To 1) investigate differences in baseline scores on the Hospital Anxiety and Depression Scale (HADS) between male and female athletes and 2) examine the influence of concussion history on baseline HADS scores.

Although post-concussion differences between sexes have been documented, whether male and female athletes differ in reporting mental health outcomes and how concussion history may influence scores remains to be fully investigated. Since athletes may experience anxiety and depression after a concussion, screening prior to the beginning of an athletic season (baseline) may identify those who are prone to post-concussion mental health disturbances.

One hundred fifty-two collegiate athletes (86 males, 66 females) completed a HADS assessment during baseline testing. Each participant also reported the number of diagnosed concussions he or she previously sustained. We used independent samples t-tests to compare baseline HADS scores between male and female athletes, and a multiple linear regression to examine the relationship between baseline HADS scores, sex, and concussion history. 

Female athletes reported significantly lower HADS depression scores at baseline compared to males (Females: 0.92±1.49, Males: 1.77±2.22, F=2.78, p=0.01). There were no significant sex differences in HADS anxiety scores (Females: 4.53±2.80, Males: 4.51±2.84, F=0.02, p=0.97), but both sexes had higher anxiety outcomes than depression. There was an independent association between higher HADS depression scores and male sex (β=-0.84, p= 0.01; 95% CI = -1.47, -0.21), but not concussion history (β=-0.09, p=0.66, 95% CI =-0.51, 0.33). Neither sex nor concussion history were significantly associated with HADS anxiety scores.

Female athletes reported lower levels of depression at baseline than males. Concussion history did not appear to influence anxiety or depression baseline scores. Psychological measures could be evaluated, both at baseline and prior to post-concussion return to play, to help identify those who may need more focused monitoring of mental health.