Perceived Stress, Mindfulness, and Clinical Concussion Outcomes in Adults with a Concussion History

Abstract

ABSTRACT Introduction Higher perceived stress negatively impacts concussion recovery, but there are limited data examining connections between perceived stress and concussion. Additionally, higher mindfulness is associated with lower perceived stress, but there is limited research on how mindfulness impacts concussion outcomes. Therefore, this study aimed to estimate the associations among perceived stress, mindfulness, and clinical concussion outcomes. Methods This was a cross-sectional, observational study in 80 young adults with a concussion history. Participants completed a single study visit measuring the following: 1) demographics, concussion history, and current mindfulness practice; 2) perceived stress (Perceived Stress Scale); 3) mindfulness (Five Facet Mindfulness Questionnaire); and 4) clinical concussion outcomes/symptoms (Rivermead Post-Concussion Symptoms Questionnaire), balance performance (Balance Error Scoring System (BESS) and center of mass), autonomic nervous system function (heart rate variability), vestibular/ocular function (vestibular ocular motor screening), and exertion tolerance (step test). Separate multivariable linear regression models were used to determine the associations among 1) perceived stress and clinical concussion outcomes and 2) mindfulness and clinical concussion outcomes. Next, a perceived stress and mindfulness interaction term was included to test the potential moderation effect of mindfulness on clinical concussion outcomes. Results Higher perceived stress was significantly associated with higher concussion symptom severity (P < 0.001) and higher number of concussion symptoms reported as worse than before injury (P < 0.001). Higher mindfulness was associated with lower concussion symptom severity (P < 0.001), and fewer concussion symptoms reported as worse than before injury (P = 0.002). There were no clinically significant models where the interaction effect was also significant, but the BESS parameter estimate did show statistical significance in the interaction model. Conclusions Our results provide a novel understanding of the association among perceived stress, mindfulness, and clinical concussion outcomes. These data are necessary to inform mechanistic concussion rehabilitation interventions.