Sex Differences in Concussion Outcomes

Sport-related concussion is a growing health concern, particularly in younger, at-risk athletic populations. Between 1.6 and 3.8 million sport- and recreation-related traumatic brain injuries occur annually in the U.S. Recently, there has been a focus on sex differences in concussion and related outcomes. Research has suggested that females are at higher risk for concussion than males and may take longer to recovery from a concussion compare to males. Specifically, female athletes have reported more total symptoms, vestibular and ocular-motor deficits and neurocognitive impairments following a sport-related concussion. Our research focuses on sex differences in concussion outcomes among athletes.

  • Moran, R., Covassin, T., Elbin, RJ. (2019). Sex differences on vestibular and ocular motor assessment in youth athletes. Journal of Athletic Training. 54(4), 445-448. [PubMed]
  • Covassin, T., Savage, J. L., Bretzin, A. C., LaFevor, M. E. (2018). Sex Differences in Acute and Sub-Acute Outcomes Following Sports-Related Concussion. International Journal of Psychophysiology. 132, 9-13. [PubMed]
  • Wallace, J., Covassin, T., Beidler, E. (2017). Sex Differences in Knowledge of Concussion and Reporting Behaviors among High School Student Athletes. Clinical Journal of Sports Medicine. 27(2), 133-138. [PubMed]
  • Sufrinko, A., Covassin, T., Mucha, A., Marchetti, G., Elbin, RJ., Collins, M., Kontos, A. (2017). Sex Differences in Vestibular/Ocular and Neurocognitive Outcomes After Sport-Related Concussion. Clinical Journal of Sports Medicine. 27(2), 133-138. [PubMed]
  • Covassin, T., Moran, R., Elbin, R.J., (2016). Sex Differences in Concussion Injury Rates and Time Loss from Participation: An Update of the NCAA ISS from 2004-2005 to 2008 – 2009. Journal of Athletic Training. 51(3), 189-194. [PubMed]

Risk Factors Associated with Concussion Outcomes

Identifying athletes who are at risk for sport-related concussion and/or prolonged recovery is important for informing prevention efforts and management approaches. In addition, clinicians who are aware of factors that influence sport-related concussion risk and recovery are more informed and better prepared to discuss prognosis and expectations for recovery with the injured athlete. Researchers have suggested that the concussion history and age are association with future risk of injury and prolonged recovery. Our research examines neurocognitive deficits and symptom reports that predict protracted recovery pediatric population and athletes with multiple concussions.

  • McGowan, A.L., Bretzin, A.B., Savage, J.L., Petit, K.M., Covassin, T., Pontifex, M.B. (2019). Acute and persistent disruptions to inhibitory control following sports-related concussion. Neuropsychologia. 131, 223-232. [PubMed]
  • Moran, R., Wallace, J., Covassin, T. (2019). Premorbid migraine history as a risk factor for vestibular and oculomotor baseline concussion assessment in pediatric athletes. Journal of Neurosurgery: Pediatrics. 23(4), 465-470. [PubMed]
  • Elbin, R.J., Covassin, T., Gallion, C., Kontos, A.P. (2015). Factors Influencing Risk and Recovery from Sport-related Concussion: Reviewing the Evidence. Neurophysiology and Neurogenic Speech and Language Disorders. 25, 4-16. [Link]
  • Covassin,T., Moran, R., Wilhelm, K. (2013). Concussion Symptoms and Neurocognitive Performance of High School and College Athletes who Incur Multiple Concussions. American Journal of Sports Medicine. 41(12). 2885-2890. [PubMed]
  • Elbin, R.J., Covassin, T., Hakun, J., Kontos, A.P., Berger, K. Pfeiffer, K. & Ravizza, S. (2012). Do Brain Activation Changes Persist in Athletes with a History of Multiple Concussions Who Are Asymptomatic? Brain Injury. 26, 1217-1225. [PubMed]
  • Covassin, T., Elbin, R.J., Parker, T., Harris, B., Kontos, A.P. (2012). The Role of Age and Sex on Symptoms, Neurocognitive Performance, and Postural Stability in Athletes after Concussion. American Journal of Sports Medicine. 40(6), 1303-12. [PubMed]

Psychological Factors Related to Concussion Outcomes

Mood disturbances have been suggested to be a potential modifying factor for concussed athletes. Previously, we have documented depression in high school athletes up to 14 days post-injury and anxiety in collegiate athletes. Baseline depression was the strongest predictor of post-concussion depression and anxiety. These results call for programs to effectively address both psychological predictors and consequences of concussions. Therefore, our research focuses on psychosocial factors that may influence recovery from a sports-related concussion.

  • Covassin, T., Bretzin, A.B., Japinga, A., Teachnor-Hauk, D., Nogle, S. (2019). Exploring the relationship between depression and seasonal affective disorder in collegiate athletes. Athletic Training and Sports Health Care. 11(3), 124-131. [Link]
  • Covassin, T., Elbin, R.J., Beidler, E., LaFevor, M., Kontos, A. (2017). A Review of Psychological Issues that May be Associated with a Sport-related Concussion in Youth and Collegiate Athletes. Sport, Exercise and Performance Psychology. 6(3), 220-229. [Link]
  • Beidler. E., Donnellan, B., Covassin, T., Phelps, A., Kontos, A. (2017). Association Between Personality Traits and Sport-related Concussion History in Collegiate Student-athletes. Sport, Exercise and Performance Psychology. 6(3), 252-261. [Link]
  • Covassin, T., Beidler, E., Oswtroski, J., Wallace, J. (2015). Psychological Aspects of Rehabilitation in Sport. Clinics in Sports Medicine. 34. 199–212. [PubMed]
  • Yang, G., Peek-Asa, C., Covassin, T., Torner, J. (2015). Post-concussion Symptoms of Depression and Anxiety in Division I Collegiate Athletes. Developmental Neuropsychology. 40(1), 18–23 . [PubMed]
  • Covassin, T., Crutcher, B., Fisher, A., Yang, G., Heiden, E., Dailey, A. (2014). Post-injury Anxiety and Social Support among Collegiate Athletes: a Comparison between Orthopaedic Injuries and Concussions. Journal of Athletic Training. 49(4), 462–468. [PubMed]

Epidemiology of Sport-Related Concussion

In collegiate and high school athletics, the participation of female athletes has increased dramatically since the implementation of Title IX as part of the Equality in Education Act of 1972. Due to this increase in sport participation, it is expected that the annual incidence of sport-related concussion will continue to rise. Our research suggests that female concussed athletes participating in comparable sports (i.e., soccer, basketball) have a higher injury rate than male concussed athletes. Our research will continue to focus on sport-related concussion injury rates at the youth, high school and collegiate levels.

  • Bretzin, A., Covassin, T., LaFevor, M., Petit, K., Savage, J., Walker, L., Gould, D. (2018). Sex Differences in Clinical Incidence, Missed School Days and Time-loss in Michigan High School Student Athletes. Part 1. American Journal of Sports Medicine. 46(9), 2263-69. [PubMed]
  • Covassin, T., Petit, K., Savage, J., Bretzin, A., LaFevor, M., Walker, L., Gould, D. (2018). Sport-related concussion occurrence at various time-points during high school athletic events: Part 2. American Journal of Sports Medicine. 46(9), 2270-76. [PubMed]
  • Wasserman., E., Kerr, Z., Zuckerman, S., Covassin,T. (2016). Epidemiology of Sports-Related Concussions in National Collegiate Athletic Association Athletes From 2009-2010 to 2013-2014: Symptom Prevalence, Symptom Resolution Time, and Return-to-Play Time. American Journal of Sports Medicine. 44(1), 226–233. [PubMed]
  • Zuckerman, S., Kerr, Z., Yengo-Kahn, A., Wasserman., E., Covassin, T., Solomon, G. (2015). Epidemiology of Sports-Related Concussion in NCAA Athletes From 2009-2010 to 2013-2014: Incidence, Recurrence, and Mechanisms. American Journal of Sports Medicine. 43(11), 2654–2662. [PubMed]