Graduation Term


Document Type


Degree Name

Master of Science (MS)


School of Kinesiology and Recreation

Committee Chair

Nicole Hoffman


Background: Concussions are a growing public health concern, and emerging long-term health risks may negatively impact an individual’s quality of life. With concussions, there can be a multitude of signs and symptoms, but frequent long-term sequelae of concussions including mood disturbances (e.g. trait anxiety and depression) and sleep disturbances (e.g. difficulties initiating and maintaining sleep) are given less attention. Few clinicians address mood and sleep disturbances in their concussion assessment and management plan, potentially placing individuals at risk for prolonged disturbances beyond recovery. Purpose: To examine the relationship between sleep disturbances (sleep quality) and mood disturbances (trait anxiety and depression) in healthy young adults with and without a history of concussions. Methods: Healthy young adults (n=436) from 3 universities across the country completed a one-time, 15–20-minute anonymous survey administered via Qualtrics. Survey components consisted of demographic information, concussion history, two mood disturbance questionnaires (State-Trait Anxiety Inventory and Beck Depression Inventory) and two sleep quality questionnaires (Pittsburgh Sleep Quality Index (PQSI) and Insomnia Severity Index (ISI)). Exclusion criteria consisted of having suffered a concussion or traumatic brain injury within the past 6 months, history of cancerous brain tumors, and diagnosed with post-traumatic stress disorder, schizophrenia, or bipolar disorder. Structural equation modeling (SEM) was used as the primary statistical analysis for trait anxiety (model 1) and depression (model 2). Results: Concussion history has an indirect relationship with trait anxiety and depression, where sleep quality mediates this relationship. Mediation analysis indicated no direct relationship of concussion history with anxiety and depression, but a significant direct pathway from concussion history to sleep quality (β=0.015, SE=0.005, p<0.001) and from sleep quality to trait anxiety (β=0.168, SE=0.015 p<0.001) and depression (β=0.186, SE=0.016 p<0.001). Model 1 accounted for a significant amount of variance in concussion history (7.9%) and sleep quality (37.3%,) on trait anxiety. Model 2 accounted for a significant variance for concussion history (7.7%) and sleep quality (36.6%) on depression. Conclusion: Concussion history may not influence trait anxiety and depression directly, but it may have an influence through an indirect pathway of sleep quality. Our preliminary findings demonstrate the importance of examining trait anxiety, depression, and sleep disturbances together within individuals with a history of concussion and these components collectively may be important to include as part of baseline screening and in the evaluation and management of concussion.

KEYWORDS: Concussion; Mild Traumatic Brain Injury; Mood Disturbances; Sleep Disturbances; Trait Anxiety


Page Count


Included in

Kinesiology Commons