Motivations Associated With Nondisclosure of Self-Reported Concussions in Former Collegiate Athletes

Abstract

Background Previous studies examining non-disclosure among athletes in various settings have found substantial proportions of athletes with undisclosed concussions. Substantial gaps exist in our understanding of the factors influencing athletes’ disclosure of sports-related concussions. Hypothesis/Purpose This cross-sectional study examined prevalence of, and factors associated with, non-disclosure of recalled concussions in former collegiate athletes. Study Design Cross-sectional survey. Methods Former collegiate athletes (n=797) completed an online questionnaire. Respondents recalled self-identified sports-related concussions (SISRC) that they sustained while playing sports in high school, college, or professionally, and whether they disclosed these SISRC to others. Respondents also recalled motivations for non-disclosure. We computed the prevalence of non-disclosure among those who recalled SISRC. Multivariate binomial regression estimated adjusted prevalence ratios (PR) with 95% confidence intervals (CI) controlling for sex, level of contact in sport, and year began playing college sports. Results Two-hundred-and-fourteen (26.9%) respondents reported sustaining at least one SISRC. Of these, 71 (33.2%) reported not disclosing at least one SISRC. Former football athletes were most likely to report non-disclosure (68.3% of those recalling SISRC); female athletes who participated in low/non-contact sports were the least likely to report non-disclosure (11.1% of those recalling SISRC). The prevalence of non-disclosure was higher among males than females in the univariate analysis, (PR=2.88; 95%CI: 1.62, 5.14) multivariate analysis (PR=2.11; 95%CI: 1.13, 3.96), and multivariate analysis excluding former football athletes (PR=2.11; 95%CI: 1.12, 3.94). The most commonly reported motivations included: did not want to leave the game/practice (78.9)%; did not want to let the team down (71.8%); did not know it was a concussion (70.4%); and did not think it was serious enough (70.4%). Conclusion Consistent with previous studies, a substantial proportion of former athletes recalled SISRC that were not disclosed. Males were less likely to disclose all their SISRC than females.

Do as I say: contradicting beliefs and attitudes towards sports concussion in Australia

“…Because we did not ask students if they would report their concussion, but rather, would they continue to play, it is difficult to directly compare our findings to previous research. Generally speaking however, our observations appear to support the recent findings of Kerr et al (2016) who found, in males compared to females, a higher prevalence of not reporting concussions, and therefore continue to play with a concussion.…”

“…Similarly, Llewellyn, Burdette, Joyner, and Buckley (2014) reported no differences between gender in reporting of concussion symptoms. However, a more recent study, also using college athletes (Kerr et al, 2016), found the prevalence of not reporting concussions to be higher among men than women.…”

“…It should be noted that the majority of studies regarding concussion attitudes have, to date, been directed towards student-athletes and their coaches (Bramley, Patrick, Lehman, & Silvis, 2012;Chrisman et al, 2013;Kaut et al, 2003;Kerr et al, 2016;Kroshus et al, 2013;Kroshus et al, 2015;McCrea et al, 2004;McLeod, Schwartz, & Bay, 2007;; although club athletes (Baker et al, 2013;Braham, Finch, McIntosh, & McCrory, 2004), have also been surveyed, but to a lesser extent. Further, the majority of these studies have been completed in North America.…”

“…As such, current understanding of concussion is not consistent with the currently accepted medical definition, promoting misunderstanding, and potentially affecting the reporting of concussions (Robbins et al, 2014). Consequently, previous studies, across a range of sports and countries, have estimated over 50% of concussion injuries are not reported by players, or under-diagnosed by physicians (Baker, Devitt, Green, & McCarthy, 2013;Kerr, Register-Mihalik, Kroshus, Baugh, & Marshall, 2016;Kroshus, Daneshvar, Baugh, Nowinski, & Cantu, 2013).…”

Epidemiology of Sport-Related Concussions in High School Athletes: National Athletic Treatment, Injury and Outcomes Network (NATION), 2011–2012 Through 2013–2014

“…Second, we examined 27 sports, many of which, such as crew and golf, had not been previously examined. Furthermore, concussion disclosure may vary by sex and sport 29,30 and thus may further affect reported rates. Last, concussion incidence and reporting may be associated with additional environmental factors.…”