An examination of changes in psychological status across four phases of injury recovery and return to sport: A prospective weekly study of competitive athletes from acute care to return to sport.

While ample research has shown that sport injuries are associated with poor psychological status, scant attention has been given to changes in injured athletes' psychological status over the full course of recovery and return to sport. The aim of the present study was to prospectively investigate potential changes in injured athletes' psychological status across four phases of recovery and return to sport. A total of 38 severely injured adult competitive athletes (58% female; mean age 24.1 ± 7.18 years) participated in this prospective weekly investigation (n = 319 observations). Athletes' were asked to indicate their current phase of recovery or return to sport (acute care, rehabilitation, adapted training, or full return to sport) after which they responded to visual analog scales assessing post-injury psychological status, including: perceived pain (frequency and intensity), emotions (positive and negative), anxiety (cognitive and physiological), motivation, self-efficacy, and satisfaction. During the acute care phase, participants showed higher scores of perceived pain, and physiological anxiety compared to the other phases. During the adapted training phase, amotivation was higher than in the acute care phase, and self-efficacy was lower than in other phases. At full return to sport, athletes showed less perceived pain, cognitive anxiety, and more satisfaction than during other phases. The present study provides a deeper prospective understanding of changes in athlete's psychological status over the course of injury recovery and return to sport and highlight the importance of monitoring psychological status.

Relationship Between Athletes' History of Stressors and Sport Injury: A Systematic Review and Meta-Analysis.

A history of stressors in athletes represents psychosocial factors that may lead to sport injury. However, empirical studies have provided varying results for the relationship between stress history and sport injury. We examined prior literature on the stress history - sport injury relationship within a systematic review and, by meta-analysis, we offered a pooled estimate of the strength of this relationship. We searched seven major academic databases (Sportdiscus, Psyinfo, Academic Search Premier, Ovid, Scopus, Web of Science, and PubMed) from January 2000 to September 2023 and identified 19 empirical studies that examined injuries in sports contexts for meta-analysis. In 19 empirical studies of moderate to high publication quality, we found moderate heterogeneity (Q(17) = 98.61; p < .001), low sensitivity (I2 77.82-83.77), and low publication bias (Z-value = 7.74; p < .001). Further, using a random effect estimate-r, we found a low but significant correlation between stress history and sport injury, yielding a small overall effect size (ES) of r = .12. Furthermore, moderation analyses found adolescents (r = .14), contact-sport athletes (r = .09), non-elite athletes (r = .13), and non-European athletes (America r = .16; Asia r = .14; Oceania r = .14) to have a relatively higher ES than their counterparts in this stress history/sport injury relationship. We concluded that inevitable life stressors may lead to many negative consequences for athletes, such that sports professionals should provide stress management educational programs to enhance athletes' health and well-being.

Screening for Anxiety and Depression Symptoms Using Concussion Symptom Scales Among Varsity Athletes.

OBJECTIVE: This study examined associations between Sport Concussion Assessment Tool-5 (SCAT-5) symptom reporting and gold-standard measures of anxiety and depression, and explored the utility SCAT-5 symptom subscales to identify anxiety and depression symptomology. DESIGN: Prospective cross-sectional study. SETTING: York University in Toronto, Canada. PARTICIPANTS: Preseason data were collected for varsity athletes (N = 296) aged between 17 and 25 years ( M = 20.01 years, SD = 1.69 years; 52% male). MAIN OUTCOME MEASURES: The SCAT-5 symptom evaluation scale was used to assess baseline symptoms. The Generalized Anxiety Disorder Index-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess symptoms of anxiety and depression, respectively. RESULTS: Endorsement of SCAT-5 symptoms of feeling anxious, sadness, irritability, and feeling more emotional had the strongest correlations with the GAD-7 ( r' s > 0.400; P' s < 0.001). Sadness, trouble falling asleep, concentration problems, feeling slowed down, anxious, irritability, mental fog, fatigue, and memory problems had the highest correlations with the PHQ-9 ( r' s >0 .400; P' s < 0.001). The Emotional subscale from the SCAT-5 predicted mild to severe anxiety on the GAD-7 ( P < 0.001). The Sleep, Cognitive, and Emotional subscales predicted mild to severe depression on the PHQ-9 ( P' s < 0.05). CONCLUSIONS: These findings provide better delineation of symptoms endorsed on the SCAT-5 symptoms that aid in identification of athletes with symptoms of anxiety or depression who may be at risk for developing a clinical disorder or experiencing persistent symptoms after a concussion.

Screening and Referral for Behavioral Health Symptoms in Collegiate Athletes.

OBJECTIVE: We aim to investigate the prevalence of behavioral health symptoms in collegiate athletes and the frequency of referrals prompted by a preparticipation behavioral health screener. DESIGN: Athletes completed a screening battery to detect behavioral health symptoms and sports psychology clinicians designed criteria for intervention based on the severity of symptoms reported. Data from the screener was retrospectively de-identified and analyzed. SETTING: National Collegiate Athletic Association Division-I university. PARTICIPANTS: All athletes on active rosters were required to complete the screener as a component of the preparticipation examination. INTERVENTIONS: Sports psychology clinicians created a protocol for intervention based on the number and severity of symptoms reported on the screener. MAIN OUTCOME MEASURES: Communication with athletes and referrals made to behavioral health services. RESULTS: Of the 1126 surveys completed, 39% had behavioral health symptoms necessitating behavioral health referral. Twelve percent required a safety check-in, given the severity of their symptoms. Seven percent of the respondents were newly established with behavioral health services. CONCLUSIONS: Symptoms of behavioral health disorders are common among athletes and yet, for a myriad of reasons, many choose to forgo treatment. By implementing a behavioral health screening battery, the prevalence of behavioral health symptoms among athletes at our institution was elucidated and many athletes were newly established with behavioral health services. The tiered intervention protocol in this study allowed for appropriate assessment and triage of high-risk individuals, while simultaneously providing lower-risk individuals with appropriate resources. Surveillance for behavioral health symptoms among college athletes using a screening battery with a tiered intervention protocol can ensure at-risk athletes are identified, contacted, and referred to behavioral health services, potentially improving their athletic performance and overall well-being, while averting poor outcomes.

Historia de lesiones, perfeccionismo, catastrofismo y vulnerabilidad a la ansiedad en triatletas / História de lesão, perfeccionismo, catastrofização e vulnerabilidade à ansiedade em triatletas / History of injury, perfectionism, catastrophizing, and vulnerability to anxiety in triathletes

La relación entre las variables psicológicas y las lesiones deportivas es un hecho constatado en la comunidad científica. Dada su gran relevancia en la actualidad parece necesario ampliar el conocimiento considerando otras variables menos estudiadas como el perfeccionismo o el pensamiento catastrofista, o en muestras como las de triatletas. El objetivo de este estudio es analizar la relación entre la historia de lesiones del triatleta y los niveles de perfeccionismo, el pensamiento catastrofista y la vulnerabilidad a la ansiedad. Se utilizó una muestra de 99 triatletas (50 chicos y 49 chicas), con una media de 25.87 ± 7.52 años de edad. Para la evaluación de las variables de estudio se utilizó un cuestionario ad hoc para variables sociodemográficas e historial de lesiones, la Escala Multidimensional del Perfeccionismo (MPS), la Escala de Catastrofismo ante el Dolor (ECD) y la Escala de Sensibilidad a la Ansiedad (ASI-3). Los resultados indican que la vulnerabilidad a la ansiedad social en el triatleta es el resultado de la combinación entre la aparición de una lesión grave, la existencia de preocupaciones recurrentes e influencias externas, de la magnificación de pensamientos catastrofistas, que ocurra a una menor edad, y que haya habido una historia de lesiones muy alta. (AU)

The relationship between psychological variables and sports injuries is a proven fact in the scientific community. Given its great relevance today, it seems necessary to expand knowledge by considering other less studied variables such as perfectionism or catastrophic thinking, or in samples such as those of triathletes. The objective of this study is to analyze the relationship between the triathlete's history of injuries and levels of perfectionism, catastrophic thinking, and vulnerability to anxiety. A sample of 99 triathletes (50 boys and 49 girls), with a mean age of 25.87±7.52 years, was used. For the evaluation of the study variables, an ad hoc questionnaire was used for sociodemographic variables and history of injuries, the Multidimensional Perfectionism Scale (MPS), the Pain Catastrophizing Scale (ECD), and the Anxiety Sensitivity Scale ( ASI-3). The results indicate that the vulnerability to social anxiety in the triathlete is the result of the combination of the appearance of a serious injury, the existence of recurrent worries and external influences, the magnification of catastrophic thoughts, that it occurs at ayounger age, and that there has been a very high injury history. (AU)

A relação entre variáveis psicológicas e lesões desportivas são um facto comprovado na comunidade científica. Considerando a sua grande relevância. parece necessário ampliar o conhecimento considerando outras variáveis menos estudadas, como o perfeccionismo ou o pensamento catastrófico, em particular em triatletas. Assim, o objetivo deste estudo é analisar a relação entre o histórico de lesões dos triatletas e os níveis de perfeccionismo, pensamento catastrófico e vulnerabilidade em relação à ansiedade. Participaram neste estudo 99 triatletas (50 masculinos e 49 femininos), com uma média de idades de 25,87±7,52 anos. Para avaliação das variáveis do estudo, foi utilizado um questionário ad hoc para variáveis sociodemográficas e histórico de lesões, e ainda a Escala Multidimensional de Perfeccionismo (MPS), a Escala Catastrofizante da Dor (ECD) e a Escala de Sensibilidade à Ansiedade (ASI-3). Os resultados indicam que a vulnerabilidade à ansiedade social no triatleta é resultado da combinação entre o aparecimento de uma lesão grave, a existência de preocupações recorrentes e influências externas, a ampliação de pensamentos catastróficos, que ocorrem em idades mais jovens, demonstando que houve um histórico de lesões muito alto. (AU)

Developing a simple risk metric for the effect of sport-related concussion and physical pain on mental health.

Risk factors associated with depression in athletes include biological sex, physical pain, and history of sport-related concussion (SRC). Due to the well-documented benefits of sport and physical activity on mental health, athletes and non-athletes were recruited to assess any differences. Beyond this, athletes were also grouped by sport-type (contact/non-contact sports) due to the increased prevalence of pain and SRC in contact sports. To our knowledge, there has been no research on how these factors influence the likelihood of depression. In the current study, 144 participants completed a short survey on the above factors and the Center for Epidemiological Studies Depression Scale. Sixty-two of these reported a history of concussion. Logistic regression revealed all the above predictors to be significantly associated with the depression scale. Individuals that had previously sustained SRC, were experiencing greater physical pain and females were more likely to display poor mental health. However, we provide further evidence for the benefits of engaging in sport and physical activity as those that took part in sport were less likely to report depression. Therefore, this study provides a simple risk metric whereby sportspeople can make a better informed choice of their sporting participation, making their own cost/reward judgement.

Current Clinical Concepts: Integration of Psychologically Informed Practice for Management of Patients With Sport-Related Injuries.

Psychologically informed practice is an approach to patient management that encourages clinicians to treat patients from a biopsychosocial perspective and can be adopted by athletic trainers to manage sport-related injuries. As described in the domains of athletic training clinical practice, athletic trainers are expected to identify, address, and make appropriate referrals regarding psychosocial responses to injuries and mental health symptoms. Psychologically informed practice suggests addressing physical impairments in addition to screening and intervening for psychosocial responses with patients. In this Current Clinical Concepts paper, we discuss appropriate patient-reported outcome measures used to screen for mental health symptoms and psychosocial responses, provide recommendations on psychological interventions that can be integrated to enhance patient outcomes, and describe how to effectively refer a patient to an appropriate mental health professional.

TEST-RETEST RELIABILITY AND RELIABLE CHANGE INDEX OF MOBILE APPLICATION NEUROCOGNITIVE TEST AMONG MIDDLE AND HIGH SCHOOL ATHLETES.

CONTEXT: A mobile application neurocognitive assessment has been used in place of equipment intensive computerized neurocognitive assessment protocol. A previous study reported high to very high test-retest reliability of neurocognitive assessment using the mobile application in healthy adults, but no studies have examined test-retest reliability, reliable change indices (RCIs), and sex effect in middle school and high school populations when conducted 1 year apart. OBJECTIVE: The purpose of this study was to examine the test-retest reliability and RCIs of baseline data collected at 2-time points approximately 1 year apart using a mobile application neurocognitive rest in middle school and high school athletes. The secondary purpose of the study was to investigate the sex difference in neurocognitive measures. DESIGN: Cross-sectional study. SETTING: Institutional. PATIENTS OR OTHER PARTICIPANTS: 172 middle school and high school healthy student-athletes (mean age=13.78±1.59 years old). MAIN OUTCOME MEASURE(S): Mobile application neurocognitive rest scores (reaction time, impulse control, inspection, and memory). RESULTS: The result from the study demonstrated that neurocognitive measures had low test-retest reliability across a 1-year time period in middle and high school settings. Upon retesting, reaction time and inspection time improved significantly in both middle and high school athletes, and impulse control showed significant improvement in middle school athletes. More athletes in middle school showed more RCI improvements compared to high school athletes. While both males and females demonstrated improvements in neurocognitive measures throughout adolescence, males outperformed females on reaction time and impulse control. CONCLUSIONS: Findings from the study indicate unacceptably low test-retest reliability of a mobile application neurocognitive test most likely due to cognitive development occurring throughout adolescence. Additionally, significant RCIs were noted. These naturally occurring improvements due to cognitive development could mask the post-concussion deficits. The findings warrant consideration of age and sex on the neurocognitive performance of middle and high school athletes.

Change in health-related quality of life and functional disability over time post-concussion in youth.

PURPOSE: Concussions can have detrimental on children's cognitive, emotional, behavioral, and/or social functioning. We sought to examine changes in health-related quality of life (HRQOL) and functional disability from pre-injury to 1-week post-concussion, and to symptom resolution among youth ages 11-17 with a concussion. METHODS: In this prospective, longitudinal cohort study, 83 concussed youth, ages 11-17, self-reported post-concussion symptoms daily as well as HRQOL and functional disability at baseline (pre-injury, retrospective), 1-week post-concussion, and symptom resolution. We modeled changes in overall and sub-scale HRQOL and functional disability scores over time from pre-injury to 1-week post-concussion and from 1-week post-concussion to symptom resolution using a piecewise linear mixed model, adjusting for potential covariables. Estimated fixed effects with a corresponding adjusted coefficient (beta), along with their 95% confidence intervals are presented. RESULTS: Overall HRQOL worsened from pre-injury to 1-week post-injury (ß = - 5.40, 95%CI - 9.22, - 1.58) but did not change from 1-week post-injury to symptom resolution. Physical HRQOL worsened from pre-injury to 1-week post-injury (ß = - 9.90, 95%CI - 14.65, - 5.14) but improved from 1-week post-injury to symptom resolution (ß = 1.64, 95%CI 0.50, 2.78), while psychosocial HRQOL showed no change over time. Functional disability worsened from pre-injury to 1-week post-injury (ß = 8.36, 95%CI 5.93, 10.79) but with no change from 1-week post-injury to symptom resolution. Youth with symptom duration > 14 days reported worse HRQOL and functional disability than those who recovered in ≤ 14 days and greater daily post-concussion symptom scores were associated with worse HRQOL and functional disability. CONCLUSION: Concussions have a negative impact on overall and physical HRQOL and functional disability in youth acutely post-injury. Ratings of HRQOL could be used to inform clinical treatment decisions to assist with the recovery process.

Association between Musculoskeletal Injuries and Depressive Symptoms among Athletes: A Systematic Review.

Musculoskeletal (MSK) injuries have a significant physical and psychological influence on an athlete's life. A systematic review of prospective cohort, cross-sectional, and case-control studies was undertaken in this study to analyze the association between MSK injuries with depressive symptoms in athletes. We searched on PubMed, Web of Science, and Scopus, with data inception to 15 February 2023. The methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Of the 3677 potential studies only nine were included. These studies showed a bidirectional association between MSK injuries and depressive symptoms. Athletes with MSK injuries had higher levels of depressive symptoms, which raises the likelihood of experiencing depression in the future. Women athletes had higher levels of depressive symptoms compared with men. The presence of depressive symptoms is a significant predictor of disability in athletes. Our findings suggest that coaches should be more aware of depressive symptoms, in order to prevent MSK injuries, and to monitor athletes following an MSK injury.

Return-to-learn after sport-related concussion: does school level matter?

OBJECTIVE: Return-to-learn (RTL) after sport-related concussion (SRC) is an important yet understudied topic. The authors sought to do the following: 1) describe patterns of RTL among athletes by school level (i.e., middle school, high school, college); and 2) evaluate the predictive value of school level on RTL duration. METHODS: A retrospective, single-institution cohort study of adolescent and young adult athletes 12-23 years old who sustained an SRC between November 2017 and April 2022 and who presented to a multidisciplinary specialty concussion clinic was conducted. The independent variable was school level, trichotomized into middle school, high school, and college. Time to RTL was the primary outcome and was defined as days from SRC to return to any academic activities. ANOVA was used to compare RTL duration across school levels. A multivariable linear regression was performed to evaluate for predictive value of school level on RTL duration. Covariates included the following: sex, race/ethnicity, learning disorder, psychiatric conditions, migraines, family history of psychiatric conditions/migraines, initial Post-Concussion Symptom Scale score, and number of prior concussions. RESULTS: Of 1007 total athletes, 116 (11.5%) were in middle school, 835 (83.0%) were in high school, and 56 (5.6%) were in college. The mean RTL times (in days) were as follows: 8.0 ± 13.1 (middle school), 8.5 ± 13.7 (high school), and 15.6 ± 22.3 (college). One-way ANOVA showed a statistically significant difference between groups (F[2, 1007] = 6.93, p = 0.001). A Tukey post hoc test revealed a longer RTL duration in collegiate athletes when compared to middle school (p = 0.003) and high school (p < 0.001) athletes. Collegiate athletes had longer RTL duration compared to other school levels (ß = 0.14, p < 0.001). There was no difference between middle school and high school athletes (p = 0.935). The subanalysis revealed a longer RTL duration in high school freshmen/sophomores (9.5 ± 14.9 days) when compared to juniors/seniors (7.6 ± 12.6 days; t = 2.05, p = 0.041), and being an older (junior/senior) high school athlete was predictive of shorter RTL duration (ß = -0.11, p = 0.011). CONCLUSIONS: When examining patients who presented to a multidisciplinary sport concussion center, RTL duration was longer in collegiate athletes when compared to middle and high school athletes. Younger high school athletes had longer time to RTL compared to their older counterparts. This study provides insight into how varying scholastic environments may contribute to RTL.

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.

Affective Disturbance and Neurocognitive Variability in College Athletes.

OBJECTIVE: Research on the neurocognitive effects of comorbid mood/anxiety disturbance in college athletes is limited. Previous research found that athletes with comorbid depression/anxiety performed worse on measures of attention/processing speed (A/PS) at baseline compared to healthy controls. However, this work solely examined mean performance. The current study expands upon this work by examining intraindividual variability (IIV) in relation to affective disturbance. METHOD: 835 (M = 624, F = 211) collegiate athletes completed baseline neuropsychological testing. Athletes were separated into four groups (Healthy Mood [n = 582], Depression Alone [n = 137], Anxiety Alone [n = 54], and Co-Occurring Depression/Anxiety [n = 62]) based on self-reported anxiety and depression. IIV was examined globally and within composites of A/PS and memory via intraindividual standard deviation, with higher scores indicating greater variability. RESULTS: Linear regression results revealed that the Co-Occurring Depression/Anxiety group exhibited greater variability within the memory composite compared to the Healthy Mood group, as well as the Depression Alone and Anxiety Alone groups. The Depression Alone and Anxiety Alone groups did not differ from the Healthy Mood group on memory IIV. None of the groups differed on A/PS or global IIV. CONCLUSIONS: Athletes with co-occurring depression/anxiety demonstrated greater variability in performance on memory tasks. Greater dispersion is predictive of greater cognitive decline following concussion; therefore, it is important that neuropsychological performance is interpreted beyond measures of central tendency. These findings also highlight the importance of having baseline data available for athletes with affective disturbance, as these factors may influence performance, place athlete at risk for poorer outcomes, and skew future post-concussion comparisons.

Contact or Collision Sport History, Repetitive Neurotrauma, and Patient-Reported Outcomes in Early to Midadulthood.

CONTEXT: Data on the early to midlife effects of repetitive neurotrauma on patient-reported outcomes have been delimited to homogeneous samples of male athletes without comparison groups or accounting for modifying factors such as physical activity. OBJECTIVE: To determine the effect of contact or collision sport participation and repetitive neurotrauma on patient-reported outcomes among early to middle-aged adults. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 113 adults (53 [46.9%] men, 60 [53.1%] women; age = 34.88 ± 11.80 years) in 4 groups: (1) physically inactive individuals with no repetitive head impact (RHI) exposure (NON); (2) noncontact sport athletes and nonathletes with no RHI exposure who were currently physically active (NCA); (3) former high-risk sport athletes with an RHI history who were physically active (HRS); and (4) former rugby players with prolonged RHI exposure who remained physically active. MAIN OUTCOME MEASURE(S): The 12-Item Short-Form Health Survey (SF-12), Apathy Evaluation Scale-self-rated version (AES-S), Satisfaction With Life Scale (SWLS), and Sport Concussion Assessment Tool-5th Edition (SCAT5) Symptom and Symptom Severity Checklist. RESULTS: The NON group had worse self-rated physical function than the NCA group as assessed by the SF-12 physical component summary (P = .03) and worse self-rated apathy (AES-S) and satisfaction with life (SWLS) than the NCA (P = .03 for both) and HRS groups (P = .03 and P = .040, respectively). We observed no group differences for self-rated mental health (SF-12 mental component summary; P = .26) or symptoms (SCAT5; P = .42). Career duration was not associated with any patient-reported outcomes. CONCLUSIONS: A history of contact or collision sport participation and career duration did not negatively affect patient-reported outcomes in physically active, early to middle-aged adults. However, physical inactivity status was negatively associated with patient-reported outcomes in these individuals in the absence of an RHI history.

Energy Availability, Mental Health, and Sleep Patterns of Athletic Trainers.

CONTEXT: Engaging in exercise and appropriate nutritional intake improves mental health by reducing anxiety, depression, and sleep disturbances. However, few researchers have examined energy availability (EA), mental health, and sleep patterns in athletic trainers (ATs). OBJECTIVE: To examine ATs' EA, mental health risk (ie, depression, anxiety), and sleep disturbances by sex (male, female), job status (part time [PT AT], full time [FT AT]), and occupational setting (college or university, high school, or nontraditional). DESIGN: Cross-sectional study. SETTING: Free living in occupational settings. PATIENTS OR OTHER PARTICIPANTS: A total of 47 ATs (male PT ATs = 12, male FT ATs = 12; female PT ATs = 11, female FT ATs = 12) in the southeastern United States. MAIN OUTCOME MEASURE(S): Anthropometric measurements consisted of age, height, weight, and body composition. Energy availability was measured through energy intake and exercise energy expenditure. We used surveys to assess the depression risk, anxiety (state or trait) risk, and sleep quality. RESULTS: Thirty-nine ATs engaged in exercise, and 8 did not exercise. Overall, 61.5% (n = 24/39) reported low EA (LEA); 14.9% (n = 7/47) displayed a risk for depression; 25.5% (n = 12/47) indicated a high risk for state anxiety; 25.5% (n = 12/47) were at high risk for trait anxiety, and 89.4% (n = 42/47) described sleep disturbances. No differences were found by sex and job status for LEA, depression risk, state or trait anxiety, or sleep disturbances. Those ATs not engaged in exercise had a greater risk for depression (risk ratio [RR] = 1.950), state anxiety (RR = 2.438), trait anxiety (RR = 1.625), and sleep disturbances (RR = 1.147), whereas ATs with LEA had an RR of 0.156 for depression, 0.375 for state anxiety, 0.500 for trait anxiety, and 1.146 for sleep disturbances. CONCLUSIONS: Although most ATs engaged in exercise, their dietary intake was inadequate, they were at increased risk for depression and anxiety, and they experienced sleep disturbances. Those who did not exercise were at an increased risk for depression and anxiety. Energy availability, mental health, and sleep affect overall quality of life and can affect ATs' ability to provide optimal health care.

Psychological analysis of injuries in a first category softball national championship in Cuba

Introduction: the systematic analysis of the relationships between relevant psychological variables for sports performance and injuries is essential to contribute to their prevention in specific sports.Material and methodsa descriptive-correlational and cross-sectional study was carried out in the first category women's national softball championship in Cuba. 88 athletes participated with an average chronological age of 22.91 (SD=6.13) and a sports experience of 10.83 years (SD=4.92). A specific questionnaire, the Competitive Sport Anxiety Inventory and the Psychological Inventory of Sport Execution was applied. Descriptive statistics and Kendall's Tau_b nonparametric correlation coefficient was used for data analysis.ResultsA high injury load was verified with a low perception of the role of psychological factors in its etiology, as well as a notable occurrence of new injuries with negative emotional repercussions. Negative correlations of self-confidence, negative coping control, visual-imaginative control, positive coping control, and attitude control with history of injuries were obtained. The high anxiety showed significant relationships with previous injuries and new injuries during the analyzed competition.Conclusionsthe findings are especially congruent with previous results in elite softball players, although new and greater relationships between variables were determined. All this means that stimulating psychological skills to control anxiety in competition could contribute to the prevention of injuries. However, longitudinal analyzes are required to confirm the predictive role of these variables before proposing psychological interventions in this regard. (AU)

Cortical thickness and neurocognitive performance in former high-level female soccer and non-contact sport athletes.

BACKGROUND: Long-term effects of playing soccer (football) on the brain structure and function of the brain are vividly debated. While some studies showed differences in neurocognitive performance and structural brain changes in retired male players, data on female players are scarce. The present study compares cortical thickness and neurocognitive performance in former high-level female soccer (SOC) and non-contact sport athletes (CON). METHODS: 3 T T1-weighted 3D MPRAGE MRI was performed, and vertex-wise cortical thickness was analyzed using FreeSurfer (v. 6.0.0). Neurocognitive performance in seven domains of SOC and CON was assessed. A multivariate linear model was used to analyze interactions with respect to heading frequency and a history of concussion. RESULTS: SOC (n = 15, mean age 38.3 ± 5.1 years) and CON (n = 16, mean age 36.6 ± 5.8 years) had a similar cortical thickness and performed similarly in the neurocognitive tests except for verbal memory and psychomotor speed, where SOC performed significantly worse than CON. Moderate headers had a significantly larger cortical thickness than rare headers in the right inferior parietal region. Visual memory and cortical thickness were positively correlated in the group of frequent headers and negatively correlated in CON, but not in the other header groups. PERSPECTIVE: In contrast to previous reports in male soccer players, female players did not reveal cortical thinning in comparison with control athletes, whereas neurocognitive profiles of female soccer players might not significantly differ from male athletes. Small sample sizes, subjective header assessment, and the case-control study design require a cautious interpretation.

La visualización en la rehabilitación de lesiones deportivas: una revisión / Guided imaginary in the rehabilitation of sports injuries: a review

La visualización se ha utilizado en programas de intervención psicológica para la rehabilitación de deportistas lesionados ya que diferentes estudios la asocian con una mejoría en el afrontamiento psicológico y reducción de la ansiedad por el temor a volver a lesionarse. Por esto, el objetivo es revisar las publicaciones que utilizan la visualización en la rehabilitación de deportistas lesionados y determinar su eficacia. Se realizó una búsqueda sistemática siguiendo la guía PRISMA, en la Web of Science, usando como palabras clave: sport injur*, psycho* y rehabilitation. Los criterios de inclusión fueron ser un estudio empírico y la aplicación de la visualización en la rehabilitación de la lesión deportiva. Se obtuvieron 394 artículos, que se redujeron a cinco. Los resultados muestran que cuatro trabajos emplean la visualización junto con otras técnicas psicológicas. Se emplearon, en su mayoría, instrumentos de evaluación ad hoc. La visualización se mostró eficaz en cuatro de los cinco estudios, consiguiendo los efectos deseados. Las variables psicológicas más estudiadas fueron el dolor, la adherencia a la rehabilitación, la autoeficacia, la motivación y la ansiedad. Se deduce que la visualización, ha resultado útil en la rehabilitación de lesiones deportivas como parte de un programa de tratamiento integral del deportista lesionado. (AU)

Guided imaginary has been used in psychological intervention programs for the rehabilitation of injured athletes, since different studies associate it with an improvement in psychological coping and a reduction in anxiety due to the fear of being injured again. Therefore, the objective is to review the publications that use guided imaginary in the rehabilitation of injured athletes and determine its effectiveness. A systematic search was carried out following the PRISMA guide, in the Web of Science, using as keywords: sport injury*, psycho* and rehabilitation. The inclusion criteria were to be empirical and the application of guided imaginary in the rehabilitation of sports injury. 394 articles were acquired, which were reduced to 5. The results show that 4 works carried out guided imaginary together with other psychological techniques. Ad hoc evaluation instruments were used for the most part. Guided imaginary was shown to be affective in 4 of the 5 studies, achieving the desired effects. The most studied psychological variables were pain, adherence to rehabilitation, self-efficacy, motivation and anxiety. It follows that guided imaginary has been useful in the rehabilitation of sports injuries as part of a comprehensive treatment program for the injured athlete. (AU)

The Psychology of Athletic Endeavor.

A considerable amount of human behavior occurs within the context of sports. In recent years there have been notable advances in psychological science research applied to understanding athletic endeavor. This work has utilized a number of novel theoretical, methodological, and data analytic approaches. We review the current evidence related to developmental considerations, intrapersonal athlete factors, group processes, and the role of the coach in explaining how athletes function within the sport domain. This body of work sheds light on the diverse ways in which psychological processes contribute to athletic strivings. It also has the potential to spark interest in domains of psychology concerned with achievement as well as to encourage cross-domain fertilization of ideas.