AASP Newsletter - May 2019

Jeffrey J. Milroy

Jeffrey J. Milroy, MPH, DrPh, The University of North Carolina at Greensboro

About 4 million sport-related concussions are reported in the U.S. each year (Langlois, Rutland-Brown, & Wald, 2006). However, some studies suggest that this isn’t a complete picture of the number of sport-related concussions in America. For example, across a variety of studies that include both high school and collegiate student-athletes, it is estimated that more than 50% of concussions go unreported (Baugh, Kroshus, Daneshvar, & Stern, 2014; Kroshus, Daneshvar, Garnett, Nowinski, & Cantu, 2013; Llewellyn, Burdette, Joyner, & Buckley, 2014; Meehan, Mannix, O’Brien, & Collins, 2013; Torres et al., 2013). The non-disclosure of concussion symptoms by young athletes is particularly concerning because concussions can result in irreversible damage to developing brains (Choe, Babikian, DiFiori, Hovda, & Giza, 2012; Shrey, Griesbach, & Giza, 2011).

The literature reveals a variety of reasons why athletes may not disclose their concussion symptoms. This includes outcome expectancies (e.g., losing a spot on a team), normative perceptions (e.g., perceived approval by others), and a lack of symptom recognition. In our study, we drew upon the Integrated Behavioral Model (Fishbein & Yzer, 2003) to identify possible factors related to concussion reporting intentions among NCAA student-athletes.

The data for this study came from a larger, 2016 project aimed at optimizing a web-based intervention for collegiate student-athletes called BrainCare. A total of 1858 student-athletes and 254 coaches from 16 NCAA colleges and universities participated in the project. The data for this study focused on relationships between risk and/or protective factors: Athletes’ Norms, Athletes’ Attitudes, Personal Agency, Coach Communication, a variety of secondary variables, and three main outcomes: Concussion Reporting Intentions (self, others, encouragement). Table 1 identifies which variables were significantly related to each outcome of interest (represented by an X).

Additional study details and results will be published during the latter part of 2019.

As we have begun to learn more about why athletes do and do not disclose concussion symptoms, it is becoming increasingly evident that athletes’ intentions can be quite impactful. Although this study didn’t include an environmental scan or observations, the factors that impacted athlete intentions stemmed from their experiences and the environment in which they lived.

What do these results specifically mean for sport psychology consultants?

Direct approach with athletes:

• Work closely with athletes, especially those who play higher contact sports who are less likely to report, to explore their previous concussion reporting experiences that may be shaping their current disclosure attitudes. Exploration of these experiences might help athletes reform their current attitudes.
• Provide athletes with accurate data to help curb erroneous norms they might hold regarding reporting (i.e., that reporting is not supported or expected by others).
• Consider integrating specific forms of communication skill-building to help improve athletes’ communication efficacy. This study revealed that athletes with higher communication efficacy were more likely to report concussion symptoms.

Indirect approach to target athletes:

• Encourage coaches to develop environments for their athletes that are conducive to concussion reporting. As noted in this study, it’s not what the coach did but what the athlete perceived the coach did that mattered when it came to concussion reporting. Therefore, coaches need to be encouraged to be thoughtful, purposeful, and consistent with their concussion safety messaging.

Ultimately, there is still much to learn about athlete concussion reporting behavior; however, sport psychology consultants have a unique opportunity to work closely with athletes and coaches to promote concussion reporting among young athletes.

References

Baugh, C. M., Kroshus, E., Daneshvar, D. H., & Stern, R. A. (2014). Perceived coach support and concussion symptom‐reporting: Differences between freshmen and non‐freshmen college football players. Journal of Law, Medicine & Ethics, 42(3), 314-322. doi:10.1111/jlme.12148

Choe, M. C., Babikian, T., DiFiori, J., Hovda, D. A., & Giza, C. C. (2012). A pediatric perspective on concussion pathophysiology. Current Opinion in Pediatrics, 24(6), 689-695. doi:10.1097/MOP.0b013e32835a1a44

Fishbein, M., & Yzer, M. C. (2003). Using theory to design effective health behavior interventions. Communication theory, 13(2), 164-183. doi:10.1111/j.1468-2885.2003.tb00287.x

Kroshus, E., Daneshvar, D. H., Garnett, C. M., Nowinski, C. J., & Cantu, R. C. (2013). NCAA concussion education in ice hockey: An ineffective mandate. British Journal of Sports Medicine, 48(2), 135-140. doi:10.1136/bjsports-2013-092498

Langlois J. A., Rutland-Brown W., & Wald M. M. (2006). The epidemiology and impact of traumatic brain injury: A brief overview. Journal of Head Trauma and Rehabilitation, 21(5), 375–378.

Llewellyn, T., Burdette, G. T., Joyner, A. B., & Buckley, T. A. (2014). Concussion reporting rates at the conclusion of an intercollegiate athletic career. Clinical Journal of Sport Medicine, 24(1), 76-79. doi:10.1097/01.jsm.0000432853.77520.3d

Meehan, W. P., Mannix, R. C., O’Brien, M. J., & Collins, M. W. (2013). The prevalence of undiagnosed concussions in athletes. Clinical Journal of Sport Medicine, 23(5), 339-342. doi:10.1097/JSM.0b013e318291d3b3

Shrey, D. W., Griesbach, G. S., & Giza, C. C. (2011). The pathophysiology of concussions in youth. Physical Medicine and Rehabilitational Clinics of North America, 22(4), 577-602. doi:10.1016/j.pmr.2011.08.002

Torres, D. M., Galetta, K. M., Phillips, H. W., Dziemianowicz, E. M., Wilson, J. A., Dorman, E. S., … Balcer, L. J. (2013). Sports-related concussion: Anonymous survey of a collegiate cohort. Neurology: Clinical Practice, 3, 279–287. doi:10.1212/CPJ.0b013e3182a1ba22