Background: A concussion is a concerning injury because of the potential long-term effects to the brain. Typical concussion evaluation and management tools include tests that ensure an athlete is physically ready to return to play (e.g., clinical evaluation, symptom reports, balance assessment). However, psychological factors are often overlooked from these protocols, despite increasing evidence that it may prolong recovery. One psychological factor to consider is athletic identity, which is defined as the exclusivity and strength with which an individual identifies with the athletic role and looks to others for confirmation of that role. Purpose: The purpose of this dissertation was to examine athletic identity in collegiate athletes to predict outcomes following concussion, including concussion symptom scores, days to symptom resolution, and days to full medical clearance (FMC). Methods: This was a prospective, repeated measures design study performed in a university laboratory setting. Participants diagnosed with a concussion were included in the study and asked to complete two testing sessions: (1) within 5 days of their injury (the acute visit), and (2) at the time of FMC (within 3 days; FMC visit). During the acute visit, participants provided informed consent, as well as information regarding demographics (e.g., age, sex), injury characteristics (e.g., mechanism of injury), and medical history questions (e.g., concussion history, diagnosis of depression/anxiety). Additionally, participants completed two surveys, the Athletic Identity Measurement Scale (AIMS) and the symptom checklist of the Sport Concussion Assessment Tool (SCAT5/SCAT6). The AIMS is a 7-item questionnaire that assesses the extent to which the athlete role is a stable and central part of one’s self-identity and includes three subscales: social identity, exclusivity, and negative affectivity. At the FMC visit, participants completed recovery information (i.e., days to symptom resolution and days to FMC) and the same surveys completed at the acute visit. A series of hierarchical multiple regression analyses were conducted in a stepwise fashion to assess the extent to which athletic identity predicted total number of symptoms, symptom severity score, days to symptom recovery and days to FMC. These analyses were evaluated based on an a-priori alpha level <0.05. Results: A total of 92 collegiate athletes (mean age: 20.8+1.6; 39 female, 53 male) completed the study. There was a statistically significant weak and positive relationship between the negative affectivity subscale and total number of symptoms (p < 0.01), symptom severity score (p < 0.01), and days to FMC (p < 0.01). The negative affectivity subscale significantly predicted an increase in total number of symptoms (F(1, 87) = 5.827, p = 0.018, R2 = 0.055) and an increase in symptom severity scores (F(1, 87) = 4.002, p = 0.049, R2 = 0.038), while controlling for sex, history of learning disorder or dyslexia, history of depression/anxiety which are known variables that impact concussion recovery outcomes. The AIMS total score, the social identity subscale and the exclusivity subscale did not predict any concussion recovery outcomes. Conclusion: Among collegiate athletes following concussion, the negative affectivity subscale was positively associated with total number of symptoms, symptom severity score, and days to FMC. Additionally, the negative affectivity subscale predicted more total number of concussion symptoms and higher symptom severity score reported at the acute visit over and above known variables that impact concussion symptom scores. These findings further expand our knowledge and understanding about a specific psychosocial factor (i.e., athletic identity) and its relationship to concussion outcomes. The information gleaned from this study gives clinicians a starting point for addressing collegiate athletes who are stronger in negative affectivity following a concussion, but further research on the psychometric properties of the AIMS in a concussion population is warranted.
Read
