Sport-Related Concussion Reporting and Coach-Athlete Attachment Among Collegiate Student-Athletes

in Journal of Clinical Sport Psychology
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Between 2001 and 2015, 3.4 million traumatic brain injury (TBI) occurrences in the U.S. were accounted for by sport participation. It is estimated between 12% and 60% of athletes delay seeking care after sustaining a concussion. Differences in sport-related concussion (SRC) reporting have been attributed to several different factors. Whereas prior research related to SRC reporting behavior focus on normative and competitive pressures to continue play, less attention is given to the interpersonal context in which reporting takes place. Grounded in attachment theory, this study investigated relationships between coach-athlete attachment and help-seeking behavior. Findings suggest that as coach-athlete anxiousness increases, not reporting increases. and as coach-athlete secureness increases, not reporting decreases. Logistic regression analyses indicate that secure coach attachment significantly predicts greater likelihood of SRC reporting. These findings underscore the important role coach-athlete relationships may have on care-seeking behaviors of student-athletes and can inform individual and group interventions promoting SRC reporting.

Milroy and Wyrick are with the University of North Carolina Greensboro, Greensboro, NC; and also with the UNC Greensboro Institute to Promote Athlete Health & Wellness, Greensboro, NC. Hebard is with the University of Alabama at Birmingham, Tuscaloosa, AL. Kroshus is with the Dept. of Pediatrics, University of Washington, Seattle, WA; Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, Seattle, WA; and also with the Harborview Injury Prevention Research Center, Seattle, WA.

Address author correspondence to Jeffrey J. Milroy at jjmilroy@uncg.edu.
  • Ainsworth, M.D.S. (1989). Attachments beyond infancy. American Psychologist, 44, 709–716. PubMed ID: 2729745 doi:10.1037/0003-066X.44.4.709

  • Ainsworth, M.D.S., & Bell, S.M. (1970). Attachment, exploration, and separation: Illustrated by the behavior of one-year-olds in a strange situation. Child Development, 41, 49–67. PubMed ID: 5490680 doi:10.2307/1127388

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Asken, B.M., McCrea, M.A., Clugston, J.R., Snyder, A.R., Houck, Z.M. (2016). Journal of Athletic Training, 51(4), 329–335. doi:10.4085/1062-6050-51.5.02

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Baugh, C.M., Kroshus, E., Daneshvar, D.H., & Stern, R.A. (2014). Perceived coach support and concussion symptom-reporting: Differences between freshmen and non-freshmen college football players. Journal of Law, Medicine & Ethics, 42(3), 314–322. PubMed ID: 25264089 doi:10.1111/jlme.12148

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bellanger, H.G., & Vanderploeg, R.D. (2005). The neuropsychological impact of sports-related concussion: a meta-analysis. Journal of the International Neuropsychological Society, 11(4), 345–357. doi:10.1017/S1355617705050411

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Belsley, D.A., Kuh, E., & Welsch, R.E. (1980). Regression diagnostics: Identifying influential data and sources of collinearity (pp. 46–76). Hoboken, NJ: Wiley-Interscience.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Berry, T., & Howe, B. (2000). Risk factors for disordered eating in Female University Athletes. Journal of Sport Behavior, 23(3), 207–216.

    • Search Google Scholar
    • Export Citation
  • Bowlby, J. (1969/1982). Attachment and loss Vol. 1: Attachment. New York, NY: Basic Books.

  • Bowlby, J. (1973). Attachment and loss, Vol. 2: Separation. New York, NY: Basic Books.

  • Brennan, K.A., Clark, C.L., & Shaver, P.R. (1998). Self-report measurement of adult attachment: An integrative overview. In J.A. Simpson & W. Rholes (Eds.), Attachment theory and close relationships (pp. 46–76). New York, NY: Guilford Press.

    • Search Google Scholar
    • Export Citation
  • Broglio, S.P., & Puetz, T.W. (2008). The effect of sport concussion on neurocognitive function, self-report symptoms and postural control: A meta-analysis. Sports Medicine, 38, 53–67. PubMed ID: 18081367 doi:10.2165/00007256-200838010-00005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cassidy, J. (1995). Attachment and generalized anxiety disorder. In D. Cicchetti & S. Toth (Eds.), Rochester symposium on developmental psychology: Emotion, cognition and representation (Vol. 6, pp. 343–370). Rochester, NY: University of Rochester Press.

    • Search Google Scholar
    • Export Citation
  • Centers for Disease Control and Prevention. (2015). Report to congress on traumatic brain injury in the United States: epidemiology and rehabilitation. Atlanta, GA: National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention

    • Search Google Scholar
    • Export Citation
  • Cote, J. (2002). Coach and peer influence on children’s development through sport. In J.M. Silva III & D.E. Stevens (Eds.), Psychological foundations of sport (pp. 520–540). Boston, MA: Allyn and Bacon.

    • Search Google Scholar
    • Export Citation
  • Davis, L., & Jowett, S. (2010). Investigating the interpersonal dynamics between coaches and athletes based on fundamental principles of attachment. Journal of Clinical Sport Psychology, 4, 112–132. doi:10.1123/jcsp.4.2.112

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Davis, L., & Jowett, S. (2014). Coach-athlete attachment and the quality of the coach-athlete relationship: Implications for athlete’s well-being. Journal of Sports Sciences, 32, 1454–1464. PubMed ID: 24713087

    • Search Google Scholar
    • Export Citation
  • Diamond, L.M., & Aspinwall, L.G. (2003). Emotion regulation across the lifespan: An integrative perspective emphasizing self-regulation, positive affect, and dyadic process. Motivation and Emotion, 27, 125–156. doi:10.1023/A:1024521920068

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Emanuelson, I., Andersson Holmkvis, E., Bjorklund, R., & Stalhammer, D. (2003). Quality of life and post-concussion symptoms in adults after mild traumatic brain injury: A population-based study in western Sweden. Acta Neurologica Scandinavica, 108, 332–338. PubMed ID: 14616303 doi:10.1034/j.1600-0404.2003.00155.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Felton, L., & Jowett, S. (2015). On understanding the role of need thwarting in the association between athlete attachment and well/ill-being. Scandinavian Journal of Medicine and Science in Sports, 25, 289–298. PubMed ID: 24593151 doi:10.1111/sms.12196

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Fox, N.A., & Calkins, S.D. (2003). The development of self-control of emotion: Intrinsic and extrinsic influences. Motivation and Emotion, 27, 7–26. doi:10.1023/A:1023622324898

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Guskiwicz, K.M., Bruce, S.L., Cantu, R.C., Ferrara, M.S., Kelly, J.P., McCrea, M., … McLeod, T.C. (2004). National athletic trainers’ association position statement: Management of sport-related concussion. Journal of Athletic Training, 39(3), 280–297.

    • Search Google Scholar
    • Export Citation
  • Halsted, M.E., McAvoy, K., Devore, C.D., Carl, R., Lee, M., & Logan, K. (2013). Returning to learning following a concussion. Pediatrics, 132(5), 948–957.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hamilton, C.E. (2000). Continuity and discontinuity of attachment from infancy through adolescence. Child Development, 71, 690–694. PubMed ID: 10953935 doi:10.1111/1467-8624.00177

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511–524. PubMed ID: 3572722 doi:10.1037/0022-3514.52.3.511

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Institute of Medicine (IOM) and National Research Council (NRC). (2014). Sports-related concussions in youth: Improving the science, changing the culture. Washington, DC: The National Academies Press.

    • Search Google Scholar
    • Export Citation
  • Jowett, S. (2003). When the “honeymoon” is over: A case study of a coach-athlete dyad in crisis. The Sport Psychologist, 17, 444–460. doi:10.1123/tsp.17.4.444

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jowett, S. (2005). On repairing and enhancing the coach-athlete relationship. In S. Jowett & M. Jones (Eds.), The psychology of coaching (pp. 14–26). Leicester, UK: The British Psychological Society.

    • Search Google Scholar
    • Export Citation
  • Kerr, Z.Y., Register-Mihalik, J.K., Kroshus, E., Baugh, C.M., & Marshall, S.W. (2015). Motivations associated with nondisclosure of self-reported concussions in Former Collegiate Athletes. Epidemiology, 44(1), 220–225.

    • Search Google Scholar
    • Export Citation
  • Kerr, Z.Y., Register-Mihalik, J.K., Marshall, S.W., Evenson, K.R., Mihalik, J.P., & Guskiewicz, K.M. (2014). Disclosure and non-disclosure of concussion and concussion symptoms in athletes: Review and application of the socio-ecological framework. Brain Injury, 28(8), 1009–1021. doi:10.3109/02699052.2014.904049

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kontos, A.P., Covassin, T., Elbin, R.J., & Parke, T. (2012) Depression and neurocognitive performance after concussion among male and female high school and collegiate athletes. Archives of Physical Medicine and Rehabilitation, 93, 1751–1756. PubMed ID: 22503738 doi:10.1016/j.apmr.2012.03.032

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kroshus, E., Baugh, C.M., Daneshvar, D.H., & Viswanath, K. (2014). Understanding concussion reporting using a model based on the Theory of Planned Behavior. Journal of Adolescent Health, 54, 269–274.e2. PubMed ID: 24560034 doi:10.1016/j.jadohealth.2013.11.011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kroshus, E., Daneshvar, D.H., Garnett, C.M., Nowinski, C.J., & Cantu, R.C. (2013). NCAA concussion education in ice hockey: an ineffective mandate. British Journal of Sports Medicine, 48(2), 135–140. PubMed ID: 23956336 doi:10.1136/bjsports-2013-092498

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kroshus, E., Garnett, B.R., Baugh, C.M., & Calzo, J.P. (2015). Social norms theory and concussion education. Health Education Research, 30(6), 1004–1013. PubMed ID: 26471918

    • Search Google Scholar
    • Export Citation
  • Kroshus, E., Kubzansky, L.D., Goldman, R.E., & Austin, S.B. (2015). Norms, athletic identity, and concussion symptom under-reporting among male collegiate ice hockey players: a prospective cohort study. Annals of Behavioral Medicine, 49(1), 95–103. doi:10.1007/s12160-014-9636-5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kuehl, M.D., Snyder, A.R., Erickson, S.E., & Valovich McLeod, T.C. (2010). Impact of prior concussions on health-related quality of life in collegiate athletes. Clinical Journal of Sports Medicine, 20, 86–91. doi:10.1097/JSM.0b013e3181cf4534

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Llewellyn, T., Burdette, G.T., Joyner, A.B., & Buckley, T.A. (2014). Concussion reporting rates at the conclusion of an intercollegiate athletic career. Clinical Journal of Sport Medicine, 24(1), 76–79. PubMed ID: 24157468 doi:10.1097/01.jsm.0000432853.77520.3d

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Master, C.L., Gioia, G.A., Leddy, J.J., & Grady, M.F. (2012) Importance of 'return-to-learn' in pediatric and adolescent concussion. Pediatric Annals, 41(9), 1–6.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McCrory, P., Meeuwisse, W., Aubry, M., Cantu, B., Dvorak, J., Echemendia, R.J., Tator, C.H. (2013). Consensus statement on concussion in sport– the 4th international conference on concussion in sport held in Zurich. Clinical Journal of Sports Medicine, 23, 89–117. doi:10.1097/JSM.0b013e31828b67cf

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Meier, T.B., Brummel, B.J., Singh, R., Nerio, C.J., Polanski, D.W., & Bellgowan, P.S.F. (2015). The underreporting of self-reported symptoms following sports-related concussion. Journal of Science and Medicine in Sport, 18, 507–511. PubMed ID: 25150463 doi:10.1016/j.jsams.2014.07.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mikulincer, M., & Florian, V. (1998). The relationship between adult attachment styles and emotional and cognitive reactions to stressful events. In J.A. Simpson & W.S. Rholes (Eds.), Attachment theory and close relationships (pp. 143–165). New York, NY: Guilford Press.

    • Search Google Scholar
    • Export Citation
  • Mikulincer, M., & Shaver, P.R. (2003). The attachment behavioral system in adulthood: Activation, psychodynamics and interpersonal processes. In M.P. Zanna (Ed.), Advances in experimental social psychology (Vol. 35, pp. 53–152). San Diego, CA: Academic Press.

    • Search Google Scholar
    • Export Citation
  • Mikulincer, M., & Shaver, P.R. (2008). Attachment theory and affect regulation. In J. Cassidy & P.R. Shaver (Eds.), Handbook of attachment: Theory, research and clinical applications (2nd ed., pp. 503–531). New York, NY: Guilford Press.

    • Search Google Scholar
    • Export Citation
  • National Collegiate Athletic Association. (2014). NCAA Sports Medicine Handbook: Guideline 21, Sport-related concussion (pp. 56–64). Indianapolis, IN: NCAA.

    • Search Google Scholar
    • Export Citation
  • Register-Mihalik, J.K., Guskiewicz, K.M., Valovich McLeod, T.C., Linnan, L.A., Mueller, F.O., & Marshall, S.W. (2013). Knowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study. Journal of Athletic Training. 48(5), 645–653. PubMed ID: 23848520 doi:10.4085/1062-6050-48.3.20

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • Sady, M.D., Vaughan, C.G., & Gioia, G.A. (2014) Psychometric characteristics of the postconcussion symptom inventory in children and adolescents. Archives of Clinical Neuropsychology, 29(4), 348–363.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Smith, R.E., & Smoll, F.L. (2002). Youth sports as a behavior setting for psychosocial interventions. In J.L. Raalte & B.W. Brewer (Eds.), Exploring sport and exercise psychology (2nd edn., pp. 341–371). Washington, District of Columbia: American Psychological Association.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Smoll, F.L., Smith, R.E., & Cumming, S.P. (2007). Coaching behaviors, motivational climate, and young athletes’ sport experiences. In C. Gonclaves, M. Coelho e Silva, L. Adelino, & R.M. Malina (Eds.), Sport and education, (pp. 165–175). Coimbra, Portugal: Coimbra University Press.

    • Search Google Scholar
    • Export Citation
  • Torres, D.M., Galetta, K.M., Phillips, H.W., Dziemianowicz, E.M., Wilson, J.A., Dorman, E.S., … Balcer, L.J. (2013). Sports-related concussion: anonymous survey of a collegiate cohort. Neurology: Clinical Practice, 3, 279–287.

    • Search Google Scholar
    • Export Citation
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