Objective To examine depression and baseline neurocognitive function and concussion symptoms in male and female high school and college athletes.

Design Cross sectional.

Setting Athletes completed testing at a designated computer laboratory at high schools and colleges.

Participants Participants included 1616 collegiate (n = 837) and high school (n = 779) athletes from 3 states participating in a variety of competitive sports.

Interventions Participants completed the baseline Immediate Postconcussion Assessment and Cognitive Test (ImPACT), symptom inventory, and Beck Depression Inventory II (BDI-II).

Main Outcome Measures Between-group comparisons for depression groups on ImPACT composite scores (verbal and visual memory, reaction time, motor processing speed), total symptoms, and symptom cluster (sleep, cognitive, emotional, somatic/migraine) scores. Between-group comparisons for age and sex on BDI-II, ImPACT, total symptoms, and symptom cluster scores.

Results The severe depression group scored worse on visual memory and reported more total, somatic/migraine, cognitive, emotional, and sleep symptoms than less depressed groups. High school athletes reported more somatic/migraine symptoms than collegiate athletes, whereas collegiate athletes reported more emotional and sleep symptoms than high school athletes. Women had higher verbal memory and reported more cognitive, emotional, and sleep symptom clusters compared with men. Women outperformed men on verbal memory, whereas collegiate athletes outperformed high school athletes on processing speed.

Conclusions Athletes with severe depression scored lower on visual memory than those with minimal depression. Athletes with severe depression report more concussion symptoms than athletes with minimal and moderate depression scores. Symptoms of depression should be included in baseline assessments to help disentangle depression from concussion symptoms.