Concussions Among College Students Warrant Greater Attention

When you think about the major problems affecting college students, what comes to mind? You may think of physical health hazards associated with alcohol, other drugs, and sex. And there are threats to psychological health including academic stress, interpersonal conflict, and being away from family and home. These are without doubt important dimensions of college life.

If you have come across mild traumatic brain injuries, or mTBIs—commonly known as concussions—as a problem on campuses, it was most likely in connection with college sports, pranks, or rough-housing among male students. You would not be alone in placing mTBIs low on your list, especially for nonathletes and women.

Underreported, Undertreated, and Understudied

An mTBI is a form of brain injury resulting from a sudden blow that causes damage to the brain. A person with an mTBI may lose consciousness briefly and experience symptoms including headache; dizziness; blurred vision; ringing in the ears; changes in sleep, behavior, or mood; and difficulty with memory, concentration, or thinking. More severe TBIs have the potential to cause more severe and longer-lasting symptoms. But mTBIs are more common and more likely to go undetected and untreated.

Psychological approaches to the problem of mTBIs are informed by health behavior theories. These can guide the design of psychoeducational programs aimed at preventing TBIs and at promoting treatment-seeking when they occur. Barriers to prevention and to prompt treatment include beliefs about vulnerability to TBIs, their perceived severity, and cost-benefit analysis of health care seeking. Vulnerability, severity, and treatment-related beliefs are relevant to a wide range of health threats. Unlike most of those, TBI prevention and treatment-seeking also may be influenced by masculinity beliefs and stigma. These factors play a role in health problems like TBI that have features that involve social identity.

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Not Just Men and Athletes

There are no definitive national data on TBIs in the general college population, but studies of individual institutions suggest they form a large and growing problem. Although athletics play a role, some studies find that most TBIs are not sports-related. Other major causes are bicycle and automobile accidents, falls, self-harm, and assault. Some data suggest a higher incidence among women compared with men, whether or not they are athletes. Women also may be more likely to experience long-lasting effects of TBI as a result of a number of biomedical factors.

Norms for Masculine Behavior

There is evidence that college students who express greater conformity to norms placing value on self-reliance and winning indicate they would be less willing to report symptoms of a possible TBI. This has been observed both among athletes and nonathletes, and among both male and female students. These are sometimes referred to as masculine norms because they involve a desire to manifest agency, a trait-like behavior pattern emphasizing a sense of control and independence. Masculine norms are a salient feature of male gender-role expectations but are present in women as well as men.

Stigma

Among athletes, the operation of masculinity norms may be augmented by the threat of being stigmatized—that is, experiencing diminished positive regard in the eyes of teammates and coaches. For college students in general, fear of potential academic consequences may play a role. A TBI also may be stigmatizing if attributed to carelessness or lack of impulse control.

Just as TBI is not high on lists of major health hazards on college campuses, it does not rise to the top when it comes to health conditions that are stigmatizing. Mental health and behavioral problems, such as depression and alcohol and other substance use disorders, are more often discussed as stigmatizing conditions, as are physical health problems that are sexually transmitted or involve bodily systems and functions that can be a source of embarrassment.

Processes involved in stigmatization are complex and variable. In the case of TBI, they may involve attributions of the injury to psychological attributes such as personality, the view that the person was responsible for its occurrence, and the belief that symptoms reports represent malingering or at least exaggeration of their severity.

Prevention, Recognition, and Timely Treatment

Campus resources for preventing TBIs and identifying them when they occur include coaches, campus safety personnel and police, disability services, psychological services, health centers, and academic assistance centers. Additional resources may be present nearby in the community and university-affiliated clinics. Staff members should be familiarized with signs and symptoms of TBI, including indicators such as pain, nausea, and dizziness, as well as more subtle cues such as evidence of impaired executive functioning. Medical treatment should be sought for anyone who loses consciousness, even just for moments, for any reason, especially if they suffered a blow to the head and experience the symptoms of TBI outlined above.

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Horses and Zebras

There is an expression used in medical school saying that, when you hear hoof beats, think horses, not zebras, an admonition to consider the most likely diagnosis. Clearly, there are other possible causes of apparent TBI symptoms that may be more likely than a TBI depending on the circumstances. Nonetheless, a TBI might be responsible and should be among the causes that are considered. And this is true regardless of the affected person’s gender or sports participation.