Sports Medicine Research: In the Lab & In the Field: Concussed Athletes Cope Differently (Sports Med Res)


Monday, October 28, 2013

Concussed Athletes Cope Differently

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

Related Posts:

Kontos AP, Elbin RJ, Newcomer Appaneal R, Covassin T, & Collins MW (2013). A comparison of coping responses among high school and college athletes with concussion, orthopedic injuries, and healthy controls. Research in Sports Medicine (Print), 21 (4), 367-79 PMID: 24067122


Unknown said...

Yes, I believe that different strategies should be developed and used to address coping mechanisms for athletes. At minimum, clinicians should be aware that different types of athletes and different injuries will elicit an array of coping responses. Anecdotally I have noticed this in many of my patients and I am glad to see that more individuals are recognizing this specific psychosocial aspect in response to injury.

Amanda Brown said...

I also believe that injury and sex-specific coping strategies should be used to help athletes deal with their injuries. For many athletes, their lives revolve around sport so when they are not able to fully participate, their whole world is changed and that can be a very difficult adjustment. It may be even more challenging for them to seek out the help they need. The culture of many sports, especially male sports, is to be tough so many athletes may view this help as a sign of weakness. Each athlete handles orthopedic injuries and concussions differently so as clinicians, I believe we need to make adjustments to our treatments to best aid these athletes mentally and physically. I have observed sex differences in coping with injuries and again I think a lot of it has to do with the culture of sports and the "tough man" mentality. We should do our best to help athletes mentally recover from injury as much as we do physically and when it is beyond our realm, we should refer them to someone who specializes in psychology.

Jane McDevitt said...

I agree with your comment. I feel like I would be able to recognize a difference in how my athlete is feeling. However I am not really confident in my coping skills and I would refer like you said right away. The athletes that are more guarded and are not overt with their emotions I may not even recognize they are having problems, and I think this is where I can use these conclusions from this article. I feel like if I can at least use these coping mechanisms that are more for males/females, concussed/ortho injury I can at least at some level get them to open up and refer if needed or at least open the athlete's eyes to coping mechanisms.

Brittany Cavacloglou said...

I agree that with male athletes it is harder to identify coping issues due to the fact that they tend to express their emotions less. I believe the main reasons for these issues comes from the removal of play and the fact that they feel lost when they aren't playing. When reading this article, I was wondering why the concussed athletes took the COPE survery online and the healthy and orthopedic injured athletes took a paper and pen test. Was this done by random or is there a specific meaning behind it?

Jason Shermer said...

It is very hard to try and help an athlete going through depression following a concussion, also keeping a professional relationship in these matters can also be difficult. Are there any suggested methods to helping a post-concussion athlete cope with what he is going through (Based on the above methods (Humor, religion...))?

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