Childhood Opportunity Index, Sex, and Race as Moderators Affecting Self-Efficacy and Concussion Recovery

<p dir="ltr">Objective: Children ages 13-18 often experience prolonged (>1 month) concussion recoveries. Many behavioral interventions exist to help adolescents recover from concussions quicker. However, immutable factors such as race, sex, and neighborhood-based social determinants of health often play a role in health outcomes. Research has shown self-efficacy in concussion recovery to have a negative relationship with symptom severity. Thus, this study examines how race, sex, and social determinants of health measured by the Childhood Opportunity Index may act as moderators effecting the relationship between adolescent self-efficacy and concussion recovery.</p><p dir="ltr">Methods: A sample of 240 adolescent patients were seen for concussion care at a hospital clinic for up to two visits. At the time of each visit, patients rated their symptom severity using the Post-Concussion Symptom Inventory-2 and their self-efficacy in concussion recovery using the Progressive Activities of Controlled Exertion- Self-Efficacy scale. The Childhood Opportunity Index data was gathered based on each patient’s zip code. Each patient’s parent or guardian completed a demographics questionnaire indicating race and sex at birth. Results: PACE-SE did have a significant direct effect on the dependent variable (symptom burden as measured by PCSI-2) at visit 1 (B = -.349, SE =.041, p <.001) and visit 2 (B = 10.065, SE =3.736, p= .008). Sex predicted reported symptom burden (B = -6.783, SE = 2.696), p =.013) and self-efficacy in concussion recovery (B = 10.065, SE =3.736, p = .008) at visit 1 such that males reported higher self-efficacy and lower symptom burden. There were no differences in symptom reporting or self-efficacy in concussion recovery by race or Childhood Opportunity Index.</p><p dir="ltr">Conclusions: This study found that lower self-efficacy directly predicts higher symptom burden in adolescent concussion patients. This relationship is not moderated by sex, race, or Childhood Opportunity Index. Males reported significantly higher self-efficacy and lower symptom burdens at visit 1, but this difference is no longer significant at visit 2. These results support targeted interventions for increasing self-efficacy in concussion recovery, perhaps aimed at female adolescents more than males. Additionally, as this relationship existed at visit 1, education about concussion symptoms and proper management for adolescents prior to injury may be beneficial in lessening reported symptoms and therefore recovery time. </p>