A comparison of coping responses among high school and college athletes with concussion, orthopedic injuries, and healthy controls
Kontos AP, Elbin RJ, Appaneal RM, Covassin T, Collins MW. Research in Sports Med. 2013;21:367-379
Take Home Message: Athletes with a concussion may not engage in coping strategies to the same extent as athletes with musculoskeletal injuries. Furthermore, males reported less frequent coping responses than females, which suggest that efforts to improve coping mechanisms may need to use sex-specific strategies.
Some athletes recovering from a concussion become frustrated because not only is their athletic participation affected but their social and academic function is also impaired. While outwardly these athletes appear no different from their uninjured peers we need to monitor their emotional responses (e.g., coping reactions). Unfortunately, helping these athletes may be challenging because we have a poor understanding of how athletes cope with a concussion and whether their responses differ from athletes after orthopedic injuries. Therefore, the authors compared the coping responses of high school and college athletes with a concussion or an orthopedic injury at 1 week following their injury to healthy controls. Additionally, the authors explored sex differences in coping and the interaction of sex and type of injury on coping. Over a 2-year period 123 participants with a concussion (25 male, 23 female), an orthopedic injury (28 male, 14 female), or no injury (healthy controls; 21 male, 12 female) volunteered for the study. One week following the athlete’s injury they completed the Brief COPE survey, which measured how the athletes were coping after the injury. The concussed group completed the online version and the healthy control and orthopedics groups completed the paper-and-pencil version. The Brief COPE survey is a 28-question survey that measures how often they use different coping strategies (e.g., acceptance, humor, religion, seeking emotional social support, denial, venting, substance abuse). The three groups were similar in age and sex. The concussion group reported lower coping scores for denial, substance abuse, behavioral disengagement, venting, planning, humor, religion, and self-blame compared with both the orthopedics and control group. The orthopedic group’s coping scores did not differ compared with the control group. Females reported more frequent self-distraction, active coping, instrumental support, humor, and self-blame than males, regardless of group. Finally, concussed females may be more likely to adopt humor coping behaviors compared with female control athletes and female athletes with orthopedic injuries.
This study highlights that an athlete with a concussion is likely to adopt different coping behaviors than those with orthopedic injuries as well as those with no injuries. Overall, concussed athletes engaged less, which may not always reflect an adverse coping response but rather a different approach. Concussed athletes may have fewer demands than athletes with orthopedic injuries. For example, the rehabilitation process for an orthopedic injury is more demanding than the passive rest an athlete with a concussion requires. Additionally, most athletes with a concussion return to play 7 to 14, which may not be a sufficient amount of time to elicit a coping response. Whether the lack of coping is reflective of an adverse coping response or the lack of a need for a response, we should determine baseline levels for coping responses and implement coping programs for concussed athletes. Authors also found sex differences related to coping, where males did not utilize coping strategies as much as females. This could be attributed to the culture of masculinity, where males may be more guarded in their response. Also, females may be more open about how they cope compared with males. Based on these results, medical professionals may consider sex-specific interventions to promote coping strategies among athletes with a concussion.
Questions for Discussion: Do you think injury-specific as well as sex-specific coping programs could be useful in a sports medicine clinic? Do you see differences in coping mechanisms in specific athletes?
Written by: Jane McDevitt PhD
Reviewed by: Stephen Thomas & Jeffrey Driban
Inter-Association Recommendations for Developing a Plan to Recognize and Refer Student-Athletes with Psychological Concerns at Collegiate Level: An Executive Summary of a Consensus Statement