Objective The purpose of our study was to assess the relationship between fear avoidance and acute concussion symptoms in athletes.

Design A cross-sectional study.

Setting On the respective college campuses.

Participants We had 34 participants, with an average age of 20.9 ± 1.8 years old, including 23 males and 11 females.

Interventions (or Assessment of Risk Factors) We assessed the athletes’ concussions within 48 hrs using the SCAT5, pain catastrophizing using the Pain Catastrophizing Scale, fear avoidance using the Athlete Fear Avoidance Questionnaire (AFAQ), and anxiety and depression using the Hospital Anxiety and Depression Questionnaire (HADS).

Outcome Measures The dependent variables were AFAQ score, HADS score and PCS score.

Main Results Our participants suffered an average of 7.4 ± 5.1 symptoms and a 16.3 ± 17.0 symptom severity score. The total number of symptoms was significantly associated with the AFAQ score (r=0.493). Moreover, the symptom severity score was associated with the AFAQ score (r=0.481). The total number of symptoms and severity score were significantly associated with the HADS score (r=0.686 and r=0.602). The AFAQ score, HADS depression and HADS anxiety scores model was a significant predictor of the total number of symptoms reported on the SCAT5, accounting for 50.4% of the variance (p>0.001) as well as severity (p=0.001).

Conclusions Our study identified a significant relationship between athlete fear avoidance, depression, and anxiety and the number of acute concussion symptoms in athletes. A higher fear avoidance means that patients report more symptoms, and this relationship could explain why there is variability in the reporting of concussion symptoms.