Predictors of Concussion Symptom-Reporting Intention Among Collegiate Athletes

Context: Underreporting of concussion symptoms in college athletics presents a challenge for sports medicine clinicians in evaluating and diagnosing such injuries. Some athletes do not report concussion symptoms because they do not recognize that they have a brain injury; however, many athletes intentionally withhold symptoms to avoid removal from sport participation. Objective: To examine individual factors that influence college athletes' intentions to report concussion symptoms. Design: Cross-sectional study. Setting: Collegiate athletics. Patient or Other Participants: Participants were 2649 student-athletes from 23 sports, across 22 colleges and universities. Main Outcome Measure(s): The primary outcome was intention to report concussion symptoms. Predictor variables included demographics (age, race/ethnicity, sex, sport type, number of years in sport, number of previous concussions, and perceived concussion symptom knowledge), athletic identity, attitudes toward symptom reporting, perceived social pressure (injunctive and descriptive norms), and perceived behavioral control (capacity and autonomy). Results: Hierarchical ordinary least-squares regression revealed positive effects of attitude (b = 0.063, P = .005), descriptive norms (b= 0.131, P < .001), injunctive norms (b= 0.107, P < .001), and capacity (b= 0.196, P < .001) on intention to report symptoms. Athletic identity and participation in collision sports had small negative indirect effects on intention, and perceived concussion knowledge had a small positive indirect effect. The full regression model explained 14.24% of the variance in concussion-reporting intention. Conclusions: These findings may help clinicians develop more focused interventions that address key social and individual determinants of underreporting, including attitude, injunctive and descriptive norms, and capacity to report. Athletic identity, sport type, and perceived understanding of concussion symptoms also influence reporting intention to a lesser extent. Previous research in this area has often failed to address a diverse population of college-age athletes from different sports and National Collegiate Athletic Association divisions.