Psychological Considerations of Sports Injury

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Psychological Considerations of Sports Injury

• Jingzhen Yang, PhD, MPH
• Department of Community and Behavioral Health
• College of Public Health
• Jingzhen-yang_at_uiowa.edu

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Sports are an important and pervasive thread in
the fabric of our society
Sports Injury Research
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Motivations of this Study
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Psychological aspect of sports injury is not a
new topic
Injury
Depression
Depression
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Psychological factor as a consequence of
athletic injury

• Depression and anger were significantly
  increased, while vigor was significantly reduced
  post-injury.
• Smith AM, Scott SG, O'Fallon WM, and Young ML.
  Emotional responses of athletes to injury. Mayo
  Clin Proc. 199065(1)38-50.
• Greater depression and lower self-esteem among
  injured than in non-injured and recovered groups,
  immediately following the injury and at the
  two-month follow-up.
• Leddy M, Lambert M, and Ogles B. Psychological
  consequences of athletic injury among high-level
  competitors. Res Q Exerc Sport. 19944347-354.
• Athletes with severe injuries had higher
  depression scores than those with minor injuries.
  
• Smith AM, et al. Competitive athletes preinjury
  and postinjury mood state and self-esteem. Mayo
  Clin Proc. 199368(10)939-47.

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Psychological factor as a risk factor of
athletic injury

• A personality profile typical of the
  injury-prone athlete does not exist.
• Lysens RJ, et al The accident-prone and
  overuse-prone profiles of the young athlete. Am J
  Sports Med. 198917612619.
• Negative life events can cause stress and mood
  disturbance among athletes .
• Andersen MB, and Williams JM A model of stress
  and athletic injury Prediction and prevention. J
  Sport Exerc Psychol. 198810294306.
• Athletes who experienced a negative family event
  or personal loss were more likely to sustain an
  athletic injury.
• Hardy CJ, and Riehl RE. An examination of the
  life stress-injury relationship among noncontact
  sport participants. Behav Med. 198814 113118.

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Limitations of previous studies

• Lack of comprehensive epidemiological data on
  post-injury depression among collegiate
  student-athletes.
• Little efforts have been devoted to research on
  how post-injury depression affects injury
  recovery, both psychologically and physically.
• A large number of studies are limited by
  retrospective study design or relatively small
  sample size.

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Psychological aspect of sports injury has a new
context

• Sport more competitive, requires more physical
  ability
• Athlete more individuals involved, start at
  younger ages
• Sports Medicine more advanced medical
  interventions, reduced time lost
• Media more public attention and expectations
• Wages earn more as a professional player

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Pilot Study 2005-06, Funded by IPRC
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13 Participating Athletic Teams

• 6 mens sports (football, wrestling, baseball,
  mens gymnastics, mens golf, and mens tennis)
• 6 womens sports (womens basketball, womens
  track field, womens cross country, womens
  golf, womens rowing, and womens field hockey)
• 1 coed sport (spirit squad)

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Study Participants

• -257 student-athletes
• -75 participation rate at student athlete level
• -in the 2005-2006 academic year, University of
  Iowa

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Research Aims

• Main Research Question
• Will social support help injured collegiate
  athletes experience fewer symptoms of depression
  and anxiety, and recover from an injury more
  quickly?
• The Central Hypothesis
• Collegiate athletes with a high level of social
  support will experience less symptoms of
  depression and anxiety, and will return to play
  sooner.

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Conceptual Model
Personal factors (e.g., gender, age, skill level,
sports, history of injury)
Perceived Social Support
Recovery Outcomes (return to play)
Symptoms of Depression and Anxiety
Athletic Injury
Depression and Anxiety
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Study Protocol

• Recruiting and obtaining consent from a cohort of
  athletes
• A baseline survey among all athletes
• Injury identified through weekly report from the
  exiting Sports Injury Monitoring System (SIMS)
• Once an athlete becomes injured, follow-ups will
  start for injured athletes
• Followed ups at intervals 1 week, 1 month, 3
  months, 6 months, and 1 week within return to
  play

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Information Collected at Baseline

• Demographic characteristics
• Playing experience with collegiate sports
• History of injury
• Symptoms of depression and State- and
  Trait-Anxiety
• Perceived social support from the coaches,
  athletic trainers, friends, and family
• Self-reported pain

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Information Collected at Follow-ups

• Self-reported pain due to injury
• Symptoms of depression and state-anxiety due to
  injury
• Perceived social support from the coaches,
  athletic trainers, friends, and family during the
  injury recovery

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The Measures Used

• Symptoms of Depression the Center for
  Epidemiological Studies Depression Scale (CESD),
  20 items.
• Anxiety the State-Trait Anxiety Inventory
  (STAI), including separate measures of
  State-anxiety (20 items) and Trait-anxiety (20
  items).
• Perceived social support the modified 6-item
  Social Support Questionnaire, a shorter version
  of the 27-item Social Support Questionnaire.

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Significance

• Integrate approaches that improve psychological
  recovery with those that improve physical
  recovery
• Findings feed into the development and evaluation
  of effective social support interventions
• Findings could be applicable to other athletes
  (e.g. children) or other types of injuries

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Main findings (n257 athletes)

• 21 of enrolled athletes experienced symptoms of
  depression
• Over half of enrolled athletes (54) sustained at
  least one injury during one year follow-up
• Female athletes reported different social support
  patterns compared to male athletes

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Proportion of Student-athletes with Symptoms of
Depression, by Their Characteristics (Number in
Percentage)
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Proportion of Student-athletes with Symptoms of
Depression, by Their Characteristics (Number in
Percentage)
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Main Findings (n257 athletes)

• Female athletes had 1.32 greater odds (95 CI
  1.01, 1.73) of experiencing symptoms of
  depression than male student-athletes.
• Freshmen had 3.3 greater odds (95CI 1.63, 6.59)
  of experiencing symptoms of depression than their
  more senior counterparts.
• Student-athletes who reported symptoms of
  depression were associated with higher scores of
  State-anxiety, and Trait-anxiety, respectively (p
  lt .0001).

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Correlation of Depression, Anxiety and Pain
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Research Project

• Title Social Support and Depression and Anxiety
  Following Injury in Collegiate Athletes
• Funder Centers for Disease Control and
  Prevention
• Period August 1, 2007 - July 31, 2012

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Research Team Co-PIs John B. Lowe, DrPh
Professor, Community and Behavioral
Health Corinne Peek-Asa, PhD, MPH Professor,
Occupational and Environmental Health Ying
Zhang, PhD Associate Professor,
Biostatistics
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Research Team Advisory Committee

• John Albright, MD, Professor, Orthopedic
  Surgery, UI
• Ned Amendola, MD, Professor, Orthopedic Surgery,
  Director, UI Sport Medicine
• Dan Foster, PhD, Professor, Exercise Science, UI
• Sam Maniar, PhD, Chair, Student-Athlete
  Depression Guidelines Committee, NCAA
• Jennifer E. Carter, PhD, Director, Sport
  Psychology, Ohio State University

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Study Universities

• University of Iowa (Iowa City)
• Iowa State University (Ames)
• Michigan State University (East Lansing)
• Purdue University (West Lafayette)

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Study Sports

• Mens baseball
• Men's basketball
• Football
• Women's basketball
• Womens soccer
• Womens softball
• Womens volleyball

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Future Direction
High school athletes
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Questions/Comments?

• Thanks!!