Alcohol misuse among college athletes: self-medication for psychiatric symptoms?

Sex Differences in Mental Health Symptoms in Elite Athletes: A Systematic Review and Meta-analysis

CONTEXT

Mental health is a growing area of concern for elite athletes.

OBJECTIVE

To determine the sex differences in mental health symptoms in elite athletes.

DATA SOURCES

PubMed, EMBASE, and Cochrane Library databases were used.

STUDY SELECTION

Included studies included comparisons of mental health symptoms of athletes by sex.

STUDY DESIGN

Systematic review and meta-analysis were conducted following the PRISMA guidelines.

LEVEL OF EVIDENCE

Level 2a.

DATA EXTRACTION

The rate ratio (RR) was calculated as the rates in female and male athletes. Data were pooled using a random-effects model.

RESULTS

Of 1945 articles identified, 60 articles were included. Male athletes reported higher alcohol misuse (RR, 0.74; CI, 0.68-0.80), illicit drug abuse (RR, 0.82; CI, 0.75-0.89), and gambling problems (RR, 0.14; CI, 0.08-0.25). Female athletes reported higher overall anxiety (RR, 1.17; CI, 1.08-1.27), depression (RR, 1.42; CI, 1.31-1.54), distress (RR, 1.98; CI, 1.40-2.81), and disordered eating (RR, 2.19; CI, 1.58-3.02). Sleep disturbances were reported at similar rates in male and female athletes (RR, 1.13; CI, 0.98-1.30).

CONCLUSION

Female and male athletes have significant differences in reported mental health symptoms. Female athletes are more likely to report anxiety, depression, distress, and disordered eating, while male athletes report more alcohol misuse, illicit drug abuse, and gambling. Monitoring and evaluation of mental health is a necessary part of any sport, including access to resources. Longitudinal studies following athletes over time to determine the development and causation for mental health symptoms should be included in future research directions.

Protective behavioral strategies as a protective factor against suicidal ideation among college student drinkers

Objective: Research shows that alcohol use is linked to suicidal ideation (SI), while depression is strongly associated with SI. Protective behavioral strategies (PBS) are safe drinking strategies. PBS are broadly protective across alcohol-related problems; however, it is unclear if these effects extend to those at risk for SI. We hypothesized that alcohol use and depressive symptoms would be risk factors for SI, and that these factors would moderate the effects of PBS. PBS was hypothesized to be protective for individuals with elevated depressive symptoms and alcohol use. Participants: College student drinkers (n = 990; M age = 19.97, SD = 3.75) from a Southeastern University. Methods: Participants completed an online survey inquiring about demographics, depressive symptoms, SI, alcohol use, and PBS use. Results: Depressive symptoms were associated with an increased likelihood of SI; however, alcohol use was not. PBS were most protective for individuals with high levels of alcohol use and/or depressive symptoms. Conclusions: PBS may be protective for heavier drinkers who are at heightened risk for SI.

Depression, anxiety and stress among female student-athletes: a systematic review and meta-analysis

OBJECTIVE

To identify, quantify and analyse determinants of depression, anxiety and stress symptoms among female student-athletes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Five online databases (PubMed, CINAHL, PsychInfo, SportDiscus and Web of Science) searched from inception through 14 September 2023. Hand-searches and contacting authors for eligible studies.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Articles were included if they were published in English, included female student-athletes competing at National Collegiate Athletic Association institutions, and measured symptom-level depression, anxiety and/or stress.

RESULTS AND SUMMARY

We screened 2415 articles; 52 studies (N=13 849) were included in the systematic review with 13 studies qualifying for meta-analysis. Seventeen determinants were identified including injury (eg, concussions), health (eg, sleep hygiene) and social factors (eg, social support). As data specific to female student-athletes was delineated from studies that included other populations, we observed 16 studies (30.7%) reported that identifying as female was a meaningful determinant of depression, anxiety and stress in athletes. Results of the meta-analysis (k=13, N=5004) suggested a small but significant association (r=0.15, 95% CI 0.05 to 0.24, p=0.004) between other determinants and depression, anxiety, and stress among female student-athletes.

CONCLUSION

Coaches, trainers and clinicians are key contributors in supporting female student-athlete mental health, with responsibilities for integrating mental skill training, sleep hygiene education and regular assessments. Comprehensive mental health and tailored education programmes considering determinants such as injury, health and social factors specific to female student-athletes are needed to enhance mental health equity in sport.

PROSPERO REGISTRATION NUMBER

CRD42022362163.

Sexual, reproductive and mental health among young men (10-24) in low-and-middle income countries: a scoping review

Background

The relationship between SRH and mental health among men is not well documented, especially in the 10-24 age group. This scoping review aimed to investigate what is known about the association between SRH and mental health among young men (10-24) in LMICs.

Methods

Embase, APA PsycInfo, MEDLINE(R) ALL, ASSIA and the Cochrane Library of Database of Systematic Reviews were searched from the year of establishment up to August 2022. The review was reported using the PRISMA-ScR checklist.

Results

A total of (n = 2636) studies were identified from the five databases. After the completion of screening, only ten studies (n = 8 cross-sectional, n = 1 mixed methods and n = 1 qualitative) met the eligibility criteria and were included in the review. The findings suggest that there is a reciprocal relationship between mental health and SRH. Sperm concentration and total sperm count were found to be lower in depressed men. Poor mental health was associated with early sexual debut, higher rates of sexual activity and an increased number of sexual partners. Poor mental health was also found among men who had sex with men (MSM). In addition, we found a relationship between sexual abuse, sexual coercion and poor mental health.

Conclusion

The findings of this unique study indicate that poor mental health is associated with poor SRH outcomes and vice versa among young men (10-24) living in LMICs. However, further research will be needed to establish the temporal relationship between SRH and mental health outcomes.

Initial examination of the mental health disorders: screening instrument for athletes

Introduction

There is a need to psychometrically develop assessment instruments capable of screening mental health disorders in athlete populations. The current study was conducted to determine reliability, validity and clinical utility of the Mental Health Disorders Screening Instrument for Athletes (MHDSIA).

Methods and results

259 collegiate athletes completed the MHDSIA. Factor analysis determined a single factor with good internal consistency, and this factor was positively correlated with an established measure of psychiatric symptomology (Symptom Checklist 90-R), demonstrating its concurrent validity. An optimum clinical cutoff score (i.e., 32) was determined using Receiver Operating Characteristic (ROC) analyses to assist appropriate mental health referrals.

Discussion

Results suggest the MHSIA is a reliable, valid, and relatively quick and easy to interpret screen for the broad spectrum of mental health disorders in collegiate athletes. As expected, NCAA athletes reported lower MHDSIA scores than club and intramural athletes, while males reported similar severity scores as females.

Substance use and Stress-Induced Cognitive Impairment: The Causes of Anxiety and Depression among College Students

This study sought to examine the effects of substance use and stress-induced cognitive impairment on anxiety and depression among college students. The data for this study came from a sample of 328 undergraduate students from a public university. The subjects in this study completed a 101-item self-administered questionnaire, which was part of a larger study on college stress. This study included not only students who are typically expected to seek help at the counseling centers, but it expanded to include self-reported cases of students who do not have documented problems of substance use or anxiety/depression. To address the main objective of this study, an eight-variable model was developed and tested for each of the two outcome variables: anxiety and depression. The results that emerged from this study show that both substance use and stress-induced cognitive impairment have a positive and a statistically significant effect on anxiety and depression in college students.

Social Networking Service, Patient-Generated Health Data, and Population Health Informatics: National Cross-sectional Study of Patterns and Implications of Leveraging Digital Technologies to Support Mental Health and Well-being

BACKGROUND

The emerging health technologies and digital services provide effective ways of collecting health information and gathering patient-generated health data (PGHD), which provide a more holistic view of a patient's health and quality of life over time, increase visibility into a patient's adherence to a treatment plan or study protocol, and enable timely intervention before a costly care episode.

OBJECTIVE

Through a national cross-sectional survey in the United States, we aimed to describe and compare the characteristics of populations with and without mental health issues (depression or anxiety disorders), including physical health, sleep, and alcohol use. We also examined the patterns of social networking service use, PGHD, and attitudes toward health information sharing and activities among the participants, which provided nationally representative estimates.

METHODS

We drew data from the 2019 Health Information National Trends Survey of the National Cancer Institute. The participants were divided into 2 groups according to mental health status. Then, we described and compared the characteristics of the social determinants of health, health status, sleeping and drinking behaviors, and patterns of social networking service use and health information data sharing between the 2 groups. Multivariable logistic regression models were applied to assess the predictors of mental health. All the analyses were weighted to provide nationally representative estimates.

RESULTS

Participants with mental health issues were significantly more likely to be younger, White, female, and lower-income; have a history of chronic diseases; and be less capable of taking care of their own health. Regarding behavioral health, they slept <6 hours on average, had worse sleep quality, and consumed more alcohol. In addition, they were more likely to visit and share health information on social networking sites, write online diary blogs, participate in online forums or support groups, and watch health-related videos.

CONCLUSIONS

This study illustrates that individuals with mental health issues have inequitable social determinants of health, poor physical health, and poor behavioral health. However, they are more likely to use social networking platforms and services, share their health information, and actively engage with PGHD. Leveraging these digital technologies and services could be beneficial for developing tailored and effective strategies for self-monitoring and self-management.

Patterns of health behaviors affecting mental health in collegiate athletes

OBJECTIVE

To examine the association of multiple health behaviors to mental health functioning in male and female collegiate athletes. Participants: Prospective National Collegiate Athletic Association (NCAA) Division I athletes (n = 183) completed a health and wellness survey in the summer prior to joining the athletic program. Methods: Health behaviors (eating, sleeping, substance use, sexual, and aggressive behaviors) and mental health functioning (psychological distress and perceived stress) were assessed. Partial least squares (PLS) modeling was used as a multivariate approach to simultaneously examine the association of health behaviors to mental health functioning. Results: Aggressive behaviors, alcohol use, and fatigue were significantly associated with symptoms of psychological distress and stress in both males and females. Attention to nutrition, unhealthy dietary habits, and lower alcohol use was further related to psychological distress in female athletes only. Conclusions: Athletes' eating, sleeping, substance use, and aggressive behaviors may provide insight into their mental health functioning.

Sport-Related and Psychosocial Factors Associated With Motives and Consequences Of Alcohol and Cannabis Use Among NCAA Athletes: A Systematic Review

AIMS

To review differences in alcohol- and cannabis-related motives and consequences among National Collegiate Athletic Association (NCAA) athletes as a function of athlete characteristics (e.g. gender and competition season status).

METHODS

Procedures followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, PsycINFO and manual reference list review were used to identify studies that reported alcohol- or cannabis-related motives and consequences among NCAA athletes as a function of gender, race, season status, division level or sport-type through December 2019. Relevant findings and any reported psychosocial correlates were extracted by two independent reviewers.

RESULTS

The majority of studies (K = 15) focused on alcohol-related motives or consequences, with one examining cannabis-related motives, and no studies examined cannabis-related consequences. Social drinking motives were strongest among men and White NCAA athletes, and athlete-specific motives were most salient for men and in-season athletes. Cannabis use motives for positive reinforcement (e.g. enhancement) and coping were also strongest during the in-season. Negative alcohol-related consequences were greatest among men, athletes of color and out-of-season athletes, although women and in-season athletes experienced more consequences in athletic performance. Our exploratory aim revealed two studies that examined psychosocial correlates, and the results indicate that sensation-seeking, stress and negative affect were associated with more alcohol-related consequences.

CONCLUSION

NCAA athletes are a heterogenous population, and their motives and consequences of use appear to vary across multiple athlete factors (e.g., gender). This review highlights the gaps in the literature and suggests future research directions to identify the risk and protective factors for substance use among NCAA athletes.

Anxiety Symptoms and Alcohol-Related Problems among College Students: A Moderated-Mediation Model of Rumination and Emotion Dysregulation

Prior research has individually linked rumination, anxiety, and emotion dysregulation to alcohol misuse, but limited research has examined a comprehensive model linking these variables together. The present study tested a moderated-mediation model to examine whether emotion dysregulation moderated the indirect association of anxiety symptoms on alcohol-related problems via ruminative thinking styles. Method: Participants were 448 college students who consumed alcohol in the previous month. A plurality of participants identified as being White, non-Hispanic (40.6%), female (68.6%), and reported a mean age of 22.75 (Median = 20.00; SD = 6.84) years. Results: Brooding and reflection subtypes of ruminative thinking mediated the association between anxiety symptoms and alcohol-related problems with higher rates of anxiety symptoms associated with higher ruminative thinking, which in turn was associated with more alcohol-related problems. Further, the indirect effect of anxiety symptoms on alcohol-related problems through ruminative thinking was stronger for individuals who reported high levels of emotion dysregulation compared to those with average and low levels of emotion dysregulation. Conclusions: In support of prior work, our results suggest that ruminative thinking, particularly brooding and reflection, are key mechanisms through which anxiety symptoms relate to problematic alcohol use, especially among individuals with high emotion dysregulation. Additional work is needed to test whether decoupling the associations between negative emotional states and ruminative thinking among college students with high emotion dysregulation is a viable intervention target to reduce problematic alcohol use.

Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention: American Medical Society for Sports Medicine Position Statement

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders, and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy (SORT) to grade level of evidence.

The relation between ADHD symptoms, perceived stress and binge drinking in college students

Binge drinking is a major public health problem associated with various negative short-term and long-term clinical and social outcomes. If there is evidence to suggest a relationship between ADHD and alcohol use in college students, no study has investigated the role of ADHD symptomatology in binge drinking. Thus, this research was designed to explore the relative contributions of inattention and hyperactivity/impulsivity symptoms to binge drinking in a sample of French college students while controlling for effects of perceived stress. Participants (N = 7011; mean age = 20.9; 74.9% of females) completed self-report surveys assessing ADHD symptoms, perceived stress, sociodemographic characteristics, and binge drinking frequency. Multinomial logistic regression revealed significant associations between higher levels of ADHD symptoms in general, but not perceived stress, and increasing frequency of binge drinking. Moreover, higher levels of inattention and hyperactivity/impulsivity symptoms were independently associated with greater frequency of binge drinking. The association was stronger between high rates of binge drinking and inattention than for hyperactivity/impulsivity. These findings, which remained statistically significant after adjusting for a range of potential confounders (including perceived stress), suggest that the presence of ADHD symptoms may be an important factor related to binge drinking.

Quantifying Behavioral Sensation Seeking With the Aroma Choice Task

Our goal was to develop a behavioral measure of sensation seeking (SS). The Aroma Choice Task (ACT) assesses preference for an intense, novel, varied, and risky (exciting) option versus a mild, safe (boring) option using real-time odorant delivery. A total of 147 healthy young adults completed 40 binary choice trials. We examined (1) intensity and pleasantness of odorants, (2) stability of responding, (3) association with SS self-report, and (4) association with self-reported illicit drug use. Participants' preference for the "exciting" option versus the safe option was significantly associated with self-reported SS (p < .001) and illicit drug use (p = .041). Odorant ratings comported with their intended intensity. The ACT showed good internal, convergent, and criterion validity. We propose that the ACT might permit more objective SS assessment for investigating the biological bases of psychiatric conditions marked by high SS, particularly addiction. The ACT measures SS behaviorally, mitigating some self-report challenges and enabling real-time assessment, for example, for functional magnetic resonance imaging (fMRI).

Vulnerable narcissism and addiction: The mediating role of shame

Problem drinking and gambling are addictive behaviours experienced by young adults and commonly occur with narcissism. Research has acknowledged two distinct forms of narcissism: grandiose and vulnerable. There has been work that has examined the relationship between grandiose and vulnerable narcissism and addictive behaviours, but it has been limited, particularly with vulnerable narcissism. Evidence suggests vulnerable narcissism, but not grandiose narcissism, is associated with greater negative affect. Accordingly, shame, a potent social emotion could be a mediator in the narcissism-addiction pathway. Shame has been implicated in both vulnerable narcissism and problem drinking and gambling. Thus, we hypothesized that shame would mediate the relationship between vulnerable narcissism and addictive behaviours. Young adults (N = 210) completed self-report baseline (Time 1) and 1-month follow-up (Time 2) assessments of shame, narcissism, problem drinking, and gambling. As predicted, those with elevated vulnerable narcissism at Time 1 had increased shame at Time 2, which predicted problem drinking and gambling at Time 2. This relationship was not observed for grandiose narcissism. Overall, our results suggest that feelings of shame are essential to understanding the vulnerable narcissism-addiction pathway, and an important consideration when designing clinical interventions for at-risk young adults.

Frequent solitary drinking mediates the associations between negative affect and harmful drinking in emerging adults

INTRODUCTION

Depression and anxiety are highly comorbid conditions that are associated with harmful drinking. Social learning theory proposes that depressed or anxious individuals learn that drinking can reduce negative affect, which makes them susceptible to harmful drinking. Consistent with theory, evidence suggests that negative affect increases risk for harmful drinking. But, less is known about mediators of negative affect-pathways to harmful drinking. Research has demonstrated that solitary drinking is an underlying mechanism of harmful drinking among emerging adults with high levels of negative affect. However, much of this work is cross-sectional. We conducted a longitudinal study to examine solitary drinking as a key explanatory variable in the negative-affect pathway to harmful drinking.

METHODS

Emerging adults (N = 308) completed online self-reports of depression and anxiety at Time 1 (the beginning of their first semester in university), and drinking context and harmful drinking at Time 2 (the end of their first semester of university).

RESULTS

Structural equation modeling supported indirect effects from negative affect to harmful drinking via solitary drinking. Specifically, emerging adults with high levels of negative affect at the beginning of their first semester engaged in frequent solitary drinking over the rest of the semester, and subsequently experienced increased harmful drinking (controlling for Time 1 solitary/social drinking and harmful use). Social drinking was not a mediator of this effect.

CONCLUSIONS

The findings reveal that solitary drinking uniquely mediated the relation between negative affect and harmful drinking. Reducing solitary drinking might mitigate negative affect-related risk for harmful drinking in emerging adults.

Poor mental health, peer drinking norms, and alcohol risk in a social network of first-year college students

OBJECTIVE

College students with anxiety and depressive symptomatology face escalated risk for alcohol-related negative consequences. While it is well-established that normative perceptions of proximal peers' drinking behaviors influence students' own drinking behaviors, it is not clear how mental health status impacts this association. In the current study, we examined cross-sectional relationships between anxiety and depressed mood, perceived drinking behaviors and attitudes of important peers, and past month alcohol consumption and related problems in a first-semester college student social network.

METHOD

Participants (N = 1254, 55% female, 47% non-Hispanic White) were first-year students residing on campus at a single university who completed a web-based survey assessing alcohol use, mental health, and social connections among first-year student peers. Network autocorrelation models were used to examine the independent and interactive associations between mental health and perceptions of close peers' drinking on drinking outcomes, controlling for important variables.

RESULTS

Mental health interacted with perceptions to predict past-month drinking outcomes, such that higher anxiety and higher perceptions that peers drink heavily was associated with more drinks consumed and consequences, and higher depression and perceptions was associated with more drinks consumed, heavy drinking frequency, and consequences. Attitudes that peers approve of heavy drinking were associated with more drinks consumed and heavy drinking frequency among students with lower (vs. higher) depressed mood.

CONCLUSIONS

This study provides strong evidence that perceiving that close peers drink heavily is particularly risk-enhancing for anxious and depressed college students, and offers implications about alcohol intervention targeted at these subgroups.

Shame mediates the relationship between depression and addictive behaviours

BACKGROUND

Alcohol and gambling problems are common in young adults. Self-medication theory states that young adults with depression drink and/or gamble to escape negative emotions. Research shows that depression is a risk factor for drinking/gambling problems, but more work is needed to examine mediators underlying these associations. One potential mediator is shame. Shame is a self-directed emotion that follows a negative life event and is characterized by intense feelings of inferiority, worthlessness, and embarrassment. Depressed individuals are especially susceptible to shame (and associated emotions). Shame has also been implicated in risk for addiction. Accordingly, we predicted that elevated shame would explain why depression is associated with both alcohol and gambling problems.

METHODS

A longitudinal design was used to examine this hypothesis. Undergraduates (N = 210) completed self-reports of depression at baseline (Time 1) and then completed self-reports of shame, alcohol misuse, gambling problems one month later (Time 2).

RESULTS

Results showed that individuals with elevated depression at Time 1 endorsed high levels of shame at Time 2, which in turn predicted more gambling (β = .038, 95% CI [.010, .087]) and alcohol problems (β = .249, 95% CI [.123, .435]) at Time 2. We found that increased levels of shame explained the effects of depression on problem drinking and gambling.

CONCLUSIONS

Study findings improve our understanding of the depressive pathway to addiction by providing evidence for shame as a potential mechanism of this pathway.

IMPACT

Reducing shame can be a target of clinical interventions for young adults with depression and alcohol/gambling problems.

Solitary drinking is associated with specific alcohol problems in emerging adults

Hazardous drinking in emerging adulthood is associated with multiple domains of alcohol problems, which range in type and severity. Alcohol problems at the severe end of the spectrum (e.g., impaired control) may be early warning signs of alcohol use disorders (AUDs) among emerging adults. However, given the emphasis in the literature on predictors of overall problem risk, we still know very little about predictors of these specific (and severe) domains of alcohol problems in emerging adults. Many emerging adults drink at social events (e.g., parties), but an estimated 15% engage in solitary drinking. Solitary drinking - a developmentally atypical behavior in emerging adulthood - may be especially risky. Data suggests that frequent solitary drinking may reflect a loss of control over drinking, leading to hazardous use and subsequent problems. Accordingly, we expected that frequent solitary drinking among emerging adults would predict severe alcohol problems that map onto diagnostic criteria for AUDs and these effects would be mediated by hazardous alcohol use. Undergraduates (N=118) completed self-report measures as a part of a larger study on motivation and alcohol use. As predicted, path analysis showed that solitary drinking positively predicted hazardous alcohol use, and this in turn predicted severe alcohol problems associated with diagnostic criteria for AUDs, particularly risky behaviors and blackout drinking. Solitary drinking also positively predicted less severe problems of diminished self-perception and poor self-care through hazardous use. Though comparatively smaller, some indirect effects were observed from social drinking (at parties, but not at bars) to alcohol problems, via hazardous alcohol use. Overall, our results suggest that solitary drinking is particularly harmful in emerging adulthood.

Effects of depressive symptoms and coping motives on naturalistic trends in negative and positive alcohol-related consequences

OBJECTIVE

Depressive symptoms and drinking to cope with negative affect increase the likelihood for drinking-related negative consequences among college students. However, less is known about their influence on the naturalistic trajectories of alcohol-related consequences. In the current study, we examined how positive and negative drinking-related consequences changed as a function of depressive symptoms and drinking motives (coping, conformity, social, enhancement).

METHOD

Participants (N=652; 58% female) were college student drinkers assessed biweekly during the first two years of college. We used hierarchical linear modeling to examine means of and linear change in positive and negative consequences related to depression and motives, controlling for level of drinking.

RESULTS

Consistent with hypotheses, negative and positive consequences decreased over the course of freshman and sophomore years. Higher levels of depression were associated with a faster decline in negative consequences during freshman year. Coping motives predicted average levels of negative and positive consequences across all years, with the effects of coping motives on consequences most pronounced at low levels of depression during sophomore year.

CONCLUSIONS

These findings indicate that screening students for depression and drinking to cope, independent of alcohol consumption, may help identify students at risk for experiencing negative alcohol consequences and that these factors should be addressed in targeted alcohol interventions.

Variability in Institutional Screening Practices Related to Collegiate Student-Athlete Mental Health

CONTEXT

Universal screening for mental health concerns, as part of the preparticipation examination in collegiate sports medicine settings, can be an important and feasible strategy for facilitating early detection of mental health disorders.

OBJECTIVE

To assess whether sports medicine departments at National Collegiate Athletic Association (NCAA) member colleges have policies related to identifying student-athlete mental health problems, the nature of preparticipation examination screening related to mental health, and whether other departmental or institutional screening initiatives are in place. I also aimed to characterize the variability in screening by institutional characteristics.

DESIGN

Cross-sectional study.

SETTING

College sports medicine departments.

PATIENTS OR OTHER PARTICIPANTS

Team physicians and head athletic trainers at NCAA member colleges (n = 365, 30.3% response rate).

MAIN OUTCOME MEASURE(S)

Electronic survey of departmental mental health screening activities.

RESULTS

A total of 39% of respondents indicated that their institution had a written plan related to identifying student-athletes with mental health concerns. Fewer than half reported that their sports medicine department administers a written or verbal screening instrument for symptoms of disordered eating (44.5%), depression (32.3%), or anxiety (30.7%). The strongest predictors of mental health screening were the presence of a written plan related to identifying student-athlete mental health concerns and the employment of a clinical psychologist. Additionally, Division I institutions and institutions with a greater ratio of athletic trainers to student-athletes tended to engage in more screening.

CONCLUSIONS

The substantial among-institutions variability in mental health screening suggests that opportunities exist to make these practices more widespread. To address this variability, recent NCAA mental health best-practice guidelines suggested that institutions should screen for a range of mental health disorders and risk behaviors. However, at some institutions, staffing deficits may need to be addressed to allow for implementation of screening-related activities.

Getting the party started--Alone: Solitary predrinking mediates the effect of social anxiety on alcohol-related problems

Predrinking (or pregaming) is common among undergraduates and has been linked with problem alcohol use. While many students predrink to save money, evidence suggests that some students predrink to cope with social anxiety (SA). Tension reduction and cognitive theories predict that those high in SA may predrink to reduce anticipatory anxiety before attending social events and their predrinking may be done alone rather than in normative social contexts. Available data suggest that, relative to social drinking, solitary drinking elevates risk for alcohol use and related problems. Informed by this evidence, we speculated that context for predrinking may be an important mechanism by which SA-risk for alcohol use unfolds. Specifically, we offered the novel hypothesis that those high in SA would engage frequently in solitary predrinking and this in turn would be associated with elevated alcohol use and related problems. Undergraduate drinkers (N=293; 70% women) completed self-reports of social anxiety, predrinking context (social, solitary), alcohol use, and alcohol-related problems. In partial support of our hypotheses, SA was a positive predictor of solitary predrinking, which in turn predicted elevated alcohol-related problems, but not alcohol use. While not hypothesized, we also found that SA was a negative predictor of social predrinking, which in turn reduced risk for alcohol use and related problems. Our study is the first in the literature to show that solitary predrinking helps explain the well-documented association between SA and alcohol-related problems. These findings may inform etiological models and clinical interventions, suggesting that SA-risk for problem drinking begins even before the party starts.

The psychological response to injury in student athletes: a narrative review with a focus on mental health

BACKGROUND

Injury is a major stressor for athletes and one that can pose significant challenges. Student athletes must handle rigorous academic as well as athletic demands that require time as well as significant physical requirements. Trying to perform and succeed in the classroom and on the playing field has become more difficult as the demands and expectations have increased. If an athlete is injured, these stressors increase.

MAIN THESIS

Stress is an important antecedent to injuries and can play a role in the response to, rehabilitation and return to play after injury. The psychological response to injury can trigger and/or unmask mental health issues including depression and suicidal ideation, anxiety, disordered eating, and substance use/abuse. There are barriers to mental health treatment in athletes. They often consider seeking help as a sign of weakness, feeling that they should be able to 'push through' psychological obstacles as they do physical ones. Athletes may not have developed healthy coping behaviours making response to injury especially challenging.

PURPOSE

I discuss the current state of knowledge regarding the psychological response to injury and delineate resources necessary to direct the injured athlete to a mental health care provider if appropriate.

The Relation Between ADHD Symptoms and Alcohol Use in College Students

OBJECTIVE

Although there is evidence to suggest an association between ADHD and alcohol use in college students, results are inconclusive primarily because studies have failed to control for related variables. Thus, this study was designed to systematically compare the relative contributions of inattention and hyperactivity/impulsivity to alcohol use and alcohol-related problems in a sample of college students while controlling for effects of antisocial behaviors.

METHOD

A total of 192 undergraduate college students from a rural Midwestern university received class credit for participating in the study. They completed measures of alcohol use, ADHD symptoms, and antisocial behavior.

RESULTS

Hierarchical regressions revealed inattention, but not hyperactivity/impulsivity, was related to alcohol-related problems even when controlling for antisocial behavior. However, neither inattention nor hyperactivity/impulsivity was related to alcohol use regardless of whether current antisocial behavior was controlled.

CONCLUSION

Inattention may be an important factor related to alcohol-related problems in college students.

Context counts: solitary drinking explains the association between depressive symptoms and alcohol-related problems in undergraduates

INTRODUCTION

According to theory, depressed individuals self-medicate their negative affect with alcohol. Due to isolation and interpersonal difficulties, undergraduates with elevated depressive symptoms may do much of their drinking alone and/or in intimate contexts (e.g., with family or romantic partners) rather than at normative social events (e.g., parties). Evidence suggests drinking in these contexts leads to heavy use and alcohol-related problems. Accordingly, context may be an explanatory mechanism linking depressive symptoms to problematic drinking. This pathway remains understudied in the literature. Our study aimed to examine solitary and intimate drinking as distinct mediators of the depression-problematic drinking association. We hypothesized that depressive symptoms would be positively associated with solitary and intimate drinking which in turn would be associated with elevated alcohol use and related problems.

METHODS

Undergraduates (N=295; 72% women) completed online self-reports.

RESULTS

Consistent with hypotheses, path analyses supported depressive symptoms as a positive predictor of solitary drinking, which in turn was a positive predictor of alcohol-related problems, but not of alcohol use. Counter to hypotheses, depressive symptoms were unrelated to intimate drinking. Interestingly, depressive symptoms were negatively associated with drinking at parties, which in turn led to reduced risk for elevated alcohol use and related problems.

CONCLUSIONS

Our results shed new light on the depression pathway to problematic drinking in undergraduates by considering the role of drinking context. Our findings suggest undergraduates with elevated depressive symptoms are at risk for potentially problematic drinking because they are drinking alone. Solitary drinking represents a malleable target for clinical interventions aimed at reducing risky depression-related alcohol use.

Is being mindful associated with reduced risk for internally-motivated drinking and alcohol use among undergraduates?

Mindfulness encompasses four core skills: observing, describing, acting with awareness, and accepting without judgment; which aim to increase one's awareness, tolerance, and acceptance of internal experiences (Baer et al., 2004). Despite promising clinical results that mindfulness reduces alcohol craving and relapse, complementary etiological research is underdeveloped. Theory suggests that those who are motivated to drink to change internal states (reduce negative/increase positive affect) are at risk for elevated alcohol use. The ability to accept one's affective state should preclude internally-motivated drinking, and thus, elevated alcohol use. The purpose of this study was to parse out which mindfulness skills are central to alcohol use. We hypothesized that accepting without judgment would be a unique negative predictor of internally-motivated drinking (drinking for coping and enhancement motives) and alcohol use. Students (N=76) completed self-report measures of past month alcohol use and four motives for drinking: to cope, for enhancement, to conform, and for social reasons. Partially supporting our hypotheses, accepting without judgment was negatively associated with drinking for coping motives, but was unassociated with drinking for enhancement motives. Interestingly, acceptance without judgment was negatively associated with drinking for conformity motives (to reduce social rejection). Unexpectedly, acting with awareness, but not accepting without judgment, was a negative predictor of alcohol use. Our findings suggest that interventions aimed at reducing coping- and conformity-motivated drinking and alcohol use by young adults may benefit from incorporating mindfulness skills training (i.e., accepting without judgment; acting with awareness).

Results of a Single Case Controlled Study of The Optimum Performance Program in Sports in a Collegiate Athlete

In this study, a sport-specific adaptation of Family Behavior Therapy (i.e., The Optimum Performance Program in Sports [TOPPS]) in a collegiate athlete was examined, including a controlled evaluation of several of its intervention components utilizing multiple-baseline methodology. After a 3-week baseline consisting of program orientation, cultural enlightenment, and goal development was established for unsafe sexual practices, alcohol binge drinking (four or more drinks per occasion), and teammate relationships, the participant was sequentially and cumulatively exposed to three distinct intervention phases across 12 meetings. In the first phase, a Dynamic Goals and Rewards intervention was implemented with the intention of reducing unsafe sexual practices. In the second phase, alcohol avoidance was additionally targeted through Goal Inspiration (Consequence Review; that is, a motivational enhancement exercise), Self-Control, and Environmental Control. The third phase focused on teammate relationships using Communication Skills Training while the aforementioned target areas continued to be addressed. A brief probe assessment was administered immediately before each intervention meeting to assess frequency of unprotected sex, frequency of binge drinking, and relationship problems with teammates. Results indicated that each of the target behaviors reduced substantially, but only after they were targeted. The participant’s scores on a standardized measure of troublesome thoughts and stress substantially decreased across intervention meetings. Various mental health and sport performance outcome measures, in addition to the aforementioned target areas, improved up to 5 months post-intervention.

Cognitive-behavioral therapy in depressed primary care patients with co-occurring problematic alcohol use: effect of telephone-administered vs. face-to-face treatment-a secondary analysis

This secondary analysis of a larger study compared adherence to telephone-administered cognitive-behavioral therapy (T-CBT) vs. face-to-face CBT and depression outcomes in depressed primary care patients with co-occurring problematic alcohol use. To our knowledge, T-CBT has never been directly compared to face-to-face CBT in such a sample of primary care patients. Participants were randomized in a 1:1 ratio to face-to-face CBT or T-CBT for depression. Participants receiving T-CBT (n = 50) and face-to-face CBT (n = 53) were compared at baseline, end of treatment (week 18), and three-month and six-month follow-ups. Face-to-face CBT and T-CBT groups did not significantly differ in age, sex, ethnicity, marital status, educational level, severity of depression, antidepressant use, and total score on the Alcohol Use Disorders Identification Test. Face-to-face CBT and T-CBT groups were similar on all treatment adherence outcomes and depression outcomes at all time points. T-CBT and face-to-face CBT had similar treatment adherence and efficacy for the treatment of depression in depressed primary care patients with co-occurring problematic alcohol use. When targeting patients who might have difficulties in accessing care, primary care clinicians may consider both types of CBT delivery when treating depression in patients with co-occurring problematic alcohol use.

Use of protective behavioral strategies and reduced alcohol risk: examining the moderating effects of mental health, gender, and race

Recent research indicates that protective behavioral strategies (PBS)-previously established as effective self-regulating tools for reducing alcohol risk among college students-may be especially useful for students with poor mental health, who are shown to be at heightened risk for alcohol-related harm. The current study examined the moderating influence of mental health (depression and anxiety severity), gender, and race (White, Asian) in the relationship between PBS use and alcohol-related negative consequences. Participants were 1,782 undergraduate students from two West Coast universities who reported past-month incidence of heavy episodic drinking (HED). Students reported on their drinking, experience of alcohol-related consequences, use of PBS, and depression and anxiety symptomatology. Overall, results demonstrated that among participants experiencing depression or anxiety, greater PBS utilization was associated with significantly lower levels of alcohol-related consequences, even after controlling for drinking and other predictors. However, findings also revealed important distinctions in the potential effectiveness of PBS by depression/anxiety severity and racial-gender subgroup, such that Asian men with poor mental health appeared to garner unique and substantial benefit (i.e., lesser consequences) from increased PBS use. Further, PBS were found to offer substantial protective benefit for White females, irrespective of mental health. This study points to the potential for targeted PBS-specific skills training and interventions to minimize alcohol-related risks faced by the growing subpopulation of college students experiencing psychological distress, and further highlights important race and gender differentials.

Mental health, sleep quality, drinking motives, and alcohol-related consequences: a path-analytic model

OBJECTIVE

Poor mental health, sleep problems, drinking motivations, and high-risk drinking are prevalent among college students. However, research designed to explicate the interrelationships among these health risk behaviors is lacking. This study was designed to assess the direct and indirect influences of poor mental health (a latent factor consisting of depression, anxiety, and stress) to alcohol use and alcohol-related consequences through the mediators of global sleep quality and drinking motives in a comprehensive model.

METHOD

Participants were 1,044 heavy-drinking college students (66.3% female) who completed online surveys.

RESULTS

A hybrid structural equation model tested hypotheses involving relations leading from poor mental health to drinking motives and poorer global sleep quality to drinking outcomes. Results showed that poor mental health significantly predicted all four subscales of drinking motivations (social, coping, conformity, and enhancement) as well as poor sleep. Most of the drinking motives and poor sleep were found to explain alcohol use and negative alcohol consequences. Poor sleep predicted alcohol consequences, even after controlling for all other variables in the model. The hypothesized mediational pathways were examined with tests of indirect effects.

CONCLUSIONS

This is the first study to assess concomitantly the relationships among three vital health-related domains (mental health, sleep behavior, and alcohol risk) in college students. Findings offer important implications for college personnel and interventionists interested in reducing alcohol risk by focusing on alleviating mental health problems and poor sleep quality.

Combined MI + CBT for Depressive Symptoms and Binge Drinking Among Young Adults: Two Case Studies

There are high rates of comorbidity between heavy drinking and depressive symptoms among college students, often resulting in severe alcohol-related consequences. No empirically supported treatment exists that concurrently addresses both of these problems in this population. Research with college students has demonstrated that brief motivational interventions (BMIs) reduce heavy drinking and alcohol-related consequences, and that cognitive behavioral therapy for depression (CBT-D) is effective in reducing depressive symptoms. Thus, a program combining BMI and CBT-D appears ideal for college students with co-occurring binge drinking and depressive symptoms. This manuscript presents the rationale and format of a BMI + CBT-D treatment protocol for this population, and provides a case example of a female college student who received the protocol and experienced improvement in depressive symptoms, a reduction in alcohol use and alcohol-related negative consequences, and an increase in readiness to change alcohol consumption. We discuss theoretical and clinical implications of these findings, and suggest directions for future research.

A prospective assessment of reports of drinking to self-medicate mood symptoms with the incidence and persistence of alcohol dependence

IMPORTANCE

Mood disorders and alcohol dependence frequently co-occur. Etiologic theories concerning the comorbidity often focus on drinking to self-medicate or cope with affective symptoms. However, there have been few, if any, prospective studies in population-based samples of alcohol self-medication of mood symptoms with the occurrence of alcohol dependence. Furthermore, it is not known whether these associations are affected by treatment or symptom severity.

OBJECTIVE

To evaluate the hypothesis that alcohol self-medication of mood symptoms increases the probability of subsequent onset and the persistence or chronicity of alcohol dependence.

DESIGN

Prospective study using face-to-face interviews-the National Epidemiologic Survey on Alcohol and Related Conditions.

SETTING

Nationally representative survey of the US population.

PARTICIPANTS

Drinkers at risk for alcohol dependence among the 43 093 adults surveyed in 2001 and 2002 (wave 1); 34 653 of whom were reinterviewed in 2004 and 2005 (wave 2).

MAIN OUTCOMES AND MEASURES

Association of alcohol self-medication of mood symptoms with incident and persistent DSM-IV alcohol dependence using logistic regression and the propensity score method of inverse probability of treatment weighting.

RESULTS

The report of alcohol self-medication of mood symptoms was associated with an increased odds of incident alcohol dependence at follow-up (adjusted odds ratio [AOR], 3.10; 95% CI, 1.55-6.19; P = .002) and persistence of dependence (AOR, 3.45; 95% CI, 2.35-5.08; P < .001). The population-attributable fraction was 11.9% (95% CI, 6.7%-16.9%) for incident dependence and 30.6% (95% CI, 24.8%-36.0%) for persistent dependence. Stratified analyses were conducted by age, sex, race/ethnicity, mood symptom severity, and treatment history for mood symptoms.

CONCLUSIONS AND RELEVANCE

Drinking to alleviate mood symptoms is associated with the development of alcohol dependence and its persistence once dependence develops. These associations occur among individuals with subthreshold mood symptoms, with DSM-IV affective disorders, and for those who have received treatment. Drinking to self-medicate mood symptoms may be a potential target for prevention and early intervention efforts aimed at reducing the occurrence of alcohol dependence.

The association between sports participation, alcohol use and aggression and violence: a systematic review

OBJECTIVES

To review the current research on alcohol-related violence and sports participation.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to identify relevant studies for inclusion. A search of six databases (EBSCOhost) was conducted.

RESULTS

A total of 6890 studies was were identified in the initial search. Of these, 11 studies met the inclusion criteria. The majority of the studies were from the US (n=10) and focused on collegiate athletes (n=7), adolescents (n=3), professional/former professional athletes (n=1).

CONCLUSION

The reviewed research indicates higher rates of alcohol use and violence in athlete populations when compared against non-athlete populations. Masculinity, violent social identity and antisocial norms connected to certain sports stand out as potential factors that may impact the association between sport and violence in athlete populations.

Mindfulness and alcohol problems in college students: the mediating effects of stress

OBJECTIVE

To examine the relationship between mindfulness and alcohol problems in college students, as well as the role of stress as a mediator in this relationship.

PARTICIPANTS

Participants were 310 students from a small, private college in the Northeast.

METHODS

Students completed self-report measures, including the Perceived Stress Scale, the Five Facet Mindfulness Questionnaire, and the Rutgers Alcohol Problems Index.

RESULTS

Mindfulness was negatively correlated with alcohol problems and stress, whereas stress positively correlated with alcohol problems. Results implicated stress as fully mediating the relationship between mindfulness and alcohol problems. Alcohol problems were negatively correlated with the Acting With Awareness and Describing Experience facets of mindfulness.

CONCLUSION

Mindfulness-based stress reduction or other mindfulness programs may be useful in decreasing alcohol problems on college campuses via the effects on stress.

Prevention of depression in the college student population: a review of the literature

The National Institute of Mental Health recommends that interventions be designed to prevent the onset of clinical depression in at-risk groups. College students are included in those groups identified as at risk. This article reports on 16 U.S. clinical trials, conducted with samples of college-aged students between 1987 and 2011, to identify effective depression-prevention strategies. Recommendations from the review of these studies include additional research to determine prevention strategies for the college student population and the use of evidence-based prevention strategies in nursing practice to improve the quality of life for this at-risk population.

Sport psychiatry: a systematic review of diagnosis and medical treatment of mental illness in athletes

Sport psychiatry focuses on diagnosis and treatment of psychiatric illness in athletes in addition to utilization of psychological approaches to enhance performance. As this field and its research base are relatively new, clinicians often deliver psychiatric care to athletes without a full understanding of the diagnostic and therapeutic issues unique to this population. In this systematic review, we discuss published findings relating to psychiatric diagnosis and medical treatment of mental illness in athletes. There have been several studies looking at the prevalence of some psychiatric disorders in various athlete populations. Eating disorders and substance abuse are the most studied of these disorders and appear to be common problems in athletes. However, to provide informed understanding and treatment, we especially need more research on overtraining syndrome, bipolar disorder, suicidality, anxiety disorders, attention-deficit hyperactivity disorder (ADHD) and psychosis in athletes. Research is needed in the areas of prevalence, risk factors, prognosis and the unique experiences facing athletes with any of these disorders. Additionally, there have not been any large, systematic studies on the use of psychotropic medications in athletes. Small studies suggest that some medications may either be performance enhancing or detrimental to performance, but we need larger studies with rigorous methodology. Higher level athletes suffering from psychiatric symptoms often have reservations about taking medications with unknown performance and safety effects, and methodological issues with the current literature database preclude any definitive conclusions on performance effects of psychiatric medications. We need many more, higher quality studies on the use by athletes of antidepressants, mood stabilizers, anxiolytics, stimulants and other ADHD medications, sedative-hypnotics and antipsychotics. Such studies should utilize sensitive performance measures and involve longer term use of psychotropic medications. Furthermore, study subjects should include athletes who actually have the psychiatric disorder for which the medication is proposed, and should include more women.

Risk for excessive alcohol use and drinking-related problems in college student athletes

There is compelling evidence that college student athletes engage in frequent episodes of heavy drinking and are prone to negative consequences resulting from such use. This study sought to identify risk and protective factors associated with student-athlete drinking and determine if student-athlete risk factors differed from those of non-athletes. Athletes compared to non-athletes reported more exaggerated perceptions of peer heavy drinking and lower sensation seeking and coping and enhancement motives for drinking, suggesting a risk profile distinct from non-athletes. In the overall sample, higher sensation seeking, overestimation of peer heavy drinking, non-use of protective behaviors while drinking, and higher enhancement and coping drinking motives were associated with greater frequency of heavy episodic drinking and more negative drinking consequences. In athletes compared to non-athletes, sensation seeking was more strongly associated with heavy episodic drinking and drinking to cope was more strongly associated with negative alcohol-related consequences. Overall, the results suggest that already proven brief intervention strategies, with minor adaptations related to the roles of sensation seeking and drinking to cope, may be helpful for student athletes.

Cross-cultural patterns in college student drinking and its consequences--a comparison between the USA and Sweden

AIMS

The aim of the study was to compare alcohol use, consequences and common risk factors between American and Swedish college students.

METHODS

A secondary comparative analysis from one American and two Swedish studies in college settings.

RESULTS

Swedish freshmen report higher alcohol use than US freshmen students. Swedish residence hall students report higher alcohol use than US residence hall students, but lower than American fraternity/sorority members. US students were less likely to be drinkers. Controlling for age, country moderated the relationship between family history and harmful drinking scores for women (stronger in the USA), and between expectancies and harmful drinking scores for men (stronger in Sweden), though in both cases this represented a small effect and patterns were similar overall.

CONCLUSIONS

Swedish students are at higher risk for alcohol use than US students, but similar patterns between aetiological predictors and outcomes in both countries suggest that research from the USA is generalizable to Swedish students and vice versa. More research is needed to better understand unique relationships associated with age and family history.

Heavy drinking in college students: who is at risk and what is being done about it?

Problem drinking and related consequences are a major social issue plaguing college campuses across the United States. Each year, alcohol is responsible for fatalities, assaults, serious injuries, and arrests that occur among college students. The authors review and discuss the risk factors, drinking patterns, and consequences that are relevant to the general student population. In addition, the authors highlight individuals at an increased risk of experiencing alcohol-related problems, such as Greek-letter social organization members and student athletes. The authors also discuss the interventions that attempt to reduce risky drinking and related problems in these subgroups as well as the future directions for research.

Professional and collegiate team assistance programs: services and utilization patterns

Elite professional and collegiate athletes underuse stress control, mental health, and substance abuse treatment services. Behavioral health services use can be increased by establishing on-site, sports-specific services. Like Employee Assistance Programs of industry and government, Team Assistance Programs (TAPs) address critical issues such as substance abuse prevention, tobacco cessation, stress recognition, mental illness management, injury rehabilitation, performance enhancement, and cultural support. Strong links with the team's medical and conditioning staff can ensure a steady stream of TAP referrals and build trust with players and team staff. This article describes nine years of operation for two professional TAPs and three years for one college TAP. Use patterns and linkage strategies with team physicians, trainers, strength staff, chiropractors, and nutritionists are discussed.

Substance Use in Athletics: A Sports Psychiatry Perspective

Athletes use substances to produce pleasure, relieve pain and stress, improve socialization, recover from injury, and enhance performance. Therefore, they use some substances in substantially higher rates that nonathletes. Despite these higher rates of use, rates of addiction may in fact be lower in athletes. This article reviews the prevalence and patterns of use, health and performance effects, and preventive and treatment interventions for alcohol, tobacco, stimulants, and steroids. Each substance is considered from the differing perspectives of abuse/addiction and performance enhancement models. Similarities and differences between college and professional athletes are discussed. Finally, suggestions for future research are made.

Psychopathology associated with drinking and alcohol use disorders in the college and general adult populations

This paper examines the associations between past-year drinking status and the prevalence of 15 different past-year anxiety, mood and personality disorders, using a large (n = 43,093) nationally representative sample of the U.S. population. The prevalence of these disorders and their associations with drinking are compared for college students 18-29 years of age, other youth 18-29 years of age, and adults 30 years of age and older. After adjusting for sociodemographic characteristics and past-year tobacco and illicit drug use, only drinkers with alcohol dependence experienced an excess risk of a mood or anxiety disorder among college students 18-29 years of age, OR = 2.4. In contrast, the excess risk of any mood or anxiety disorder associated with drinking status among non-college youth varied from an OR of 1.8 for non-binge drinkers to 4.7 for drinkers with alcohol dependence. Among persons 30 years of age and older, the degree of excess risk was slightly lower but still higher than those for college students, OR = 1.5-3.8. Similarly, the excess odds of any personality disorder associated with drinking varied from 1.6 to 5.0 for the younger, non-college group and from 1.5 to 3.8 for the older adults, with no significant effect observed among college students. Factors that may help explain the weaker association of psychopathology and drinking in the college population include selectivity and greater availability of social and treatment resources that serve as alternatives to self-medicating the symptoms of psychological distress with alcohol.

The college athlete

Participation in sports is important to many college students. Student athletes come from different levels of previous sport experience as they enter collegiate athletics. The primary source of student medical care is the campus student health center. The health care providers at student health centers attend to many of the sports-related concerns of student athletes. Preparticipation evaluation provides an opportunity to assess the general health of the student athlete and to identify conditions that might increase the risk of further injury. Sudden cardiac death and sports-associated concussions have generated much interest and are reviewed in this article. Other areas reviewed here include use of drugs and supplements, ankle sprains, acute knee ligament injuries, back pain, and shoulder impingement syndrome.

Current drug education policies in NCAA institutions: perceptions of head athletic trainers

This study compared the perceptions of head athletic trainers (HATS) from NCAA member Divisions I, II, and III regarding current athletic department drug education policies in their institutions. A Web-based questionnaire collected responses from 353 HATS. Drug education programs focused more on providing information about the negative consequences of drugs than changing the attitudes and behaviors of students in relation to drug use. More Division I and II schools offered comprehensive ATOD education programs to their athletes compared to Division III schools; however, the majority of these programs were not scheduled on a regular basis. HATS in all divisions reported that the abuse of alcohol and other drugs by student athletes during and after athletic and social events was a significant concern and indicated the importance of scheduling drug education programs closer to such events. Majority of HATS did not view participating in the drug education programs as part of their professional duties; however, they expressed an interest to increase their involvement in these activities.