In it to win it: Competitiveness, concussion knowledge and nondisclosure in athletes

Despite having a general understanding of concussions, many athletes choose not to report symptoms of a sports-related concussion (SRC) which leads to a larger burden on our healthcare system due to longer recoveries, more Emergency Department visits, and future medical appointments. Thus, there is a need to identify factors, such as competitiveness, that may help to better explain the nondisclosure of concussion symptoms. The current study aimed to investigate the role of athletes' concussion knowledge and competitiveness on concussion nondisclosure.

Participants included 161 Canadian athletes (ages 14-32; 71% male) participating in collision sports (American football, rugby, hockey), soccer or rowing. Concussion knowledge, reporting and competitiveness were measured using the Rosenbaum Concussion Attitude and Knowledge Survey and Sports Orientation Questionnaire (SOQ). Two logistic regression models were performed to explain both history and future intention of playing despite experiencing concussion symptoms.

Age, sex, and concussion knowledge were not significant for the regression models. The SOQ scores (measuring competitiveness) were significant for both regression models, such that higher competitiveness was associated with increased likelihood for past nondisclosure (b =.03, p =.03, OR = 1.03 (97.5% CI: 1.003,1.06)) and future nondisclosure intention (b =.05, p =.00, OR = 1.05 (97.5% CI: 1.03,1.08)). Regarding concussion knowledge, soccer players had significantly higher knowledge than those in collision sports and rugby, F(2, 158) = 140.5, p =.00; female athletes had significantly higher knowledge than males, t(66) = -4.26, p =.00; age was negatively associated with concussion knowledge (r = -0.35, p < .01).

The results suggest that healthcare providers should be aware that athletes tend to have adequate concussion knowledge, but this knowledge does not explain past nondisclosure or future nondisclosure intention. Based on these findings, healthcare providers should focus on being able to identify highly competitive athletes who are most at risk of nondisclosure instead of exclusively aiming to increase concussion knowledge in athletes.