A concerning new study indicates that athletes may take longer to recover from a concussion if they had mental distress before the injury.

The study involved 127 high school and college athletes who had concussions. About 80 percent were male. Two-thirds of them got the concussion playing football, a quarter had them during soccer, and the remainder had them playing lacrosse, hockey, rugby, wrestling, and field hockey, according to an American Academy of Neurology statement.

On average, concussions symptoms lasted five days on average, but athletes who had psychosomatic symptoms before — mental distress — took longer to recover.

Most who had a concussion and psychosomatic symptoms recovered in about three weeks, compared to those who had no psychosomatic symptoms beforehad, who recovered in about 10 days on average.

“The goal of this study was to determine how physical complaints before and after concussion play a role in recovery,” study author Lindsay D. Nelson, PhD, assistant professor of Neurosurgery and Neurology at the Medical College of Wisconsin in Milwaukee, said in the statement. “We found the greatest predictor of recovery after a concussion was the severity of early post-concussion symptoms. But somatic complaints before injury also play an important role, either by possibly enhancing how a person experiences the injury or affecting their reporting of post-concussive symptoms.”

Nelson added: “That these athletes were relatively healthy physically and psychologically highlights the relevance of psychosomatic symptoms and the role they play in recovery even in healthy people. Our hope is our study will lead to further research, because identifying those at risk for prolonged recovery is critical to developing early interventions that improve outcomes for people who suffer concussions.”

The findings were published in the journal Neurology.