Research has found that college athletes may be less likely to report a concussion because they consider the impact on their team and their career prospects. A new study from the United States Air Force Academy suggests that a similar dynamic could be at play among pilots.

The findings, which appear in PLOS One, suggest that seeking medical assistance for a concussion becomes a problem in some populations when disclosure is viewed as being costly.

“Being a professor at the Academy, we see a population with a lot of unique characteristics. For example, all cadets are required to remain physically active during their time at the Academy – either through NCAA sports or intramurals, plus military training,” said study author Christopher D’Lauro.

“This physical activity level increases their concussion risk, so it’s something that I realized that could be interesting to research with our unique environment here, where even non-athletes are very fit and get free walk-in health care.”

“As I began to research this topic at the Academy, I realized that 1.) concussion treatment and diagnosis is heavily reliant on symptom self-report, as there are no bullet-proof objective measures and 2.) self-report of concussion has almost exclusively been investigated in athlete populations, so there was a real need to expand beyond that group.”

In the study, the researchers surveyed 2,504 cadets at the Academy regarding their feelings about reporting concussions. The participants were assured that their responses would remain anonymous.

The researchers found that cadets who planned to become pilots tended to have more negative attitudes about reporting a concussion to medical staff, compared to cadets who had no plans to become pilots. Cadets who planned to become pilots were increasingly reluctant to disclose concussions as they neared graduation.

“The main thing we found is that people seems less willing to report concussions if they perceive reporting as costly to themselves – regardless of whether they were an athlete or not. That seems pretty straightforward, but it really means we need to demonstrate the benefits of reporting a concussion – quicker recoveries, fewer related orthopedic injuries – if we want people to do more of it,” D’Lauro told PsyPost.

“Many studies have found athletes unwilling to report concussion for fear of missing practices or games, but an interesting wrinkle from our population is that our future pilots were less willing to report because they thought reporting a concussion would negatively affect their flying career. Just like athletes don’t want to derail their sports careers, our pilots did not want to miss out on their aviation careers.”

“There is a lot of confusion and misinformation surrounding how concussions can affect a pilot’s career, so we have identified this as a point of education to increase concussion reporting here at the Academy,” D’Lauro explained.

“This matters beyond the Academy because people often use identity-based explanations for why people don’t report concussions, e.g. ‘Athletes will never report their concussions.’ Our research says maybe they will if given a better understanding of the real benefits – for example of a quicker return to sport.”

The study — like all research — includes some caveats.

“This area is still so under-researched, especially outside of an athlete population, and this is just one study. This is also based on a survey, so people could always respond in one way while behaving in another,” D’Lauro told PsyPost.

“Also, cadets, like athletes, are a non-random sample, so more work needs to be done to see how this study generalizes outside of these highly fit and motivated groups. How do college age non-athletes view concussion-reporting? How about typical adults? We still have a lot to learn.”

Despite the limitations, the findings provide policymakers and others with insights into how to encourage people to seek assistance after they have suffered a concussion.

“Interdisciplinary research like this is both hard to execute and publish, but it really matters. We’re using some insights from psychology, some from sports medicine, and others from public health perspectives. Being able to work across disciplines to use appropriate tools is harder, but often worth the effort,” D’Lauro said.

“We consider this study our school’s concussion reporting ‘baseline.’ Since this time we’ve worked hard to address and improve these issues, especially our clinicians who work with the athletes and other cadets every day.

“We’re doing all this work on concussion reporting as part of an NCAA-DoD program called Mind Matters, along with eight other research sites. Being a part of this collegial and innovative group of researchers has been an eye-opening, incredibly positive experience. We’re glad for their support as well as the cooperation from USAFA leadership,” D’Lauro added.

(Note: The views represented are those of the author and not the US Air Force Academy or the Department of Defense.)

The study, “Pilots and athletes: Different concerns, similar concussion non-disclosure“, was authored by Craig A. Foster, Christopher D’Lauro, and Brian R. Johnson.