OBJECTIVE: To describe the differences in postinjury psychological symptoms among Division I collegiate student athletes who sustained concussions versus orthopedic injures and to examine the effects of injury type on postinjury psychological symptoms during the course of recovery. DESIGN: A prospective cohort study with repeated measures. SETTING: Two Big 10 Conference universities. PARTICIPANTS: Student athletes who were at least 18 years old and participated in one of 9 National Collegiate Athletic Association (NCAA) Division I-sponsored sports during the 2007 to 2011 seasons. MAIN OUTCOME MEASURES: Baseline depressive symptoms and anxiety were measured at enrollment. On identification of an eligible injury, follow-up surveys were conducted among injured athletes at multiple intervals until the injured athlete returned to play. Depressive symptoms, anxiety, fear of return-to-play, and fear of reinjury were measured at the postinjury follow-ups. RESULTS: The concussion group had significantly lower scores of fear of return-to-play (B = -0.94, P = 0.0278) and fear of reinjury (B = -1.11, P = 0.0152) compared with the orthopedic injury group. The concussion group scored higher on depressive symptoms than the orthopedic injury group at 1 month after injury (P = 0.0264), although both groups scored similarly at baseline (P = 0.9729) and at 1 week after injury (P = 0.1475). CONCLUSIONS: Patterns of psychological disturbance differ after concussions and orthopedic injures. Further research is warranted to identify the factors contributing to these differences and to develop effective intervention programs to prevent these symptoms.