Research Article: Pilots and athletes: Different concerns, similar concussion non-disclosure

Date Published: May 1, 2019

Publisher: Public Library of Science

Author(s): Craig A. Foster, Christopher D’Lauro, Brian R. Johnson, Valerio Capraro.


Concussion non-disclosure research has focused almost exclusively on athletes. The focus on athletic populations has been sensible considering athletes’ demonstrated susceptibility to sustaining and concealing concussions. Nevertheless, the habitual use of athletic populations has allowed researchers and practitioners to omit the development of generalized perceived costs and perceived rewards as critical determinants of concussion self-disclosure. We hypothesized that perceiving concussion disclosure as generally more costly than rewarding would predict negative attitudes towards disclosure and decreased intent to disclose. We also hypothesized that generalized perceived costs and rewards could explain concussion non-disclosure in different populations, athletes and future pilots specifically, even when those populations perceive concussion self-disclosure as costly for different specific reasons.

We examined concussion disclosure using 2,504 cadets at the United States Air Force Academy. Cadets completed anonymous surveys assessing their intention to self-disclose undiagnosed concussions (Anticipated Concussion Disclosure) as well as several variables potentially related to concussion self-disclosure: perceived cost, perceived reward, personal identity, attitudes, normative behavior, social support, and self-efficacy.

The results demonstrate that concussion non-disclosure develops when a population perceives disclosure as more costly (i.e. directly or emotionally) and less rewarding. Perceived Cost and Perceived Reward variables alone accounted for 50% of the variance in Anticipated Conclusion Disclosure (Adjusted R2= 0.50, F(2,2312) = 1,145.31, p < 0.001). As expected, Anticipated Conclusion Disclosure developed for different reasons within different sub-populations. Consistent with existing research, cadet intercollegiate athletes reported being primarily concerned that concussion self-disclosure would cause them to miss practice or game time (t (736.7) = 14.20, p < .001, Cohen’s d = 0.96). In contrast, cadet future pilots reported being primarily concerned that concussion self-disclosure would have negative United States Air Force career repercussions (t (1828) = 10.25, p < .001, Cohen’s d = 0.50). These results suggest that cultures of concussion non-disclosure can develop in any population where disclosure is perceived as having undesirable consequences, not just athletic populations. Concussion researchers and practitioners should devote more attention to the perceived cost-benefit structures that create concussion non-disclosure to address this crucial public health issue more effectively.

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Public and scientific interest in concussions has grown rapidly over the past decade. Concussions have now been linked with numerous long-term health sequelae including increased risk of depression [1], neurodegeneration [2], suicide [3], and Chronic Traumatic Encephalopathy [4], among others. The Centers for Disease Control and Prevention (CDC) estimates that up to 3.8 million concussions occur per year in the United States [5]. Concussions can be treated, but a proper treatment plan requires patients to disclose their symptoms accurately [6]. Unfortunately, anywhere from 30.5%-69% of concussions go unreported [7, 8, 9, 10, 11], meaning many individuals lose the benefits of treatment [12].




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