Motivations Associated With Nondisclosure of Self-Reported Concussions in Former Collegiate Athletes

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. PURPOSE: To examine the prevalence of, and factors associated with, nondisclosure of recalled concussions in former collegiate athletes. STUDY DESIGN: 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%). CONCLUSION: 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.