Growing research supports the central role of psychological factors, including anxiety and depression, in recovery from sport-related concussion (SRC).1 Indeed, mental health is among the most robust predictors of concussion outcomes, including SRC.1 This is reflected in the recent Consensus Statement on Concussion in Sport,2 which explicitly recommends consideration of anxiety, depression and psychological response to injury in assessment and treatment, including referrals for psychological evaluation as needed. However, these recommendations often fail to trickle down to clinical practice. Psychological factors remain under-addressed,3 and programmes specifically addressing psychological factors after SRC (eg, dealing with anxiety, teaching coping skills) remain scarce. In this commentary, we identify four challenges impeding the integration of psychological care into the treatment of SRC, and we propose strategies to ‘tackle’ these challenges. Despite considerable support for a biopsychosocial approach in SRC assessment and treatment as well as recommendations to monitor and address anxiety and depression symptoms in concussion treatment guidelines (eg, Ontario Living Concussion Guidelines),4 the majority of SRC measures neither require robust psychological health screening nor typically include metrics to assess coping skills. The most highly recommended screening and assessment tools, including the most recent Consensus Statement on Concussion in Sport, the Sport Concussion Assessment Tool 6, the Sport Concussion Office Assessment Tool (SCOAT6), Post-Concussion Symptom Scale and the Rivermead Post Concussion Symptoms Questionnaire, are limited to a gross and non-specific assessment of psychological factors.2 5–8 The recently released SCOAT6 covers more psychological factors than previous measures, yet these are classified as ‘optional’. Despite acknowledging psychological factors, these tools and recommendations remain discordant with the mounting evidence supporting the importance and prognostic value of psychological factors in recovery from SRC.1 9 This likely results in under-identifying emotional and psychological needs important …

中文翻译：

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为什么心理因素在运动相关脑震荡治疗中仍然被忽视以及我们可以采取什么措施


越来越多的研究支持包括焦虑和抑郁在内的心理因素在运动相关脑震荡 (SRC) 恢复过程中的核心作用。1 事实上，心理健康是包括 SRC 在内的脑震荡结果最有力的预测因素之一。1 这反映在最近的《运动脑震荡共识声明》2 明确建议在评估和治疗中考虑焦虑、抑郁和对伤害的心理反应，包括根据需要转介进行心理评估。然而，这些建议往往无法落实到临床实践。心理因素仍然没有得到充分解决，3并且专门解决 SRC 后心理因素的项目（例如，处理焦虑、教授应对技能）仍然很少。在这篇评论中，我们确定了阻碍将心理护理纳入 SRC 治疗的四个挑战，并提出了“应对”这些挑战的策略。尽管在 SRC 评估和治疗中采用生物心理社会方法以及在脑震荡治疗指南（例如安大略生活脑震荡指南）4 中监测和解决焦虑和抑郁症状的建议得到了大力支持，但大多数 SRC 措施既不需要强有力的心理健康筛查，也不需要通常包括评估应对技能的指标。最强烈推荐的筛查和评估工具，包括最新的运动脑震荡共识声明、运动脑震荡评估工具 6、运动脑震荡办公室评估工具 (SCOAT6)、脑震荡后症状量表和 Rivermead 脑震荡后症状问卷，仅限于对心理因素的粗略和非具体评估。2 5–8 最近发布的 SCOAT6 比以前的测量涵盖了更多的心理因素，但这些因素被归类为“可选”。尽管承认心理因素，但这些工具和建议仍然与越来越多的证据不一致，这些证据支持心理因素在 SRC 恢复中的重要性和预后价值。1 9 这可能会导致无法识别重要的情感和心理需求……