Sex-Based Differences in Concussion Outcomes Among Adolescents and Young Adults

Concussive injuries among youth are a serious public health concern in the United States, with increasing incidence leading the Centers for Disease Control and Prevention to classify these injuries a “silent epidemic.” Though most concussions in youth resolve within a few weeks, a significant proportion (~15-20%) of individuals will experience persisting symptoms that can negatively affect important aspects of social life, as well as academic and vocational performance. Furthermore, guidelines from the most recent Consensus Statement on Concussion in Sport highlight the importance of considering individual characteristics that may modify the nature and outcomes of concussion. Biological sex is one such factor gaining interest among researchers and health care professionals. Present scientific literature indicates adolescent and young adult females may experience higher rates of concussion and may be more likely to experience longer recoveries when compared to male counterparts. However, current evidence regarding the influence of biological sex on symptoms, cognitive function, and psychological health following concussive injury remains tentative and incomplete. Additionally, important biological factors, such as sex hormones, may moderate recovery outcomes in females; though current evidence is limited. Therefore, the purpose of this study was to further examine the influence of biological sex and sex-based hormones on concussion outcomes among adolescents and young adults. The series of investigations that comprise this study span clinical, population-based, and college athletic settings to thoroughly examine potential sex-based differences across symptom, cognitive, and psychological outcomes of concussion. Overall, results from the present study suggest that females may exhibit increased symptom burden and greater cognitive dysfunction following concussion when compared to males. In general, results from the present study do not indicate concussed females and males experience differing levels of depression which cannot be explained by potential baseline differences. However, when factoring for other key moderators of injury (i.e., frequency prior concussion), our results indicate females and males may exhibit differing mental health risk behaviors. Specifically, results indicate females with single or multiple concussions exhibit greater odds of reporting increased suicidal behaviors; whereas males with history of concussion may only exhibit increased odds of reporting increased suicidal behaviors in the context of multiple concussions. Lastly, our results do not indicate that hormonal factors (i.e., hormonal contraceptives) influence post-concussive recovery outcomes. Altogether, findings from the studies described herein address important gaps in current literature, and illuminate the influence of biological sex on symptom, cognitive, and psychological outcomes of concussion