Relationship Between Concussion History and Concussion Knowledge, Attitudes, and Disclosure Behavior in High School Athletes

OBJECTIVE: Examine the association between self-reported concussion history and measures of concussion knowledge, attitude, and disclosure behavior. DESIGN: Cross-sectional survey. SETTING: Classroom. PARTICIPANTS: A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey. INDEPENDENT VARIABLES: Concussion history (main predictor) was defined as the number of self-recalled concussions during participants' high school career. MAIN OUTCOME MEASURES: The outcomes were recalled concussion disclosure behavior (3 measures) and scales assessing both concussion knowledge and concussion attitude. RESULTS: A greater number of previous concussions was associated with worse attitude to concussion and negative concussion disclosure behavior. For every 3 additional self-recalled concussions, there was a mean decrease of 7.2 points (range of possible scores = 14-98) in concussion attitude score (P = 0.002), a 48% decrease in the self-reported proportion of concussion events disclosed (P = 0.013), and an increased prevalence of self-reported participation in games (67%) and practices (125%) while experiencing signs and symptoms of concussion (P < 0.001). Increased concussion history did not affect concussion knowledge score (P = 0.333). CONCLUSIONS: Negative trends in concussion disclosure behavior were identified in youth athletes with a positive history of concussion. Improving disclosure in this subgroup will require targeted efforts addressing negative attitude to concussion.