttebarge, V, . . . Purcell, R. (2019). Determinants of anxiety in elite athletes: A systematic review. Behavioral Journal of Sports Medicine, 53, 722730.

    • Search Google Scholar
    • Export Citation
  • Rochat, L., Amman, J., Mayer, E., Annoni, J.M., & van der Linden, M. (2009). Executive disorders and perceived socio-economic changes after traumatic brain injury. Journal of Neuropsychology, 3(2), 213227. PubMed ID: 19338726 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Saldaña, J. (2013). The coding manual for qualitative researchers (2nd ed.). Thousand Oaks, CA: SAGE.

  • Sandal, N., Reynolds, E., Cohen, P.E., Gillie, B.L., & Kontos, A.P. (2017). Anxiety and mood clinical profile following sport-related concussion: From risk factors to treatment. Sport, Exercise, and Performance Psychology, 6(3), 304323.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Spielberger, C.D. (1999). State-Trait Anger Expression Inventory-2: Professional manual. Odessa, FL: Psychological Assessment Resources.

    • Search Google Scholar
    • Export Citation
  • Spitzer, R.L., Kroenke, K., Williams, J.B.W., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder. Archive Internal Medicine, 166(10), 10921097. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stanford, M.S., Mathias, C.W., Dougherty, D.M, Lake, S.L., Anderson, N.E., & Patton, J.H. (2009). Fifty years of the Barratt Impulsiveness Scale: An update and review. Personality and Individual Differences, 47(5), 385395. doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Starkstein, S.E., & Robinson, R.G. (1997). Mechanism of disinhibition after brain lesions. The Journal of Nervous & Mental Disease, 185(2), 108114. PubMed ID: 9048703 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vasconcelos, A.G., Malloy-Dinez, L., & Correa, H. (2012). Systematic review of psychometric properties of Barratt Impulsiveness Scale version II. Clinical Neuropsychiatry, 9(2), 6174.

    • Search Google Scholar
    • Export Citation
  • Weber, M.L., Lynall, R.C., Hoffman, N.L., Miller, E.H., Kaminski, T.W., Buckley, T.A., . . . CARE Consortium investigators. (2018). Health-related quality of life following concussion in collegiate student-athletes with and without concussion history. Annals of Biomedical Engineering, 47(10), 21362146. PubMed ID: 30302664 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wiese-Bjornstal, D.M., Smith, A.M., & LaMott, E.E. (1995). A model of psychological response to athletic injury and rehabilitation. Athletic Training: Sports Health Care Perspectives, 1(1), 1730.

    • Search Google Scholar
    • Export Citation
  • Yang, J., Peek-Asa, C., Covassin, T., & Torner, J.C. (2015). Post-concussion symptoms of depression and anxiety in Division I collegiate athletes. Developmental Neuropsychology, 40(1), 1823. PubMed ID: 25649775 doi:

    • Crossref
    • Search Google Scholar
    • Export Citation
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