Sports Medicine Research: In the Lab & In the Field: Should Athletic Trainers Add Anxiety Surveys to Preseason Baseline Testing? (Sports Med Res)


Monday, May 22, 2017

Should Athletic Trainers Add Anxiety Surveys to Preseason Baseline Testing?

Preseason Anxiety and Depressive Symptoms and Prospective Injury Risk in Collegiate Athletes

Li H, Moreland JJ, Peek-Asa C, Yang J. Am J Sports Med. 2017; ahead of print.

Take Home Message: An athlete with anxiety symptoms during preseason was more likely to get injured during a season than an athlete without symptoms.

National College Health Assessment surveys demonstrated that more than 1 in 3 NCAA student athletes reported anxiety or depressive symptoms. These symptoms can become elevated by the challenges these student-athletes face (academic demands, relationships, being away from home). Athletes with anxiety or depression symptoms may be at a higher risk of injury due to decreased concentration and/or reduced apprehension to problematic situations; however, this has not been verified in a large cohort of different sports and both sexes. Therefore, the authors followed 958 NCAA Division I athletes to determine the influence of anxiety and depressive symptoms, experienced during preseason, on risk of injury from 2 Universities during the 2007 to 2011 seasons. Six hundred and thirty one males (basketball, baseball, football, and wrestling) and 327 females (basketball, softball, field hockey, soccer, and volleyball) completed a 20-item survey to measure depression (Center for Epidemiologic Studies Depression Scale) and a 20-item survey to measure anxiety (State-Trait Anxiety Inventory) symptoms during preseason. The authors followed the athletes through their respective seasons and athletes completed both surveys again when they sustained an injury. The authors defined an injury as an event that required medical attention and resulted in loss of play for at least 1 day from either game or practice. Three hundred and eighty-nine athletes sustained 597 injuries. At preseason, 276 (29%) athletes reported anxiety symptoms, and 208 (22%) reported depressive symptoms. Among athletes reporting any of these symptoms, 49% (158 athletes) reported having both anxiety and depressive symptoms. Overall, an athlete who reported preseason anxiety symptoms was more likely to get injured than an athlete without preseason anxiety symptoms. A male athlete who reported preseason depressive and anxiety symptoms was 2 times more likely to experience an injury compared with a male athlete who reported no depressive or anxiety symptoms. However, this was not the case among female athletes. Finally, an athlete with only depressive symptoms, regardless of sex, was at no greater risk for injury.

The authors found that 46% of male athletes and 53% of female athletes reported anxiety and/or depression symptoms at preseason. Hence, many clinicians are already working with athletes who would report these symptoms and would be at an increased risk of injury, which could then exacerbate these symptoms. For both sexes the injury risk was highest for those who reported anxiety symptoms but not depressive symptoms. This suggests that a medical professional should assess anxiety and depression separately. The authors’ findings reinforce the importance of including preseason screening for psychological symptoms. Not only could preseason screening help recognize athletes who may benefit from assistance from a healthcare professional but it could also reduce the risk of injury during a season. This could also be especially valuable since some of these athletes may not recognize the benefits or want to seek assistance for anxiety or depression symptoms.  Medical professionals should understand how to follow through with proper referral for treatment as well as to ensure that the athletes receive education on effective coping strategies to further improve overall mental and physical health.

Question for Discussion: Do you assess for anxiety or depression during preseason and/or baseline testing? What do you do when you see an athlete with anxiety or depression symptoms? Do you have access to a psychologist/psychiatrist to refer athletes with preseason anxiety or depression?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

Related Posts:
Athletes with Concussion or Orthopedic Injury Have Similar Social Support Usage and Anxiety Levels

Li H, Moreland JJ, Peek-Asa C, & Yang J (2017). Preseason Anxiety and Depressive Symptoms and Prospective Injury Risk in Collegiate Athletes. The American Journal of Sports Medicine PMID: 28441037


Kyle Morris said...

Very interesting study. This fits in well with the Andersen and Williams Model of what can predispose an athlete to an athletic injury. If they have poor coping resources for their anxiety to begin with, and they are placed in a potentially stressful situation, the risk of sustaining an injury becomes greater. I think it would be a great idea to incorporate more psychological testing into PPE's to find out who is potentially at risk and intervene if possible.

Jane McDevitt said...

I agree if the athlete is already suffering with anxiety to begin with they are going to be at a greater risk for injury. Do you currently use any PROMs? Hospital Anxiety and Depression Scale or the Disablement for Physically Active Scale (DPAS) may be a good start. I would love to see one implemented in the PPE. They only take 5 minutes and would be a better assessment for depression or anxiety than just asking yes or no do you have depression. Athletes may not want to be that up front. Especially if this is a freshman and you have yet to form a student athlete-athletic trainer rapport with them these may be helpful indicators to speak to the athlete/parent, you need to see someone.

Kate Hill said...

I agree with Kyle, incorporating psychological testing into PPEs is a great idea in order to see who is at risk. People with anxiety and depression respond to injuries in different ways and knowing how to deal with an those athletes would be helpful. Also being aware beforehand that an athlete has anxiety or depression could help to look for warning signs and symptoms during stressful situations.

Juliana Jimenez said...

I am happy mental health has become more acceptable to openly talk about. I think it is hugely important for taking care of the athlete as a whole and not just the sum of their injuries. I expected to see the injury risk highest for both sexes who had anxiety but was surprised it was not high in those with depression. It is also interesting when you look at the relationship between anxiety and performance because having too little anxiety can lead to just as poor performance seen with too much anxiety. I would be curious to see if this could be similar with injury recurrence and recovery. I definitely think mental health should be assessed during Preseason baselines and followed up with a healthcare specialist to help the athlete cope.

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