Structural validity of a self-report concussion-related symptom scale

Purpose: This study evaluated the factorial validity of a self-report measure of concussion-related symptom severity among a large sample of male, high-school athletes. Methods: Participants (N = 1089) were nonconcussed, male, high-school football players. All participants completed a single baseline self-report measure of concussion-related symptom severity, namely the graded symptom checklist (GSC). We tested the factorial validity of the measure with confirmatory factor analysis using LISREL 8.50. Results: The analysis indicated that a theoretically derived, three-factor model provided a good, but not excellent, fit for the 16-item GSC. Excellent model-data fit was demonstrated for the three-factor model for a 9-item version of the GSC. In both instances, the three factors were best described by a single second-order factor, namely concussion symptomatology. Conclusions: This study provides additional evidence for the factorial validity of a summative self-reported measure of concussion-related symptoms. The factor structure represents a cohesive group of nine symptoms that can be explained by three underlying latent variables, namely somatic symptoms, neurobehavioral symptoms, and "cognitive" symptoms, subsumed under a single higher-order factor, namely concussion symptoms.