A comparison of
coping responses among high school and college athletes with concussion,
orthopedic injuries, and healthy controls

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.

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.

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?

by: Jane McDevitt PhD
by: Stephen Thomas & Jeffrey Driban


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