Symptoms of Anxiety and Depression in Young Athletes Using the Hospital Anxiety and Depression Scale

Primary Care Considerations for the Pediatric Endurance Athlete

PURPOSE OF REVIEW

This study aimed to provide an overview of some of the medical concerns surrounding the care of the pediatric endurance athletes and add to the limited literature specific to the pediatric endurance athlete.

RECENT FINDINGS

Endurance athletes are at risk for overtraining, relative energy deficiency in sport (RED-S), overuse injuries, nutritional deficiencies, and sleep dysfunction. Youth runners and female endurance athletes are particularly high-risk populations for RED-S; nutritional deficiencies and their care should involve thoughtful mitigation of modifiable risk factors. The growing endurance athlete may experience slightly different cardiac adaptations than the adult endurance athlete with the long-term implications of these changes still unclear. Endurance sports are common among youth athletes. Multidisciplinary care that includes screening and early intervention for high-risk areas is critical to optimize their care and promote, safe lifelong sport participation.

Anxiety Disorders in Athletes

Athletes and non-athletes experience many anxiety-related symptoms and disorders at comparable rates. Contributory factors may include pressure to perform, public scrutiny, sporting career dissatisfaction, injury, and harassment and abuse in sport. Anxiety may negatively impact sport performance. Specific types of anxiety may have unique presentations in athletes. It is important to rule out general medical and substance-related causes of anxiety symptoms. Psychotherapy and pharmacology treatment options should be considered, bearing in mind athletes' environmental circumstances and physiologies.

The mediating role of proactive coping in the relationships between stress mindset, challenge appraisal tendencies, and psychological wellbeing

Objective

Stress is ubiquitous and how individuals view the nature of stress can influence psychological wellbeing. The present study aimed to investigate the mediating role of proactive coping on the relationships between stress mindset and challenge appraisal tendencies and examine how this in turn related to psychological wellbeing. A secondary aim was to investigate if there were any differences in stress mindset between athletes and non-athletes. It was hypothesised that stress mindset would be indirectly positively associated with challenge appraisal tendencies through proactive coping, that a challenge appraisal tendency would positively relate to vitality, and that vitality would negatively relate to depressive symptoms. It was also hypothesised that athletes would possess more facilitative views of stress compared with non-athletes.

Methods

Two hundred and seven individuals (n = 101 athletes, n = 106 non-athletes, Mage = 22.76 years, SD = 4.94) completed an online questionnaire pack assessing stress mindset, proactive coping, challenge appraisal tendencies, vitality, and depressive symptoms.

Results

Using path analysis, the hypothesised model demonstrated a good fit to the data and the positive relationship between stress mindset and challenge appraisal tendencies was mediated by proactive coping. Challenge appraisal tendencies were positively associated with vitality, which was negatively associated with depressive symptoms. Athletes reported a significantly greater 'stress-is-enhancing' mindset, greater vitality, and fewer depressive symptoms than non-athletes.

Conclusion

Findings offer support for the role that stress mindset has in potentially influencing psychological wellbeing and offer the novel suggestion that this mechanism may operate through proactive coping and challenge appraisal tendencies.

Clinical Commentary: Depression and Anxiety in Adolescent and Young Adult Athletes

Mental health (MH) symptoms and disorders are common in adolescents and young adults, and athletes may be at risk due to sport-specific triggers such as injury or illness as well as stressors related to performance, transition, or retirement from sport. Anxiety and depression are reported frequently in this age group, and early recognition and treatment can improve outcomes. The medical team (eg, athletic trainers or therapists, team physicians) should be familiar with the symptoms of depression and anxiety, recognize "red flags" for these symptoms and disorders, and seek to provide screening assessments and develop MH plans and MH emergency action plans. As a part of their scope of practice, team physicians should have the initial assessment and management of patients with these MH conditions and appreciate the importance of referrals to other MH providers with expertise caring for athletes. Athletic trainers are often the first point of contact for athletes who may be experiencing MH symptoms and therefore play a key role in early recognition and referrals to team physicians for early diagnosis and treatment. Additional resources that provide more in-depth information regarding the treatment and management of anxiety and depression are provided herein.

Mental health profiles among 13-16-year-Old Norwegian talent and mainstream students - A prospective person-centered analytical approach

OBJECTIVES

To contribute further knowledge about symptoms of anxiety, depression, body concerns, and self-worth among young talent development (TD) and mainstream students by exploring the indicators within-person combinations prospectively, aiming to identify distinct profiles.

METHODS

We included 946 students, n = 168 (45% girls) from three TD sports schools and one ballet class, n = 778 (52% girls) from ten mainstream schools. All were 13-14 years at T1 and 15-16 years at T2. Descriptive statistics were examined via variable-centered approaches: ANOVA and cross-tabulations. Mental health profiles were explored via person-centered approaches: latent profile and latent transition analysis, including profile stability over two years and school type, gender, and perfectionism association with profiles.

RESULTS

TD girls' and boys' anxiety and depression scores did not differ, but girls reported more weight-shape concerns. Mainstream schoolgirls fared worse compared to all others. Four retained profiles (distressed-body concerned, dissatisfied, moderate mentally healthy, mentally healthy) showed distinct patterns of co-occurring anxiety, depression, weight-shape concerns, and self-worth. Profile stability was high overall (72-93%). The highest proportion of TD boys was in the mentally healthy, TD girls and mainstream boys in moderate, and mainstream girls within the dissatisfied profile. Noteworthy transitions: TD boys who transitioned were likely changing to healthier profiles and girls to unhealthier. Unhealthier profiles were associated with socially prescribed perfectionism.

CONCLUSION

TD students fared relatively better than mainstream students. Still, considerable proportions of girls were identified in the unhealthiest profiles. These findings involving young TD and mainstream students propose a need for specific follow-up measures to promote mental health.

Athletes with Eating Disorders: Analysis of Their Clinical Characteristics, Psychopathology and Response to Treatment

Eating disorders (ED) have frequently been described among athletes. However, their specific features and therapy responses are lacking in the literature. The aims of this article were to compare clinical, psychopathological and personality traits between ED patients who were professional athletes (ED-A) with those who were not (ED-NA) and to explore differences in response to treatment. The sample comprised n = 104 patients with ED (n = 52 ED-A and n = 52 matched ED-NA) diagnosed according to DSM-5 criteria. Evaluation consisted of a semi-structured face-to-face clinical interview conducted by expert clinicians and a psychometric battery. Treatment outcome was evaluated when the treatment program ended. ED-A patients showed less body dissatisfaction and psychological distress. No differences were found in treatment outcome among the groups. Within the ED-A group, those participants who performed individual sport activities and aesthetic sports presented higher eating psychopathology, more general psychopathology, differential personality traits and poor therapy outcome. Individual and aesthetic sports presented more severity and worse prognosis. Although usual treatment for ED might be similarly effective in ED-A and ED-NA, it might be important to develop preventive and early detection programs involving sports physicians and psychologists, coaches and family throughout the entire athletic career and afterwards.

Burnout Syndrome in Selectable Athletes for the Brazilian Handball Team-Children Category

To investigate the presence of burnout syndrome in child athlete tryouts for the Brazilian Handball Team, before and after the National Development and Technical Improvement Camp is of great interest. A correlational study, with longitudinal design of the before-and-after type, carried out with 64 male athletes in the children's category, immersed in the National Camp for Development and Improvement of Handball Technique, in the municipality of São Bernardo do Campo, São Paulo, Brazil, in December 2018. To evaluate burnout syndrome, we used the Athlete Burnout Questionnaire (ABQ). There was a statistically significant increase of the mean scores for burnout and dimensions (Physical and Emotional Exhaustion = 1.5 to 1.6; p-value < 0.001; Reduced Sense of Accomplishment = 2.7 to 2.9; p-value < 0.001; Sports Devaluation = 1.4 to 1.6; p-value < 0.001; and General Burnout = 1.9 to 2.0; p-value < 0.001). The athletes selected for the national team had lower mean scores for general burnout and dimensions (Physical and Emotional Exhaustion = 1.5; Reduced Sense of Accomplishment = 2.7; Sports Devaluation = 1.5; General Burnout = 1.9). The National Camp for Development and Technical Improvement can have a negative impact on the mental health of athletes. This event is important to select the competitors with greater ability to face the pressure and adversities present in the sport environment.

EVALUATION OF ANXIETY AND DEPRESSION SYMPTOMS AMONG U-20 SOCCER ATHLETES IN RECIFE-PE: A CROSS-SECTIONAL STUDY

ABSTRACT Introduction Being a soccer player is one of the dreams most present in the popular imagination of Brazilian children. However, the path to professionalization is arduous and several reasons can be pointed out for this difficulty: a very competitive environment, few chances, and poor career counseling, among others. In competitive soccer, the athlete must be ready for all the demands that will be made, as well as accept the demand for the best possible performance. Furthermore, athletes from the youth system are still adolescents and youths in development, usually up to 21 years of age, who are often forced to choose soccer and its demands, at the expense of their studies and family lives, to become professional players. In this scenario, a still little-debated topic is mental health among soccer players. Objectives To verify the frequency of anxiety and depression symptoms among soccer players of the under-20 youth categories of Pernambuco clubs and to assess its association with sociodemographic, athletic, and health data. Methods The Hospital Anxiety and Depression Scale (HADS) was applied and socio-demographic, athletic, and health data were collected. A marginal descriptive analysis was conducted, as well as categorical and numerical assessments of anxiety- and depression-related variables. Finally, a linear regression study of the anxiety and depression scores was conducted. Results A statistically significant association was found between income received and an increase in anxiety symptoms. An increase in depressive symptoms as income decreased was also identified. Conclusion Further research with larger numbers of participants is needed, as well as with a greater variety of clubs, to better understand the relationship observed. Level of Evidence II; Prognostic study – Investigation of the effect of a patient characteristic on the outcome of their illness.

The relationship between resilience, anxiety, and depression in Chinese collegiate athletes

Anxiety disorder is becoming increasingly prevalent across college campuses, particularly among collegiate athletes who face different stressors and challenges than their non-athlete peers. Anxiety and depression are well documented comorbidities. Furthermore, the number of Chinese collegiate athletes suffering from anxiety and depression is increasing. Psychologists have recently begun to take a more prophylactic approach to defend against these disorders through resilience education. Resilience education focuses on developing greater capacity to cope when mental and emotional challenges arise. The purpose of this study was to analyze the relationship between resilience, depression, and anxiety in Chinese collegiate athletes. This study provides additional evidence of the value of incorporating an effective resilience educational module amongst collegiate athletes.

Adolescent Soccer Athletes’ Irrational Beliefs About Basic Psychological Needs are Related to Their Emotional Intelligence and Mental Health

There has been a scarcity of research regarding the unique mental health risk factors that adolescent athletes face. The recently proposed Rational Emotive Self Determination Scale for Adolescents (RESD-A) has been suggested to understand some of the antecedent and associative factors of adolescent athlete mental health. The principal aim of this study is to examine the structural and criterion validity of the RESD-A in an athlete sample for the first time. To achieve this aim, two hundred and forty-two club level soccer athletes participated in the study. Confirmatory factor analysis (CFA) was conducted to test the validity of the RESD-A’s factor structure. Partial correlation analyses with the subscales of RESD-A, emotional intelligence, and mental health scores were used to examine criterion validity. Initial results for the structural and criterion validity of the RESD-A with an athlete population are promising. The potential importance, limitations and directions for future research are discussed.

A Mediation Model between Self-Esteem, Anxiety, and Depression in Sport: The Role of Gender Differences in Speleologists

The scientific literature on mental health has found an association between physical activity and emotional wellbeing and recommends active leisure activities as a way of keeping stress under control. The purpose of this research study is to analyze the level of anxiety, the symptoms of depression and the level of self-esteem of people practicing speleology, as well as possible gender differences. This paper also attempts to understand whether self-esteem is associated with the presence of symptoms of depression in speleologists and whether anxiety has a mediating effect. We conduct a cross-sectional and descriptive research study with a sampling of 105 adult speleologists. The results reveal that the total mediation model is applicable, as self-esteem has a significant indirect association with depression through trait anxiety, as well as a partial mediation model that is applicable through state anxiety. This means that speleologists with high levels of self-esteem, who appreciate and value themselves adequately, reveal lower levels of trait anxiety, and this negatively influences their levels of depression (that is, a lower level of depressive symptoms). At the same time, speleologists with high levels of self-esteem, who appreciate and value themselves adequately, also reveal lower levels of state anxiety, which again has a negative impact on their levels of depression (with fewer symptoms of depression). Emotions such as anxiety, self-esteem, depression and their collateral effects are international topics of interest, which are relevant for people from all sporting backgrounds; therefore, value should be placed on supporting and carrying out further research into this topic.

Psychological Resilience in Young Female Athletes

Psychological resilience is an important construct that can enhance athletic performance and foster valuable life skills. Through positive adaptation to adversity and stressors in the athletic arena, athletes are able to cultivate their ability to effectively respond to negative stimuli, ultimately evolving to personal growth. For young female athletes, development of resilience may be particularly important. Young female athletes face distinct challenges in sport including sport inequity, body image issues, eating disorders, increased mental distress, and internalization of emotions. The aim of this review is to define and describe the construct of resilience and discuss the implications and applications relevant to young female athletes. By understanding how to foster resilience strategies in this population, we can enhance sport performance and enjoyment, as well as bolster valuable life skills that facilitate personal growth.

Changes in the Health of Adolescent Athletes: A Comparison of Health Measures Collected Before and During the CoVID-19 Pandemic

CONTEXT

In the spring of 2020, schools closed to in-person teaching and sports were cancelled to control the transmission of CoVID-19. The changes that took place to the physical and mental health among young athletes during this time remain unknown, however.

OBJECTIVE

Identify changes in the health (mental health, physical activity and quality of life) of athletes that occurred during the CoVID-19 pandemic.

DESIGN

Cross-sectional study.

SETTING

Sample recruited via social media.

PATIENTS OR OTHER PARTICIPANTS

3243 Wisconsin adolescent athletes (age=16.2±1.2 yrs., female=58% female) completed an online survey in May 2020 (DuringCoVID-19). Health measures for this cohort were compared with previously reported data for Wisconsin adolescent athletes (n=5231, age=15.7±1.2, 47% female) collected in 2016-2018 (PreCoVID-19).

MAIN OUTCOME MEASURE(S)

Demographic information included: sex, grade and sports played. Health assessments included the Patient Health Questionnaire-9 Item (PHQ-9) to identify depression symptoms, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for health related quality of life (HRQoL). Univariable comparisons of these variables between groups were made via t-tests or chi-square tests. Means and 95% confidence intervals (CI) for each group were estimated by survey weighted ANOVA models.

RESULTS

Compared to PreCoVID-19, a larger proportion of the During-CoVID-19 participants reported rates of moderate to severe levels of depression (9.7% vs 32.9%, p<0.001). During-CoVID-19 participants reported 50% lower (worse) PFABS scores (mean:12.2 [95%CI: 11.9, 12.5] vs 24.7 [24.5, 24.9] p<0.001) and lower (worse) PedsQL total scores compared to the PreCoVID-19 participants (78.4 [78.0, 78.8] vs. 90.9 [90.5, 91.3] p<0.001).

CONCLUSIONS

During the CoVID-19 pandemic, adolescent athletes reported increased symptoms of depression, decreased physical activity and decreased quality of life compared to adolescent athletes in previous years.

What Lies Beneath: Exploring Different Depressive Symptoms Across Selected Risk Factors in Icelandic Team Sport Athletes

The aim of the study was to explore the prevalence of specific symptoms of depression in athletes and to test differences in the likelihood of athletes exhibiting these symptoms across age, sex, type of team sport, and level of competition. A sample of Icelandic male and female team sport athletes (N = 894, 18–42 years) was included in the study. Of the athletes exhibiting clinically significant depressive symptoms on the Patient Health Questionnaire-9, 37.5% did not exhibit core symptoms of depression. Compared with males, females were significantly more likely to exhibit depressed mood, feelings of worthlessness/guilt, and problems with sleep, fatigue, appetite, and concentration. Within males, differences were mostly related to neurovegetative aspects of depression (sleep and appetite), whereas in females, differences were related to cognitive/emotional aspects (e.g., depressed mood, guilt/worthlessness). The findings underline the importance of exploring specific symptoms of depression to provide a richer understanding of depressive symptomology in athletes.

Mental Health Status of Psychogeriatric Patients During the 2019 New Coronavirus Disease (COVID-19) Pandemic and Effects on Caregiver Burden

Introduction: There is a growing awareness about the noxious effects of the 2019 Coronavirus Disease (COVID-19) pandemic on the mental health of the elderly. However, there is limited information from clinically driven research. The objectives of the present study were to examine the magnitude of psychiatric symptoms and to determine their association with caregiver distress, in a cross-section of community-dwelling older adults and a subsample of aging adults with Down syndrome (DS) attending a psychogeriatric service in São Paulo, Brazil. Method: Telephone-based interviews and electronically filled self-assessment questionnaires were used to collect information from patients and caregivers, addressing their impressions and concerns about the pandemic and related effects on the patient's emotional state and behavior. Clinical information was obtained from hospital charts, medical records, and psychometric tests administered through telephone interviews [Hospital Anxiety and Depression Scale (HADS) and Neuropsychiatric Inventory Questionnaire (NPI-Q)]. Results: We included 100 consecutive participants, comprising 71 older adults with psychogeriatric/neurocognitive disorders and 29 aging adults with DS. Higher HADS and NPI-Q scores were significantly associated with caregiver distress (p < 0.05) in both groups. Correlation analyses indicated strong, positive associations between caregiver burden and scores in HADS anxiety (HADS-A) and HADS depression (HADS-D) scales in the subsamples of euploid and DS subjects. Higher NPI-Q scores in the former group were also correlated with caregiver distress, with stronger associations for neuropsychiatric symptoms. Similar findings were observed among DS subjects. ANOVA tests indicated significant associations between NPI-Q scores and caregiver distress among dementia patients, as well as with HADS scores. Similar results were found after multiple linear regressions; as such, among the elderly subsample, higher scores in HADS-A (p = 0.002) and HADS-D (p = 0.001) predict a significant impact on caregiver burden (p < 0.00001, R 2 0.46); taking into consideration caregiver burden as a dependent variable and NPI-Q total score as an independent variable, we obtained significant strong prediction values for either DS (p < 0.00001, R 2 0.95) or elderly adults (p < 0.00001, R 2 0.88). Conclusion: During the COVID-19 pandemic, patients with neurocognitive disorders present with clinically relevant neuropsychiatric symptoms, with significant impact on caregiver distress. Apathy, aberrant motor behavior, sleep disorders, and psychoses were the main psychopathological domains, which had determined caregiver burden worsening.

Impact of sports participation on incidence of bone traumatic fractures and health-care costs among adolescents: ABCD - Growth Study

Objective: To analyze the risk of bone traumatic fractures according to the engagement in sports, as well as to identify the potential impact of sports participation and traumatic fractures on health-care costs among adolescents. Methods: This is a longitudinal 12-month study of 285 adolescents of both sexes in Brazil. We assessed the occurrence of traumatic fractures and health-care services (hospitalizations, medicine use, medical consultations, and exams) by phone contact every month for 12 months. Adolescents were divided into four groups according to sport characteristics: non-sport (n = 104), non-impact sport (swimming [n = 34]), martial arts (n = 49 [judo, karate, kung-Fu]) and impact sports (n = 98 [track-and-field, basketball, gymnastics, tennis, and baseball]). Results: The incidence of new fractures was 2.1%. The overall costs accounted during the 12-month follow-up were U$ 3,259.66. Swimmers (US$ 13.86) had higher health-care costs than non-sport (US$ 1.82), martial arts (US$ 2.23), and impact sports (US$ 2.32). Conclusion: swimming seems to be related to higher health-care costs among adolescents.

The Psychosocial Implications of Sport Specialization in Pediatric Athletes

Data on the psychosocial implications of sport specialization in pediatric athletes are lacking. Sport specialization often requires increased training hours and may predispose young athletes to social isolation, poor academic performance, increased anxiety, greater stress, inadequate sleep, decreased family time, and burnout. Sport specialization frequently introduces multiple stressors that could be expected to adversely affect mental health and function in young athletes and may increase the risk for burnout. This may be confounded by altered sleep duration and quality, increased drive for elite status, and perfectionistic personality types. The signs and symptoms of burnout in young athletes can be difficult to detect. It is important to be aware of the possible diagnosis of burnout in young athletes who display vague symptoms and a decrease in academic performance. The purpose of this review was to survey the available literature on sport specialization in young athletes and its association with mental health, sleep, the drive for success in sport, and burnout.

Determinants of anxiety in elite athletes: a systematic review and meta-analysis

Objective

To identify and quantify determinants of anxiety symptoms and disorders experienced by elite athletes.

Design

Systematic review and meta-analysis.

Data sources

Five online databases (PubMed, SportDiscus, PsycINFO, Scopus and Cochrane) were searched up to November 2018 to identify eligible citations.

Eligibility criteria for selecting studies

Articles were included if they were published in English, were quantitative studies and measured a symptom-level anxiety outcome in competing or retired athletes at the professional (including professional youth), Olympic or collegiate/university levels.

Results and summary

We screened 1163 articles; 61 studies were included in the systematic review and 27 of them were suitable for meta-analysis. Overall risk of bias for included studies was low. Athletes and non-athletes had no differences in anxiety profiles (d=−0.11, p=0.28). Pooled effect sizes, demonstrating moderate effects, were identified for (1) career dissatisfaction (d=0.45; higher anxiety in dissatisfied athletes), (2) gender (d=0.38; higher anxiety in female athletes), (3) age (d=−0.34; higher anxiety for younger athletes) and (4) musculoskeletal injury (d=0.31; higher anxiety for injured athletes). A small pooled effect was found for recent adverse life events (d=0.26)—higher anxiety in athletes who had experienced one or more recent adverse life events.

Conclusion

Determinants of anxiety in elite populations broadly reflect those experienced by the general population. Clinicians should be aware of these general and athlete-specific determinants of anxiety among elite athletes.

Increased Mental Well-Being and Reduced State Anxiety in Teachers After Participation in a Residential Yoga Program

BACKGROUND Reducing stress in the workplace improves mental health. Teaching is of social importance, but it may receive inadequate recognition and rewards. The present study compared mental well-being and state anxiety in primary school teachers who practiced 15 days of yoga in a residential setting with those who continued their usual routine. MATERIAL AND METHODS We enrolled 236 primary school teachers to participate in the study. We assigned 118 primary school teachers (group mean ±S.D., age 41.5±6.0 years, 74 females) to the experimental group; they underwent 15 days of yoga training for 6 hours/day) in a residential yoga center. The non-yoga control group (group mean ±S.D., age 42.3±6.0 years, 79 females) consisted of 118 teachers who continued with their normal teaching routine. RESULTS After 15 days in the residential yoga program, there was an increase in overall mental well-being (p<.001) and lower state anxiety (p<.01) (repeated-measures ANOVA, followed by post hoc multiple comparison tests). At baseline, the non-yoga control group had higher levels of state anxiety, presumably related to their remaining in the workplace. CONCLUSIONS The study was a 15-day, comparative, controlled trial. The results show that after 15 days of participation in the residential yoga program, primary school teachers increased all aspects of mental well-being and had reduced state anxiety.