Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy




Dickey, James P.


This thesis investigated the consequences of concussion injuries on various aspects of adults’ lives from a Canadian perspective. Study one investigated the influence concussion injury has on future employment income. Latent growth curve analysis using structural equation modeling was used to assess if income trajectory changed three years after injury. We compared the income trajectories of working-aged adults with a history of concussion against balanced cohorts of those who did not have a history of a concussion and those who experienced an ankle or foot injury. The model results demonstrated a year-over-year loss of income for the respective concussion-injured cohorts: -0.9% for the male non-concussion comparison, -1.1% for the male ankle-injured comparison, -0.53% for the female non-concussion comparison, and -0.9% for the female ankle-injured comparison. These values have economic significance as they represent negative changes year-over-year after adjusting for inflation. In study two, both a time-to-first-event analysis and a parametric shared frailty recurrent event survival analysis were used to investigate the relative risk of subsequent injury following a concussion in working-aged adults. The time-to-first event (i.e., first reinjury after concussion) revealed that females who have a history of concussion injury had a 2% lower survival probability at the 500-day mark compared to females who did not have a history of concussion. Females with a history of concussion injury demonstrated a 110% increased relative risk of injury (recurrence of injury). Males did not demonstrate a significant difference in relative risk of injury recurrence. The third study was a feasibility study to assess the ability to perform a randomized control trial evaluating the remote delivery of a breath control and mindfulness intervention for treating persisting symptoms of anxiety and depression in concussed adults. Our assessment determined that the study is feasible with consideration of factors related to the time needed for participant recruitment. Overall, this thesis demonstrated that there are financial implications and risks of subsequent injury for working-aged adults who suffer concussions.

Summary for Lay Audience

Have you ever been curious about whether there are long-term consequences after someone experiences a concussion? A concussion is a type of brain injury that occurs when the head or body receives a strong impact, leading to a range of symptoms like headaches, nausea, confusion, memory problems, and vision issues. Some individuals who sustain a concussion may have symptoms that persist for an extended period. Examples of such persistent symptoms include increased anxiety and depression. Concussion injuries can also have far-reaching effects on various aspects of life. Our research specifically focused on adults of working age and aimed to uncover how concussions impact different aspects of adult life. We delved into whether experiencing a concussion influenced future income and whether concussion injuries increased the likelihood of getting injured again. Our findings from these investigations revealed that concussions indeed have a negative impact on employment income, decreasing it by about 1% year-over-year for three years, and on subsequent injury risks, increasing it by about 50%. These residual effects of concussion might be improved if successful rehabilitation programs are broadly instituted. However, it is not known whether it is feasible to perform research to evaluate these programs. In our final study, we explored the feasibility of performing research to assess the effectiveness of remote treatments for individuals who experience heightened anxiety and depression after a concussion injury. Our results showed that this research is feasible. The next step would be to investigate the effectiveness of this virtual therapy. This therapy could reduce the impact of concussion injury on employment income and subsequent injury risks and help adults in their ongoing journey to recover from a concussion injury.

Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

Available for download on Sunday, August 31, 2025