The Relationship Between Coping, Neurocognitive Performance, And Concussion Symptoms In High School And Collegiate Athletes

Journal of Athletic Training.. 2013 Jun;


Covassin, T., R. J. Elbin, B. Crutcher, S. Burkhart and A. Kontos.



Context: The inconsistent presentation of concussive symptoms in conjunction with the uncertainty of prognosis (i.e., return to play) can result in a difficult and frustrating time for the injured athlete. Although previous researchers have reported that effective coping efforts are linked to improved outcomes following musculoskeletal sports injuries, the relationship between coping efforts and concussion is unclear. Objective: The purpose of the study was to explore the relationship of neurocognitive performance and symptoms to coping responses at 3 and 8 days postconcussion. Design: Prospective cohort study Setting: This study was performed in a controlled laboratory and field setting. Patients or Other Participants: A total of 104 concussed athletes volunteered to participate in the study (73 males: age = 16.26 + 2.07 years, mass = 77.2 + 16.8 kg, height = 178.4 + 8.15 cm, 31 female: age = 16.77 + 2.45 years, mass = 62.03 + 7.82 kg, height = 166.7 + 7.57 cm). Interventions: The independent variable in this study was time (baseline, 3, and 8 days postconcussion). Participants completed the Immediate Post-concussion Assessment and Cognitive Test (ImPACT), Post-concussion Symptom Scale (PCSS), and Brief COPE at baseline; and at 3 and 8 days postconcussion. A series of multiple regressions were performed with each of the three coping response factors as the outcome variables and the four neurocognitive composite scores and total symptoms as predictors. A series of repeated measures (RM) analysis of covariance (ANCOVA) were performed on the Brief COPE subscales and three coping response factors. History of concussion was used as the covariate for all ANCOVAs. Main Outcome Measures: Dependent variables included ImPACT composite scores (verbal/ visual memory, reaction time, processing speed), PCSS, and Brief Cope individual and three coping response factors (approach, avoidance, social). RM ANCOVAs with Bonferroni correction and post-hoc means comparisons were performed using Tukey’s HSD. Statistical significance was set at apriori at p<0.05. Results: Concussed athletes reported more frequent use of self-distraction (M=3.34+1.49: 3.16+1.56, p=.046), behavioral disengagement (M=2.29 +.90: 2.14+.51, p=.039), religion (M=2.58+1.38: 2.48+1.27, p= .014), and self-blame (M=2.48+.97: 2.27+.69, p=.001) at 3 days postconcussion compared to 8 days postconcussion. Concussed athletes reported more use of avoidance coping behavior at 3 days than 8 days (F [1, 100] =4.71, p=.032) post-injury. Total symptoms was a significant (p=.001) predictor of avoidance coping at 3 days post-concussion and decreased performance on visual memory was associated with increased avoidance coping (p= .03) at 8 days post-injury. Conclusion: Time since injury likely plays a role between neurocognitive performance, symptom reports, and coping. Clinicians should be aware of patients who report higher symptoms early in the course of recovery and have lingering visual memory deficits 1 week post-injury as they may use more potentially maladaptive avoidance coping following concussion.

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