title: Motivations Associated With Nondisclosure of Self-Reported Concussions in Former Collegiate Athletes.
abstract: BACKGROUND
  Previous studies examining nondisclosure among athletes in various settings have found substantial proportions of athletes with undisclosed concussions. Substantial gaps exist in our understanding of the factors influencing athletes' disclosure of sports-related concussions.
  
  
  OBJECTIVE
  To examine the prevalence of, and factors associated with, nondisclosure of recalled concussions in former collegiate athletes.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  Former collegiate athletes (N = 797) completed an online questionnaire. Respondents recalled self-identified sports-related concussions (SISRCs) that they sustained while playing sports in high school, college, or professionally, and whether they disclosed these SISRCs to others. Respondents also recalled motivations for nondisclosure. The prevalence of nondisclosure was calculated among those who recalled SISRCs. Multivariate binomial regression estimated adjusted prevalence ratios (PRs) with 95% CIs, controlling for sex, level of contact in sports, and year the athletes began playing collegiate sports.
  
  
  RESULTS
  A total of 214 respondents (26.9%) reported sustaining at least 1 SISRC. Of these, 71 (33.2%) reported not disclosing at least 1 SISRC. Former football athletes were most likely to report nondisclosure (68.3% of those recalling SISRCs); female athletes who participated in low/noncontact sports were the least likely to report nondisclosure (11.1% of those recalling SISRC). The prevalence of nondisclosure was higher among men than women in the univariate analysis (PR, 2.88; 95% CI, 1.62-5.14), multivariate analysis (PR, 2.11; 95% CI, 1.13-3.96), and multivariate analysis excluding former football athletes (PR, 2.11; 95% CI, 1.12-3.94). The most commonly reported motivations were as follows: did not want to leave the game/practice (78.9%), did not want to let the team down (71.8%), did not know it was a concussion (70.4%), and did not think it was serious enough (70.4%).
  
  
  CONCLUSIONS
  Consistent with previous studies, a substantial proportion of former athletes recalled SISRCs that were not disclosed. Male athletes were less likely to disclose all of their SISRCs than female athletes.
authors.affiliation: Datalys Center for Sports Injury Research and Prevention Inc, Indianapolis, Indiana, USA Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA Center for the Study of Retired Athletes, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA zkerr@datalyscenter.org.
authors.forename: Zachary Y
authors.initials: ZY
authors.lastname: Kerr
authors.affiliation: Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA Center for the Study of Retired Athletes, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Johna K
authors.initials: JK
authors.lastname: Register-Mihalik
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Kroshus
authors.affiliation: Harvard Interfaculty Initiative in Health Policy, Harvard University, Cambridge, Massachusetts, USA Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Baugh
authors.affiliation: Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA Center for the Study of Retired Athletes, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Marshall
mesh_terms: D000328:Adult; D056352:Athletes / Q000523:psychology*; D001265:Athletic Injuries / Q000523:psychology*; D001924:Brain Concussion / Q000523:psychology*; D003430:Cross-Sectional Studies; D030881:Disclosure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011939:Mental Recall; D009042:Motivation; D012574:Schools; D057566:Self Report; D017678:Sex Distribution; D013334:Students / Q000523:psychology; D011795:Surveys and Questionnaires; D014495:Universities
keywords: epidemiology; reporting; sport; traumatic brain injury