Magdalena Wojtowicz

Background: More severe substance use, defined as higher scores on validated measures of problematic use, is increasing within young adult populations. Substance use has been associated with mild traumatic brain injury (mTBI) and elevated symptoms of depression and anxiety. We aimed to understand the relationship between these factors and sex differences in a university sample. Method: 894 university students (372 males and 522 females, aged 18–25 years) self-reported their mTBI history, substance use (Alcohol Use Disorders Identification Test (AUDIT) and the Cannabis Use Disorders Identification Test-Revised (CUDIT-R)), and psychological measures (Patient Health Questionnaire–9 (PHQ-9) and Generalized Anxiety Disorder–7 (GAD-7). Regression analyses examined whether the number of previous mTBIs was associated with increased cannabis (within the past six months) or alcohol use (within the past twelve months) severity. Logistic and linear regression models were used to explore how mTBI history, sex, and mental health symptoms relate to the likelihood and severity of cannabis and alcohol use and were also run separately by sex. Results: Individuals with multiple mTBIs reported more problematic substance use and a higher number of substances used. Hazardous substance use, as defined by scores above AUDIT and CUDIT-R cut-offs, was associated with both a previous history of mTBI and greater scores on depression and anxiety measures. Individuals with higher scores on an anxiety measure were more likely to use cannabis, especially if they had a history of mTBI. A history of mTBIs and higher current depression scores among cannabis users was associated with more problematic cannabis use. Among alcohol-using individuals, those with higher depression scores in addition to a history of mTBI were more likely to endorse more problematic alcohol use. Finally, males and females were affected differently by mental health and mTBI risk factors. Conclusion: mTBI history and mental health problems may be associated with hazardous substance use, but these findings highlight the importance of considering sex-specific risk patterns when developing interventions or preventive strategies for young adults with a history of mTBI or elevated anxiety/depression symptoms.

Objective: This study examined associations between Sport Concussion Assessment Tool-5 (SCAT-5) symptom reporting and gold-standard measures of anxiety and depression, and explored the utility SCAT-5 symptom subscales to identify anxiety and depression symptomology. Design: Prospective cross-sectional study. Setting: York University in Toronto, Canada. Participants: Preseason data were collected for varsity athletes (N = 296) aged between 17 and 25 years (M = 20.01 years, SD = 1.69 years; 52% male). Main Outcome Measures: The SCAT-5 symptom evaluation scale was used to assess baseline symptoms. The Generalized Anxiety Disorder Index-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess symptoms of anxiety and depression, respectively. Results: Endorsement of SCAT-5 symptoms of feeling anxious, sadness, irritability, and feeling more emotional had the strongest correlations with the GAD-7 (r’s > 0.400; P’s < 0.001). Sadness, trouble falling asleep, concentration problems, feeling slowed down, anxious, irritability, mental fog, fatigue, and memory problems had the highest correlations with the PHQ-9 (r’s >0 .400; P’s < 0.001). The Emotional subscale from the SCAT-5 predicted mild to severe anxiety on the GAD-7 (P < 0.001). The Sleep, Cognitive, and Emotional subscales predicted mild to severe depression on the PHQ-9 (P’s < 0.05). Conclusions: These findings provide better delineation of symptoms endorsed on the SCAT-5 symptoms that aid in identification of athletes with symptoms of anxiety or depression who may be at risk for developing a clinical disorder or experiencing persistent symptoms after a concussion.

Our prior research has suggested that athletes with history of traumatic brain injuries (TBIs) are at greater risk of single and polysubstance use. The present study further explored the factors associated with this relationship in a large undergraduate population. 894 university students (44% athletes) completed self-reported TBI history (blows to the head or whiplash causing loss of consciousness or memory, or feeling dazed), substance use (Alcohol and Cannabis Use Disorders Identification Tests (AUDIT; CUDIT)) and psychological measures. Relationships between these factors were examined using linear regression models. 200 (22.4%) students reported a history of one or more TBIs (45.63% sport-related). TBI history predicted current cannabis and alcohol use, with those with a history of multiple TBIs reporting more problematic use of each substance (ps<.01) as well as greater polysubstance use (p<.001). Past history of depression predicted more problematic cannabis use (p=.007), while past history of anxiety and depression predicted more problematic alcohol use. When examining multiple factors associated with use, history of TBIs (p=.008) and higher current depression symptoms (p=.006) predicted more problematic cannabis use, whereas for alcohol users, history of TBI and female sex was related to more problematic use (p=.041). History of TBI predicts higher levels of substance use and polysubstance use and increased number of TBIs and mental health problems may be related to greater risk of hazardous substance use. Consideration of TBI history is essential for identifying players at risk for engaging in problematic behaviours such as hazardous substance use.

[Outstanding Trainee Award Winner] Assessment of postural balance in varsity athletes is essential to managing sport-related concussion. The current study characterizes the relationship between subjective and objective measures of balance in varsity athletes. A total of 208 varsity athletes across 12 sports participated in pre-season testing from June 2019 to January 2020 (no history of concussion= 117; 1+ past concussion= 91). Measures included the Sport Concussion Assessment Tool (SCAT-5) and the AccuGait force plate. Relationships between objective and subjective balance measures were assessed using correlations, parametric, and non-parametric tests. Of the total sample, 9.6% (n=20) endorsed subjective balance issues and 5.3% (n=11) reported subjective dizziness. Those with a history of concussion, endorsed greater total number of symptoms at baseline (M=2.95, SD=4.03) than those without (M=1.90, SD=3.07; p=.04; Cohen’s d=.30). However, there were no differences on subjective or objective balance measures (i.e., total balance error on the MBESS or force plate measures; ps>0.05) between athletes with and without a history of concussion. For those with no history of concussion, total balance errors from the Modified Balance Error Scoring system were significantly associated with force plate metrics in the eyes closed condition (ps0.05). Similarly, no associations were found between subjective balance issues and objective balance metrics. Overall, findings suggest poor alignment between subjective and objective balance measures in varsity athletes, regardless of concussion history. Associations were observed across the objective balance measures in those with no history of injury, but not in athletes with a history of concussion.

Objective: This study examined the relationship between mild traumatic brain injury (mTBI) history, mental health, and sex with single and polysubstance use in university athletes. Design: Observational study. Setting: University in Ontario, Canada. Participants: Participants were identified from a dataset of 416 university athletes ages 18 to 21. Participants were classified based on their substance use habits and, 153 met criteria for the nonsubstance group, 195 for the alcohol use (AU) only group, and 64 polysubstance use group [ie, a combined substance use (AU+) group]. Independent Variables: Athletes received baseline assessments and completed self-reported questions regarding alcohol, cannabis, or other recreational substance use, the Patient Health Questionnaire-9, self-reported mTBI history, and self-reported anxiety, and/or panic disorder endorsement information. Main Outcome Measures: Comparison of mTBI history and mental health status between individuals in the alcohol only or polysubstance use group. Results: Mild traumatic brain injury history was a significant predictor of AU (P < 0.001) and AU+ (P < 0.001). Anxiety endorsement was also a significant predictor of polysubstance use (P < 0.001) and there was a small but nonsignificant association of polysubstance use in men (P = 0.057). Conclusions: University athletes who experience mTBI are more likely to engage in single or polysubstance use and athletes who experience anxiety are more likely to engage in polysubstance use. Consideration of mTBI history and mental health may inform clinical concussion management for identifying potential high-risk behavior such as polysubstance use in university athletes and tailoring intervention strategies (eg, incorporating education about substance use).

University athletes are exposed to numerous impacts to the body and head, though the potential cumulative effects of such hits remain elusive. This study examined resting-state functional connectivity (rsFC) of brain networks in female varsity athletes over the course of a season. Nineteen female university athletes involved in collision ( N = 12) and contact ( N = 7) sports underwent functional magnetic resonance imaging scans at both pre- and post-season. A group-level independent component analysis (ICA) was used to investigate differences in rsFC over the course of a season and differences between contact and collision sport athletes. Decreased rsFC was observed over the course of the season between the default mode network (DMN) and regions in the frontal, parietal, and occipital lobe ( p false discovery rate, ≤0.05) driven by differences in the contact group. There was also a main effect of group in the dorsal attention network (DAN) driven by differences between contact and collision groups at pre-season. Differences identified over the course of a season of play indicate largely decreased rsFC within the DMN, and level of contact was associated with differences in rsFC of the DAN. The association between exposure to repetitive head impacts (RHIs) and observed changes in network rsFC supplements the growing literature suggesting that even non-concussed athletes may be at risk for changes in brain functioning. However, the complexity of examining the direct effects of RHIs highlights the need to consider multiple factors, including mental health and sport-specific training and expertise, that may potentially be associated with neural changes.

Examining non-sport-related cognitive tasks of attention and executive control in skilled athletes may provide insight into the acquisition of highly specific skills developed in experts as well as help identify successful performance in sport. Through a cross-sectional design, this study examined performance on aspects of attention and executive control among varsity athletes playing soccer (strategic sport) or track & field (static sport) using a computerized test of attention and executive control. Ninety-seven university athletes participating in soccer (n = 50) or track and field (n = 47) were included in the study. Domains of attention and executive control were examined using the Attention Network Test-Interactions (ANT-I). Mean reaction time (RT) and intra-individual variability (IIV) were compared between groups as measures of performance speed and performance stability respectively. Soccer players demonstrated overall faster RTs (p = 0.0499; ηp2 = .04) and higher response accuracy (p = .021, d = .48) on the ANT-I compared to track and field athletes. Faster RTs were observed for soccer players when presented with an alerting tone (p = .029, d = .45), valid orienting cue (p = .019, d = .49) and incongruent flanker (p = .031, d = .45). No significant group differences were observed in IIV (p = .083, d = .36). Athletes engaging in strategic sports (i.e., soccer) demonstrated faster performance under test conditions that required higher vigilance and conflict resolution. These findings suggest that engagement in strategic sports is associated with enhanced performance on non-sport-related cognitive tasks of attention and executive control.

To examine attention, executive control, and performance variability in healthy varsity athletes and identify unique resting-state functional connectivity (rsFC) patterns associated with measures of speed, stability, and attention. A sample of 29 female university varsity athletes completed cognitive testing using the Attention Network Test- Interactions (ANT-I) and underwent resting-state functional MRI (rsfMRI) scans. Performance was characterized by examining mean reaction time (RT), variability in performance (ISD), and attention network scores on the ANT-I. RsfMRI data were analyzed using an independent component analysis (ICA) in the frontoparietal (FPN), dorsal attention (DAN), default mode, (DMN), salience (SN), and sensorimotor (SMN) networks. Group-level analyses using the performance variables of interest were conducted. Athletes’ performance on the ANT-I revealed a main effect of orienting and executive control (ps2 = 0.68 and 0.89, respectively), with performance facilitated (i.e., faster RT) when athletes were presented with valid cues and congruent flankers. Alerting, orienting, and executive control performance were associated with differences in rsFC within the SN, DMN, and FPN, respectively. Slower RTs were associated with greater rsFC between DAN and bilateral postcentral gyri (p<.001), whereas more stable performance was associated with greater FC between the SMN and the left precuneus (p<.05). Consistent with prior studies, we observed that efficiency in alerting, orienting, and executive control aspects of attention was associated with differences in rsFC in regions associated with the SN, DMS, and FPN. In addition, we observed differential patterns of rsFC for overall speed and variability of performance.

Aim: This cross-sectional study aimed to better understand parental knowledge and attitudes regarding pediatric sport-related concussions, and association with parent/child biopsychosocial factors. Methods: A community sample of ninety families (n = 140 children) were included. Parental concussion knowledge and attitudes, concussion history, sport participation and social risk status score (SRS) were collected. Results: Parents scored an average of 76% accuracy on factual concussion knowledge, with 74% confidence in responses. Parents endorsed a favorable attitude toward concussion reporting and management. Low SRS had higher perceived accuracy of knowledge than medium or high SRS (p = 0.003). SRS influenced over-and-underestimations of factual knowledge (p = .04). Age at first sport and sport contact level influenced factual and perceived concussion knowledge. Conclusion: These findings identify common gaps in concussion knowledge in parents.

Objective: To systematically review the literature on the long-term neuroimaging findings (≥10 years from exposure) for exposure in adulthood to mild traumatic brain injury (mTBI) and repetitive head impacts (RHIs) using neuroimaging across all available populations.Data sources: Four electronic databases: MEDLINE, SPORTDiscus, PsycINFO, and EMBASE.Study selection: All articles were original research and published in English. Studies examined adults with remote exposure to mTBI and/or RHIs from ten or more years ago in addition to any associated neuroimaging findings.Data extraction: Parameters mainly included participants' population, age, years since head injury, race, sex, education level, and any neuroimaging findings. Scores for the level of evidence and risk of bias were calculated independently by two authors.Results: 5,521 studies were reviewed, of which 34 met inclusion criteria and were included in this study. The majority of adults in these studies showed positive neuroimaging findings one or more decades following mTBI/RHI exposure. This was consistent across study populations (i.e., veterans, athletes, and the general population). There was evidence for altered protein deposition patterns, micro- and macro-structural, functional, neurochemical, and blood flow-related differences in the brain for those with remote mTBI/RHI exposure.Conclusion: Findings from these studies suggest that past mTBI/RHI exposure may be associated with neuroimaging findings. However, given the methodological constraints related to relatively small sample sizes and the heterogeneity in injury types/exposure and imaging techniques used, conclusions drawn from this review are limited. Well-designed longitudinal studies with multimodal imaging and in-depth health and demographic information will be required to better understand the potential for having positive neuroimaging findings following remote mTBI/RHI.