Masculinity, optimism bias, and perceived pressure from stakeholders influence on student-athlete concussion reporting intentions and behavior.

Weber Rawlins ML, Welch Bacon CE, Tomporowski P, Gay JL, Bierema L, Schmidt JD. J Am Coll Health. 2022 Sep 9:1-7. doi: 10.1080/07448481.2022.2115300. Epub ahead of print.

Take-Home Message

Student-athletes with pessimistic views of concussion risks have higher intentions to report symptoms or a concussion.


Clinicians rely on student-athletes to report a possible concussion to ensure proper diagnosis and treatment. We can optimize educational efforts to improve concussion reporting with a better understanding of the barriers to reporting a concussion. Three emerging areas that may influence reporting are masculinity (qualities traditionally related to men), optimism bias (thinking bad things are less likely to occur to a person than others), and perceived pressure from stakeholders (e.g., coaches, teammates).

Study Goal

Weber Rawlins and colleagues completed a survey study to determine how masculinity, optimism bias, and perceived pressure from others related to reporting intentions and behaviors.


Student-athletes from 3 universities in the Southeastern USA used online survey software to complete five tools that assessed key factors:

  1. masculinity (winning, emotional control, risk-taking, violence, power over women, playboy, self-reliance, primacy of sport, and heterosexual self-presentation)
  2. optimism bias
  3. perceived pressure (from coaches, teammates, parents/guardians, sports medicine professionals, athletes administrators, and sports fans)
  4. concussion and symptom reporting intentions (summarized as being a reporter or non-reporter)
  5. concussion and symptom reporting behaviors (summarized as being a reporter or non-reporter)


A total of 313 respondents completed all portions of the survey, and 369 respondents completed at least 1 part of the survey. A student-athlete had less intention to report symptoms or a concussion if they were not a pessimist (neutral or optimist). Furthermore, they had less intention to report symptoms if they reported more masculinity in two domains:  “playboy” and “heterosexual self-preservation”. Regarding intention to report concussions, someone with increased scores for “primacy of sport” and “pressure from athletic administration” tended to be less likely to report.


Interestingly, the most consistent result was that someone who was neutral or felt less likely to experience bad events than someone else was less likely to report symptoms or a concussion. Based on this finding, the authors suggest that “educational efforts should highlight the realistic risk student-athletes have for sustaining a concussion in sport or developing long-term health consequences as result of that concussion”. The authors also reported predictors for reporting behaviors during the prior year. These analyses led to different results than what we reported above. One explanation is that reporting intentions and actual behaviors do not match. However, it is hard to compare these results because only 10-20% of the participants had symptoms or a concussion to report (or not report) in the prior year. Therefore, the different results could be a fluke, or this subset of people is unique to the other 80-90% of the participants without a concussion or symptoms in the prior year. It will be interesting to see if future studies with a larger group of people with symptoms or concussion in the previous year yield similar results.

Clinical Implications

Clinicians should encourage timely reporting of concussions and offer realistic estimates of a student-athlete’s risk for a concussion and the consequences of a concussion.

Questions for Discussion

What strategies have you employed to help educate stakeholders about the dangers of not reporting concussions? Have you found those efforts to be successful? Why or why not?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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