Non-disclosure in Irish collegiate student-athletes: do concussion history, knowledge, pressure to play and gender impact concussion reporting?

Objectives: Non-disclosure of concussions by collegiate student-athletes is documented internationally. This study aims to examine, for the first time, concussion non-disclosure frequency in Irish collegiate student-athletes and ascertain whether concussion history, knowledge, pressure to play and gender impacts this behavior.Methods: A cross-sectional study was implemented. A convenience sample of 268 Irish collegiate student-athletes from high-risk sports completed an anonymous survey developed from previous reliable, validated instruments.Results: One in four Irish collegiate student-athletes reported concussion non-disclosure. While a significant statistical model was generated to predict concussion non-disclosure (χ2= 13.07 p = 0.004) with high specificity (99.5%), the sensitivity was non-existent (0.0%) and explained just 4.8-7.0% of the variance in non-disclosure. Just previous history of a concussion diagnosis contributed significantly to the model (OR = 2.6, 95% CI: 1.46-4.6). Gaps in concussion knowledge were evident and some participants previously felt pressure to return to play after sustaining a blow to the head by coaches (50.0%), teammates (45.5%) and fans (38.0%).Conclusion: Non-disclosure of concussions is common in this population. While gender, concussion knowledge and pressure to play do not seem to impact non-disclosure, a previous history of concussion increases the odds of concussion non-disclosure by 2.6 times. Thus, creating a positive concussion reporting culture in high-risk Irish collegiate sports is critical, particularly for those with a previous medically diagnosed concussion. Multifaceted strategies that incorporate the complexity of why athletes choose to not report a concussion targeted to the specific issues identified in this population and to all key stakeholders involved in collegiate sport are needed.