Validity of the ImPACT Post-Concussion Symptom Scale (PCSS) Affective Symptom Clusters as a Screener for Depression in Collegiate Athletes

Restricted (Penn State Only)
Riegler, Kaitlin Elizabeth
Graduate Program:
Master of Science
Document Type:
Master Thesis
Date of Defense:
August 31, 2018
Committee Members:
  • Peter Andrew Arnett, Thesis Advisor
  • Frank Gerard Hillary, Committee Member
  • Semyon Slobounov, Committee Member
  • concussion
  • neuropsychology
  • depression
  • assessment
  • gender
Objective: The relationship between depression and sports-related concussion is complex and has implications both pre-and-post injury. The current study established the construct validity, convergent and discriminant, of the affective symptom cluster of The Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) post-concussion symptom scale (PCSS) as a screening tool for depression. Method: 930 (M=695, F=235) college athletes were assessed at baseline using the ImPACT PCSS and Beck-Depression Inventory-Fast Screen (BDI-FS). Previous factor analysis identified four symptom clusters on the PCSS: affective, physical, cognitive, and sleep. Clinically significant depression was operationalized as a BDI-FS score ≥4. Receiver Operating Characteristic curves (ROC) were used to determine the ideal cutoff, Chi-square tests of independence were calculated to establish convergent validity, and Fisher’s r-to-z comparisons were used to establish discriminant validity of the affective symptom cluster. Results: The 90th percentile cutoff yielded the highest sensitivity and specificity on the affective symptom cluster for males (6) and females (4). The correlation between BDI-FS and the 90th percentile cutoff was statistically significantly higher in females (φ= .96) than males (φ = .83), Z = 9.49, p < .001. When correlating the BDI-FS with each PCSS symptom cluster, the correlation with the affective symptom cluster was stronger than its correlation with cognitive, sleep, and physical clusters across gender. Discussion: By utilizing a measure of depression within an existing and commonly used assessment, clinicians can easily screen for depression and identify athletes at risk for complicated recovery even in the absence of a supplemental depression assessment.