The underreporting of self-reported symptoms following sports-related concussion

J Sci Med Sport. 2015 Sep;18(5):507-11. doi: 10.1016/j.jsams.2014.07.008. Epub 2014 Jul 24.


Objectives: This cohort study was conducted to examine patterns of symptom reporting in concussed athletes in two different testing environments.

Design: A prospective cohort study was conducted with repeated measures.

Methods: Self-reported symptoms collected by team athletic trainers using the ImPACT Post-Concussion Scale (PCS) were compared to symptoms collected in a confidential setting using structured interviews for depression and anxiety. Ratings were scaled to match scoring of the PCS and categorized into symptom-domains. Scores collected 2 days post-concussion were compared across different rating scales. Confidential self-report scores approximately 9 days post-concussion in cleared athletes were compared to PCS scores collected during return-to-play decisions. Finally, confidential self-report scores collected 9 days post-concussion were compared between cleared and not cleared athletes.

Results: Athletes self-reported significantly fewer symptoms to team athletic trainers using the ImPACT test compared to self-reported symptoms collected in a confidential setting during the acute phase of concussion using standard psychiatric interviews. Athletes cleared to play continued to underreport symptoms 9 days post-concussion, particularly psychiatric symptoms. Finally, cleared athletes self-reported similar magnitude of symptoms than non-cleared athletes 9 days post-concussion in confidential research setting.

Conclusions: The systematic underreporting of post-concussion symptoms may represent motivated behavior or differences in self-reporting data acquisition. By underreporting symptoms, many cleared athletes are still symptomatic over 1-week post-concussion. This study highlights the need for objective measures for somatic and psychiatric symptoms.

Keywords: Mild traumatic brain injury; Neuropsychological testing; Post-concussion symptoms.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analysis of Variance
  • Anxiety / diagnosis
  • Anxiety / etiology
  • Athletic Injuries / diagnosis*
  • Athletic Injuries / psychology
  • Brain Concussion / diagnosis*
  • Brain Concussion / etiology
  • Brain Concussion / psychology
  • Depression / diagnosis
  • Depression / etiology
  • Female
  • Humans
  • Male
  • Neuropsychological Tests*
  • Prospective Studies
  • Return to Sport / psychology*
  • Self Report*
  • Young Adult