Lifestyle Medicine and Vasomotor Symptoms: An Analytic Review.

Concussion has been conceptualized as a complex multi‐level system,, and neurobehavioral outcomes following concussion are posited to depend on numerous biopsychosocial factors., Approximately 12% of youths 12–17 years of age have experienced symptoms of a concussion in their lifetime, and among youths who sustain a concussion, approximately one‐third experience symptoms persisting longer than 4 weeks. Previous research highlights the role of preinjury factors (e.g., prior concussions, migraines, sex, age, mental health, and neurodevelopmental disorders) in experience with and reporting of concussion symptoms as well as the need to parse out baseline differences in reporting from clinical outcome. The overlap with concussion‐like symptoms experienced in daily life, variable sample sizes, and diverse methodologies have led to mixed findings regarding predictors associated with recovery. Further, these predictors rarely occur in isolation; more often than not, adolescents present with more than one associated risk factor. The current study builds on this previous research by using structural equation modeling to examine the unique, additive effects of each predictor on both baseline and postinjury symptom reporting when evaluated in the context of other associated factors. Both injury and noninjury factors contribute to symptom severity and recovery following a head injury, with growing attention to mental health (e.g., anxiety and depression) as a noninjury factor that may exacerbate or prolong self‐reported concussion symptoms., , As time progresses following a concussion, the contribution of injury characteristics lessens and the contribution of noninjury factors becomes increasingly important., This pattern is evident in recovery from sports‐related injuries as well as other mechanisms of injury (e.g., motor‐vehicle collisions and falls). For children and adolescents, in particular, restrictions from normal activities for a prolonged period, both in school and extracurricular, may lead to less social interactions, a reduced quality of life, and depressed mood. Recent reviews of existing literature examining preinjury mental health and postconcussive outcomes have identified a need to pay greater attention to this relation among diverse samples of middle school– and high school–age populations and to better understand the mechanisms underlying this increased risk for poor outcomes., Among an ethnically diverse subspecialty clinic sample made of up athletes and nonathletes as well as individuals with prolonged symptoms and more typical recovery trajectories, this study used path analysis to quantify the relations among multiple variables potentially related to outcome from concussion. Both direct and indirect pathways were tested to better understand how these factors influence baseline and postinjury symptom reporting as well as time to clearance.