Perceptions of Concussion and Associated Anxiety in Irish Collegiate Athletes.

BACKGROUND: Concussion nondisclosure and poor management after a concussion are a concern in Irish collegiate sports. How athletes perceive concussions and appraise their own concussion may affect their decisions and behaviors after a suspected concussion. However, this has yet to be examined in an Irish context. This study aimed to (1) establish concussion perceptions and associated anxiety in Irish collegiate athletes; (2) examine how sex, concussion, and mood disorder history influenced their perceptions; and (3) investigate factors associated with higher anxiety perceptions. HYPOTHESIS: Irish collegiate athletes will display negative concussion perceptions and anxiety related to concussion, especially in female athletes and those without a concussion history. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: Irish collegiate athletes [n = 268 (141 women,127 men), mean age = 21.5 ± 2.2 years] from high-risk sports completed a survey including the Perceptions of Concussion Inventory for Athletes (PCI-A), demographics, diagnosed concussion history, self-reported mood disorder history, and a concussion knowledge assessment. Differences in concussion perceptions by sex, concussion history, mood disorder history were examined using Mann-Whitney U tests, and factors associated with anxiety-related concussion perceptions were identified using multivariate logistic regression. RESULTS: Over half (53.0%, n = 142) of participants reported concerns regarding concussion. The thoughts of sustaining a concussion made participants feel upset (63.4%, n = 170), fearful (47.7%, n = 128), and anxious (35.1%, n = 94). Women reported significantly higher anxiety (P < 0.01, r = 0.23), effects (P = 0.04, r = 0.12), and clarity (P = 0.01, r = 0.16) perception scores. Participants with a diagnosed concussion history displayed greater symptom variability perception scores (P = 0.04, r = 0.12), but lower anxiety (P = 0.03, r = 0.13) and treatment (P < 0.01, r = 0.19) beliefs on the PCI-A. No differences were observed for those with a history of a mood disorder (P > 0.05). A significant multivariate model was established (χ2 = 55.44, P < 0.01), with female sex [odds ratio (OR) = 1.53], concussion history (OR = 0.63), effects (OR = 1.31), and treatment (OR = 1.15) subscales associated with greater anxiety. CONCLUSION: Concerns about sustaining a concussion are prevalent in Irish collegiate athletes. Women displayed more negative perceptions and those with a concussion history displayed fewer perceived benefits of treatment. CLINICAL RELEVANCE: The findings support the need for concussion awareness campaigns to provide accurate concussion information to mitigate anxiety-related concussion perceptions and injury belief misconceptions.

Non-disclosure in Irish collegiate student-athletes: do concussion history, knowledge, pressure to play and gender impact concussion reporting?

Objectives: Non-disclosure of concussions by collegiate student-athletes is documented internationally. This study aims to examine, for the first time, concussion non-disclosure frequency in Irish collegiate student-athletes and ascertain whether concussion history, knowledge, pressure to play and gender impacts this behavior.Methods: A cross-sectional study was implemented. A convenience sample of 268 Irish collegiate student-athletes from high-risk sports completed an anonymous survey developed from previous reliable, validated instruments.Results: One in four Irish collegiate student-athletes reported concussion non-disclosure. While a significant statistical model was generated to predict concussion non-disclosure (χ2= 13.07 p = 0.004) with high specificity (99.5%), the sensitivity was non-existent (0.0%) and explained just 4.8-7.0% of the variance in non-disclosure. Just previous history of a concussion diagnosis contributed significantly to the model (OR = 2.6, 95% CI: 1.46-4.6). Gaps in concussion knowledge were evident and some participants previously felt pressure to return to play after sustaining a blow to the head by coaches (50.0%), teammates (45.5%) and fans (38.0%).Conclusion: Non-disclosure of concussions is common in this population. While gender, concussion knowledge and pressure to play do not seem to impact non-disclosure, a previous history of concussion increases the odds of concussion non-disclosure by 2.6 times. Thus, creating a positive concussion reporting culture in high-risk Irish collegiate sports is critical, particularly for those with a previous medically diagnosed concussion. Multifaceted strategies that incorporate the complexity of why athletes choose to not report a concussion targeted to the specific issues identified in this population and to all key stakeholders involved in collegiate sport are needed.