The Association of Sport Specialization and Concussion History on Self-Reported Depressive Symptoms and Quality of Life Among High School Athletes.

Chou TY, Biese K, Leung W, Bell D, Kaminski T, McGuine T. [published online ahead of print, 2022 Nov 11]. Clin J Sport Med. 2022; doi:10.1097/JSM.0000000000001092

Take-Home Message

Sport specialization in high school student-athletes may increase depressive symptoms and reduce quality of life. Concussion history may be unrelated to mental health in this population.


As sports participation increases, so does sport specialization and sports-related concussions. Adverse psychosocial outcomes associated with these factors include burnout, depression, and reduced quality of life. Although published studies suggest concussion and sports specialization may relate to adverse mental health outcomes, no studies exist addressing student-athletes with both of these risk factors.  

Study Goal

The researchers aimed to determine if sport specialization and concussion history relate to depressive symptoms and quality of life in high school student-athletes.


The authors recruited student-athletes from 31 high schools in Wisconsin during the 2016-2018 school years. All participants met the inclusion criteria by participating in interscholastic sports, enrolling in grades 9-12, and being medically eligible to participate in sports on the day of study recruitment. After meeting these criteria and consenting to participate, researchers collected participant demographic data, including concussion and sports history (single- or multi-sport participation). Athletic Trainers validated the information provided by the participant. Researchers used The Patient Health Questionnaire-9 to collect data related to depressive symptoms and the Pediatric Quality of Life 4.0 Scale to assess participant quality of life.


Of the 2,453 athletes, 19% reported a previous concussion, and 57% specialized in a sport. Athletes who participated in only one sport reported more depressive symptoms and lower quality of life than their multi-sport counterparts. Specifically, single-sport athletes had 50% greater odds of reporting higher depression scores than multi-sport high school student-athletes. Sport-related concussion history was unrelated to depressive symptoms and quality of life.


This research adds to the growing body of literature suggesting sport specialization may lead to negative mental health outcomes for student-athletes. This relationship may explain the increased mental health concerns in athletic populations over the past several years. This study also adds to the literature that concussion history is unrelated to mental health conditions among non-elite athletes. However, this is not intended to downplay that some patients may experience depressive symptoms after a concussion and that we should carefully monitor all patients after an injury for mental well-being. This study is not without limitations. The authors relied on patients to recall prior concussion history, which introduces concerns about the accuracy of someone’s recall. The cross-sectional nature of this study also limits the authors’ ability to determine whether sport specialization (playing a single sport) causes adverse mental health and quality-of-life outcomes or whether depressive symptoms make an athlete less likely to participate in multiple sports.

Clinical Implications

Sports medicine professionals should advocate for diverse sports experiences for youth, adolescent, and teen athletes while ensuring preparedness to handle mental health concerns in this population. Furthermore, these professionals should avoid suggesting that sport-related concussions lead to mental health consequences, including depression.

Questions for Discussion

What are your experiences with sport-specialization athletics and mental health? How do you address sport specialization in athletics? How does this study change your perspectives regarding sport specialization and concussions in athletics?

Related Posts

  1. We Need to Break the Stigma of Seeking Mental Health Services among Student-Athletes
  2. Mom and Dad Say Specialization is Important
  3. Playing High School Football May Not Lead to Impaired Cognition or Depression

Written by: Cade Watts
Reviewed by: Jeffrey Driban