Psychological Considerations of Sports Injury

1. Psychological Considerations of Sports Injury Jingzhen Yang, PhD, MPH Department of Community and Behavioral Health College of Public Health Jingzhen-yang@uiowa.edu

2. Sports Injury Research Sports are an important and pervasive thread in the fabric of our society

3. Motivations of this Study

4. Psychological aspect of sports injury is not a new topic Injury Depression Depression

5. 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. 1990;65(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. 1994;4:347-354. • 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. 1993;68(10):939-47.

6. 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. 1989;17:612–619. • 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. 1988;10:294–306. • 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: 113–118.

7. 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.

8. 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

9. Pilot Study: 2005-06, Funded by IPRC

10. 13 Participating Athletic Teams UI Sports Medicine 6 men’s sports (football, wrestling, baseball, men’s gymnastics, men’s golf, and men’s tennis) 6 women’s sports (women’s basketball, women’s track & field, women’s cross country, women’s golf, women’s rowing, and women’s field hockey) 1 coed sport (spirit squad)

11. Study Participants UI Sports Medicine -257 student-athletes -75% participation rate at student athlete level -in the 2005-2006 academic year, University of Iowa

12. ResearchAims • 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.

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

14. Study Protocol UI Sports Medicine 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

15. Information Collected at Baseline UI Sports Medicine 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

16. Information Collected at Follow-ups UI Sports Medicine 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

17. The Measures Used UI Sports Medicine 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.

18. 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

19. Main findings (n=257 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

20. Proportion of Student-athletes with Symptoms of Depression, by Their Characteristics (Number in Percentage) UI Sports Medicine

21. Proportion of Student-athletes with Symptoms of Depression, by Their Characteristics (Number in Percentage) UI Sports Medicine

22. Main Findings (n=257 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 (95%CI= 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 < .0001).

23. Correlation of Depression, Anxiety and Pain UI Sports Medicine

24. 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

25. 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

26. 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

27. Study Universities • University of Iowa (Iowa City) • Iowa State University (Ames) • Michigan State University (East Lansing) • Purdue University (West Lafayette)

28. Study Sports • Men’s baseball • Men's basketball • Football • Women's basketball • Women’s soccer • Women’s softball • Women’s volleyball

29. Future Direction High school athletes

30. Questions/Comments? Thanks!! UI Sports Medicine