Concussion under-reporting and pressure from coaches, teammates, fans, and parents

Abstract

Concussions from sport present a substantial public health burden given the number of youth, adolescent and emerging adult athletes that participate in contact or collision sports. Athletes who fail to report symptoms of a suspected concussion and continue play are at risk of worsened symptomatology and potentially catastrophic neurologic consequences if another impact is sustained during this vulnerable period. Understanding why athletes do or do not report their symptoms is critical for developing efficacious strategies for risk reduction. Psychosocial theories and frameworks that explicitly incorporate context, as a source of expectations about the outcomes of reporting and as a source of behavioral reinforcement, are useful in framing this problem. The present study quantifies the pressure that athletes experience to continue playing after a head impact—from coaches, teammates, parents, and fans—and assesses how this pressure, both independently and as a system, is related to future concussion reporting intention. Participants in the study were 328 male and female athletes from 19 teams competing in one of seven sports (soccer, lacrosse, basketball, softball, baseball, volleyball, field hockey) at four colleges in the northeast region of the United States. Results found that more than one-quarter of the sample had experienced pressure from at least one source to continue playing after a head impact during the previous year. Results of a latent profile mixture model indicated that athletes who experienced pressure from all four of the measured sources were significantly more likely to intend to continue playing in the future than were athletes who had not experienced pressure from all sources, or only pressure from coaches and teammates. These findings underscore the importance of designing interventions that address the system in which athletes make decisions about concussion reporting, including athletes’ parents, rather than focusing solely on modifying the individual’s reporting cognitions.

A Multifactorial Approach to Sport-Related Concussion Prevention and Education: Application of the Socioecological Framework

“…College students who perceived pressure from their parents to continue playing while experiencing the symptoms of an SRC were less likely to report a suspected future SRC. 64 Understanding how this pressure is communicated between parents and athletes and how the nature of this communication changes by sport context and athlete age is an important direction for future investigation. For example, Kroshus et al 64 suggested that pressure from some parents may not be communicated directly but that athletes internalize the investment parents have made and infer parental reporting preferences.…”

Social norms theory and concussion education

“…These could include perceptions about what stakeholders in the athletic environment other than teammates, such as coaches or parents want them to do when it comes to concussion reporting. Recent research conducted with the same sample of athletes finds that the more stakeholders from whom an athlete experiences pressure to continue play while symptomatic after a concussion the less likely they are to intend to report symptoms of a future concussion [65]. Other explanations could include nonrelational expectancies about concussion reporting such as perceptions about whether or not reporting E. Kroshus et al…”

Removal From Play After Concussion and Recovery Time

“…15,16 The Centers for Disease Control's Heads Up concussion education program states, "It is better to miss one game than the whole season." 17 However, due to many factors, including the culture of sports (ie, play through injury), 18,19 poor awareness of SRC signs/symptoms, 20, 21 and limited access to medical professionals, an estimated 50% to 70% of concussions go unreported/ undetected. 20,22,23 In fact, in 2013, the Institute of Medicine and National Research Council stated that the culture of sports negatively influences SRC reporting and that athletes, coaches, and parents do not fully acknowledge the risks of playing while injured.…”