Identifying Sports-Related Concussion Incidence, Symptom Reporting, and Return to Play Risk Factors in an Adolescent Sample: The Effects of Personality and Social Determinants of Health

Research Objectives: To determine if: 1) personality factors associated with health risk behaviors and 2) social determinants of health (SDOHs) associated with less privilege are associated with: 1) greater likelihood of diagnosed SRC, 2) less honesty and comfortability in symptom reporting, and 3) faster return-to-play (RTP) in adolescent athletes.

Design: Retrospective, cross-sectional, survey study.

Setting: Participants completed an online survey following recruitment from medical clinics, high school sports camps, Twitter, or a university subject pool.

Participants: Adolescent participants played a high school sport in the past year, denied history of moderate to severe traumatic brain injury, and either endorsed or denied diagnosed SRC in the past year (N = 317; Mage = 17.8, SD = 0.97, female = 55.0%, White race = 81.4%).

Interventions: N/A

Main Outcome Measures: All outcome measures were assessed via online survey.
- Days to RTP following diagnosed SRC - evaluated using survival analysis.
- Medically diagnosed SRC incidence; honesty and comfortability in symptom reporting - evaluated using logistic regression.

Results: - Higher socioeconomic status (SES; HR=1.126, CI=[1.017-1.247], p=.023) and female sex (HR=1.470, CI=[1.016-2.126], p=.041) were significantly associated with earlier RTP.
- Lower conscientiousness (OR=0.823, CI=[0.704-0.961], p=.014), higher agreeableness (OR=1.220, CI=[1.047-1.423], p=.011), female sex (OR=0.509, CI=[0.271-0.954], p=.035), lower SES (OR=0.806, CI=[0.677-0.960], p=.016), and increased pressure to continue to playing while symptomatic (“pressure”; OR=1.271, CI=[1.030-1.569], p=.025) were significantly associated with an increased odd of sustaining SRC.
- Higher openness to experience (OR=1.448, CI=[1.027-2.041], p=.035), lower impulsivity (OR=0.891, CI=[0.803-0.989], p=.031), female sex (OR=2.610, CI=[1.110-6.136], p=.028), and lower pressure (OR=1.319, CI=[1.012-1.720], p=.041) were positively associated with greater comfort and more honesty in symptom reporting.

Conclusions: Personality and SDOHs have differential and meaningful associations with RTP, SRC incidence, and symptom reporting in adolescent athletes. These findings could be used to inform and tailor SRC prevention and intervention efforts for specific groups. Future work should continue to investigate symptom reporting – especially if influenced by personality and SDOHs factors – as an intervention target to reduce SRC risk.

Author(s) Disclosures: None.