The influence of coping, perceptions of limitations, interference, and locus of control on concussion care-seeking intentions in collegiate athletes
Background: Athletes who delay seeking care for a suspected concussion can experience longer recovery outcomes. Concussion care-seeking intentions may be influenced by several understudied factors; coping, perceptions of limitations, perceptions of interference, and locus of control.
Aim: Describe and compare coping, perceptions of limitations, perceptions of interference and locus of control and determine whether these variables influence symptom and concussion care-seeking intentions in collegiate student-athletes.
Methods: Collegiate student-athletes (n=204; female=54.9%) reported demographic information (i.e. sex, division, contact level), symptom and concussion care-seeking intentions, coping (approach, social, avoidance), perceptions of limitations, perceptions of interference, and locus of control ratings (internal, powerful others, chance). Non-parametric statistics were conducted to compare all outcomes between groups (=0.05). Multiple linear regressions were used to predict symptom and concussion care-seeking intentions based each of the variables. Spearman-rank order correlations supplemented the regression models.
Results: Females had significantly higher symptom care-seeking intentions (p = 0.04) and greater powerful other ratings (p=0.04) than males. Non-contact student-athletes had significantly higher symptom care-seeking intentions (p<0.00) compared to collision sport athletes. Coping, perceptions of limitations, perceptions of interference and locus of control did not significantly predict symptom or concussion care-seeking intentions. There was a weak positive association between perceptions of limitations and symptom care-seeking intentions (rs(198)=0.23, p<0.01) and concussion care-seeking intentions (rs(198)=0.15, p<0.05).
Conclusions: We may not need to focus extensively on coping, perceptions of limitations, perceptions of interference and locus of control ratings when creating concussion education since none of these variables significantly predicted care-seeking intentions.
Relevance for patients: Care-seeking intentions for concussion do not appear to be influenced largely by these variables.
[1] Langlois JA, Rutland-Brown W, Wald MM. The Epidemiology and Impact of Traumatic Brain Injury: A Brief Overview. J Head Trauma Rehabil 2006;21:375-8.
[2] Zuckerman SL, Kerr ZY, Yengo-Kahn A, Wasserman E, Covassin T, Solomon GS. Epidemiology of Sports-Related Concussion in NCAA Athletes from 2009-2010 to 2013- 2014: Incidence, Recurrence, and Mechanisms. Am J Sports Med 2015;43:2654-62.
[3] Llewellyn T, Burdette GT, Joyner AB, Buckley TA. Concussion Reporting Rates at the Conclusion of an Intercollegiate Athletic Career. Clin J Sport Med 2014;24:76.
[4] McCrea M, Barr WB, Guskiewicz K, Randolph C, Marshall SW, Cantu R, et al. Standard Regression-based Methods for Measuring Recovery after Sport-related Concussion. J Int Neuropsychol Soc 2005;11:58-69.
[5] Register-Mihalik JK, Guskiewicz KM, McLeod TC, Linnan LA, Mueller FO, Marshall SW. Knowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study. J Athl Train 2013;48:645-53.
[6] Kerr ZY, Register-Mihalik JK, Kroshus E, Baugh CM, Marshall SW. Motivations Associated With Nondisclosure of Self-Reported Concussions in Former Collegiate Athletes Motivations Associated With Nondisclosure of Self-Reported Concussions in Former Collegiate Athletes. Am J Sports Med 2016;44:220-5.
[7] Kroshus E, Baugh CM, Daneshvar DH, Viswanath K. Understanding Concussion Reporting Using a Model Based on the Theory of Planned Behavior. J Adolesc Health 2014;54:269-74.e2.
[8] Kroshus E, Garnett B, Hawrilenko M, Baugh CM, Calzo JP. Concussion under-Reporting and Pressure from Coaches, Teammates, Fans, and Parents. Soc Sci Med 2015;134:66-75.
[9] Milroy JJ, Hebard S, Kroshus E, Wyrick DL. Sport-Related Concussion Reporting and Coach-Athlete Attachment among Collegiate Student-Athletes. J Clin Sport Psychol 2018;12:268-81.
[10] Miyashita TL, Diakogeorgiou E, VanderVegt C. Gender Differences in Concussion Reporting Among High School Athletes. Sports Health Multidiscip Approach 2016;8:359-63.
[11] Sullivan L, Pursell L, Molcho M. Evaluation of a Theorybased Concussion Education Program for Secondary School Student-athletes in Ireland. Health Educ Res 2018;33:492-504.
[12] Wallace J, Covassin T, Beidler E. Sex Differences in High School Athletes’ Knowledge of Sport-Related Concussion Symptoms and Reporting Behaviors. J Athl Train 2017;52:682-8.
[13] Kontos AP, Elbin RJ, Appaneal RN, Covassin T, Collins MW. A Comparison of Coping Responses among High School and College Athletes with Concussion, Orthopedic Injuries, and Healthy Controls. Res Sports Med 2013;21:367-79.
[14] Chrisman SP, Quitiquit C, Rivara FP. Qualitative Study of Barriers to Concussive Symptom Reporting in High School Athletics. J Adolesc Health 2013;52:330-5.e3.
[15] Delaney JS, Lamfookon C, Bloom GA, Al-Kashmiri A, Correa JA. Why University Athletes Choose Not to Reveal Their Concussion Symptoms During a Practice or Game. Clin J Sport Med 2015;25:113.
[16] Delaney, Caron JG, Correa JA, Bloom GA. Why Professional Football Players Chose Not to Reveal Their Concussion Symptoms During a Practice or Game. Clin J Sport Med 2018;28:1-12.
[17] Ajzen I. Perceived Behavioral Control, Self-Efficacy, Locus of Control, and the Theory of Planned Behavior. J Appl Soc Psychol 2002;32:665-83.
[18] Blau GJ. Brief Note Comparing the Rotter and Levenson Measures of Locus of Control. Percept Mot Skills 1984;58:173-4.
[19] Carver CS. You want to Measure Coping but Your Protocol’s Too Long: Consider the Brief COPE. Int J Behav Med 1997;4:92-100.
[20] Yusoff N. Reliability and Validity of the Brief COPE Scale (English Version) Among Women with Breast Cancer Undergoing Treatment of Adjuvant Chemotherapy: A Malaysian Study. Med J Malaysia 2010;65:41-4.
[21] Snell DL, Siegert RJ, Hay-Smith EJC, Surgenor LJ. Factor Structure of the Brief COPE in People With Mild Traumatic Brain Injury. J Head Trauma Rehabil 2011;26:468-77.
[22] Weber ML, Suggs DW, Bierema L, Miller LS, Reifsteck F, Schmidt JD. Collegiate Student-athlete Sex, Years of Sport Eligibility Completed, and Sport Contact Level Influence on Concussion Reporting Intentions and Behaviours. Brain Inj 2019;33:592-7.
[23] Rice SG. Medical Conditions Affecting Sports Participation. Pediatrics 2008;121:841-8.
[24] Sanderson J, Weathers M, Snedaker K, Gramlich K. I was able to Still do my Job on the Field and Keep Playing: An Investigation of Female and Male Athletes’ Experiences with (not) Reporting Concussions. Commun Sport 2017;5:267-87.
[25] Sherman AC, Higgs GE, Williams RL. Gender Differences in the Locus of Control Construct. Psychol Health 1997;12:239-48.
[26] Mansfield A, Addis M, Mahalik J. Why won’t he go to the Doctor?: The Psychology of Men’s Help Seeking. Int J Mens Health 2003;2:93-109.
[27] Taber JM, Leyva B, Persoskie A. Why do People Avoid Medical Care? A Qualitative Study Using National Data. J Gen Intern Med 2015;30:290-7.
[28] Elman WF, McKelvie SJ. Narcissism in Football Players: Stereotype or Reality? Athl Insight 2003;5:1-9.
[29] Lemieux P, McKelvie SJ, Stout D. Self-reported Hostile Aggression in Contact Athletes, No Contact Athletes and Non-athletes. Athl Insight 2002;15:42-56.
[30] Reuter JM. The Relationships among Three Components of Perceived Risk of Injury, Previous Injuries and Gender in Non-Contact/Limited Contact Sport Athletes. Athl Insight 2005;23:39-46.
[31] Nicholls AR, Polman RC, Levy AR, Backhouse SH. Mental Toughness in Sport: Achievement Level, Gender, Age, Experience, and Sport Type Differences. Personal Individ Differ 2009;47:73-5.
[32] Lynn RW, Phelan JG, Kiker VL. Beliefs in InternalExternal Control of Reinforcement and Participation in Group and Individual Sports. Percept Mot Skills 1969;29:551-3.
[33] Master CL, Gioia GA, Leddy JJ, Grady MF. Importance of “Return-to-Learn” in Pediatric and Adolescent Concussion. Pediatr Ann 2012;41:e160-6.
[34] Asken BM, McCrea MA, Clugston JR, Snyder AR, Houck ZM, Bauer RM. “Playing Through It”: Delayed Reporting and Removal From Athletic Activity After Concussion Predicts Prolonged Recovery. J Athl Train 2016;51:329-35.
[35] Elbin RJ, Sufrinko A, Schatz P, French J, Henry L, Burkhart S, et al. Removal From Play After Concussion and Recovery Time. Pediatrics 2016;138:e20160910.
[36] Schmidt JD, Lynall RC, Lempke LB, Weber ML, Devos H. Post-concussion Driving Behaviors and Opinions: A Survey of Collegiate Student-athletes. J Neurotrauma 2018;35:2418-24.