Stress, Sport Anxiety, Neuroticism, and Coping in Student-Athletes: Implications for Patient Mental Health.

CONTEXT: Patients' mental health has been recognized as important in providing patient-centered care in athletic training. OBJECTIVE: To evaluate stress, sport anxiety, neuroticism, and coping in student-athletes. DESIGN: Cross-sectional study. SETTING: University athletics. PATIENTS OR OTHER PARTICIPANTS: The sample comprised 86 student-athletes competing in National Collegiate Athletic Association (NCAA) Division III. MAIN OUTCOME MEASURE(S): The Perceived Stress Scale, Sport Anxiety Scale-2, neuroticism scale of the Big Five Inventory, and Brief COPE were used to measure stress, sport anxiety, neuroticism, and coping, respectively. RESULTS: Sport anxiety was positively related to stress (r = 0.446, P < .001) and neuroticism (r = 0.311, P < .01) and not related to emotion-focused coping (r = 0.270, P = .804). Neuroticism was a negative predictor of emotion-focused coping (b = -0.373, P < .001), and sport anxiety and stress were predictors of dysfunctional coping (b = 0.120, P < .05; b = 0.037, P < .05). Stress, sport anxiety, and neuroticism were not predictors of problem-focused coping. CONCLUSIONS: Support was evident for the relationship among stress, sport anxiety, neuroticism, and coping in NCAA Division III student-athletes. Such results warrant future exploration to inform behavioral interventions targeting student-athlete psychosocial factors to promote improved performance, reduce injury risk factors (eg, stress, personality, coping), and enhance student-athlete mental health and well-being.

Certified athletic trainers' perspectives on rehabilitation adherence in collegiate athletic training settings.

CONTEXT: Adherence to sport-injury rehabilitation protocols may be pivotal in ensuring successful rehabilitation and return-to-play outcomes. OBJECTIVES: To investigate athletic trainers' perspectives related to the degree to which rehabilitation adherence is an issue in collegiate athletic training settings, gain insight from certified athletic trainers regarding the factors contributing to rehabilitation nonadherence (underadherence and overadherence), and ascertain views on the most effective means for promoting adherence. DESIGN: Cross-sectional, mixed methods. SETTING: Collegiate athletic training in the United States. PARTICIPANTS: Certified athletic trainers (n = 479; 234 male, 245 female). MAIN OUTCOME MEASURES: Online survey consisting of 3 questions regarding rehabilitation adherence, each followed by an open-ended comments section. Descriptive statistics were calculated for quantitative items; hierarchical content analyses were conducted for qualitative items. RESULTS: Most (98.3%) participants reported poor rehabilitation adherence to be a problem (1.7% = no problem, 29.2% = minor problem, 49.7% = problem, 19.4% = major problem), while most (98.96%) participants reported that they had athletes who exhibited poor rehabilitation adherence (1% = never, 71.4% = occasionally, 22.5% = often, 5% = always). In addition, the majority (97.91%) of participants reported that overadherence (eg, doing too much, failing to comply with activity restrictions, etc) was at least an occasional occurrence (2.1% = never, 69.3% = occasionally, 26.3% = often, 1.9% = always). Hierarchical content analyses regarding the constructs of poor adherence and overadherence revealed 4 major themes: the motivation to adhere, the development of good athletic trainer-athlete rapport and effective communication, athletic trainers' perception of the coaches' role in fostering adherence, and the influence of injury- or individual- (eg, injury severity, sport type, gender) specific characteristics on rehabilitation adherence. CONCLUSIONS: These results suggest that participants believe that underadherence (and to a lesser extent overadherence) is a frequent occurrence in collegiate athletic training settings. Strategies for enhancing rehabilitation adherence rates and preventing overadherence may therefore be important for optimizing rehabilitation outcomes.

Psychosocial aspects of athletic injuries as perceived by athletic trainers.

CONTEXT: Despite the Psychosocial Strategies and Referral content area, athletic trainers (ATs) generally lack confidence in their ability to use this information. OBJECTIVE: The current study's primary purpose was to determine (a) perceived psychological responses and coping behaviors athletes may present to ATs, (b) psychosocial strategies ATs currently use with their athletes, (c) psychosocial strategies ATs deem important to learn more about, and (d) ATs' current practices in referring athletes to counseling or sport psychology services. DESIGN: Mixed-methods study. SETTING: Online survey containing both quantitative and qualitative items. PATIENTS OR OTHER PARTICIPANTS: A total of 215 ATs (86 male, 129 female), representing a response rate of 22.50%. MAIN OUTCOME MEASURE(S): The Athletic Training and Sport Psychology Questionnaire. RESULTS: Stress/anxiety (4.24 ± 0.82), anger (3.70 ± 0.96), and treatment adherence problems (3.62 ± 0.94) were rated as the primary psychological responses athletes may present upon injury. Adherence and having a positive attitude were identified as key determinants in defining athletes' successful coping with their injuries. The top 3 selected psychosocial strategies were keeping the athlete involved with the team (4.57 ± 0.73), using short-term goals (4.45 ± 0.67), and creating variety in rehabilitation exercises (4.32 ± 0.75). The top 3 rated psychosocial strategies ATs deem important to learn more about were understanding motivation (4.29 ± 0.89), using effective communication (4.24 ± 0.91), and setting realistic goals (4.22 ± 0.97). Of the sample, only 59 (27.44%) ATs reported referring an athlete for counseling services, and 37 (84.09%) of those who had access to a sport psychologist (n = 44) reported referring for sport psychology services. CONCLUSIONS: These results not only highlight ATs' current use of psychosocial strategies but also their desires to increase their current knowledge and understanding of these strategies while caring for injured athletes.

Development of a measure of rehabilitation adherence for athletic training.

CONTEXT: Rehabilitation adherence is accepted as a critical component for attaining optimal outcomes. Poor adherence is recognized as a problem in the athletic training setting. Measurement has been inconsistent, and no measure has been developed for athletic training settings. OBJECTIVE: To identify indicators of sport-injury rehabilitation adherence relevant to athletic training and develop a Rehabilitation Adherence Measure for Athletic Training (RAdMAT) based on these indicators. DESIGN: Mixed methods, 3 steps. SETTING: College athletic training facility. PARTICIPANTS: Practicing certified athletic trainers (ATCs; n=7) generated items, experts (n=12) reviewed them, and practicing ATCs (n=164) completed the RAdMAT for their most, average, and least adherent athlete. MAIN OUTCOME MEASURE: RAdMAT. RESULTS: The RAdMAT is 16 items with 3 subscales. Subscales and total have good internal consistency and clearly discriminate among adherence levels. CONCLUSIONS: The RAdMAT is based on scholarly literature and clinical practice, making it particularly appropriate for use in athletic training clinical practice or for research purposes.