Essay: Psychological health in athletes

Psychological health is a sensitive topic and many people including athletes experience different forms of psychological health problems throughout their life. Our study is designed to identify the psychological health of Division II collegiate athletes following acute, non-traumatic and non-surgical musculoskeletal injuries.
The literature analyzed incorporates multiple questionnaires in order to track changes in emotional and physical behavior in athletes following an injury. The questionnaires utilized in the literature are as follows: Emotional Response of Athletes to Injury Questionnaire (ERAIQ), athletic identity measurement scale (AIMS), Ways of Coping Checklist, Qualtrics Surveys to include demographic information, General Anxiety Disorder 7- item (GAD-7), Tampa Scale of Kinesiophobia (TSK) and the Knee Injury and Osteoarthritis Outcome Score (KOOS). (Kvist, Ek, Sporrstedt, Good, 2005; Parks, 2015) Each study was unique and used either a single questionnaire or incorporated multiple questionnaires. There is significant research on the effects of psychological health in long term injuries, such as ACL reconstruction, as well as chronic orthopedic conditions (Kvist et al., 2005). The surveys used for each study are dependent upon the severity of the athlete’s injury and the analysis design of the study. Few studies assessed the differences between gender, differences among sport season, and psychological health changes following injury. Multiple questionnaires were not always used, however the studies that incorporated more than one survey analyzed more factors than compared to those that did not.
Injuries requiring long-term recovery pose a risk for negatively affecting an athlete’s psychological health. Following ACL reconstruction 53% of athletes were able to fully return to their sport within 3-4 years after surgery (Kvist et al., 2005). The research identifies athletes of long-term injuries, specifically ACL rupture had greater psychological changes compared to athletes without injury. Fear was the most prevalent reason for not being able to return to sport and pre-injury performance levels because of fear of pain or re-injury (Kvist et al., 2005).
Granito (2002) looked at the psychological responses of male and female athletes after injury. The athlete’s injuries were acute and chronic, but it was not analyzed if injury severity impacted psychological health between genders. Through individual interviews, athletes were asked various questions about their relationships with coaches, teammates, family and significant others, as well as the impact their injury had on their future health (Granito, 2002).
Similar to Granito’s (2002) study, Johnson (1997) also assessed psychological responses among genders. According to Johnson (1997), age, gender and experience with previous injuries are all psychological risk factors during long-term rehabilitation. Initially Johnson’s (1997) study was not focused on gender, but through his research he found differences between males and females. He concluded that females were more susceptible to longer recovery times in returning to sport and their injury presented negative psychological effects in daily life. The research also analyzed how the separation between the injured athlete and their teammates influenced their psychological outcomes (Johnson, 1997).
Both studies concluded that females showed differences in behavior responses following injury. Concerns after their injury related to physical ability and how others would perceive their injury. These two studies looked at gender differences as part of their analysis, even though the primary purpose of each study was to look at how injury affects psychological outcomes (Granito, 2002; Johnson, 1997).
Another difference among the studies was assessing the injured athletes psychological responses during their recovery, directly following their return to play and/or a few years following injury (Johnson, 1997; Granito, 2002; Podlog et al., 2010; Kvists et al., 2005).
Klenk (2006) incorporated the Emotional Response of Athletes to Injury Questionnaire (ERAIQ) and adapted it to meet the needs of his study. The primary differences were changing the format to a patient-reported survey instead of a physician-reported survey. The ERAIQ is used to assess emotional responses after an injury, but was modified into three different formats including a questionnaire for athletes who had never been injured, injured prior to college, or injured while in college (Klenk, 2006). The ERAIQ is a broad assessment of psychological health issues for injured athletes and is a helpful tool for assessing emotional health, however the primary conditions that are analyzed are depression and anxiety (Klenk, 2006).
A study by Yang and colleagues (2014) analyzed the social support that the athletic trainer provides to the student athlete as they recover from injury. Injury was defined as being an event that required medical attention and prevented the athlete from participating in sport for at least one day (Yang, 2014). Yang and colleagues (2014) found that athletes who reported being satisfied with the support of their athletic trainer were less likely to report feelings of depression or anxiety when they returned to play after an injury than those that were dissatisfied. There was no significant difference between athletes that felt supported by their athletic trainer and those that did not (Yang, 2014). This shows there are many aspects to maintaining good psychological health in athletes after injury and that those all need to connect in order to fully help the athlete (Yang, 2014).
The National Collegiate Athletic Association (NCAA) has policies and procedures for how to approach athletes with psychological health conditions either from injury or those without injury (NCAA, 2016). In addition the NCAA (2016) provides multiple questionnaires to assess various conditions and recommends pre-participation mental health screening. Performing these screens prior to an athlete’s season can assist in assessing their psychological health after injury.
Statement of Purpose/Hypothesis:
The purpose of this study is to determine if acute, non-traumatic musculoskeletal injury affects the psychological health of Division II collegiate athletes.
Hypothesis: Acute non-traumatic musculoskeletal injury will negatively affect an athlete’s psychological health.
Methods
Every athlete will complete a pre-participation examination (PPE) with components recommended by the National Athletic Trainer’s Association (NATA). Each PPE will include medical history, family history, physical examination, and mental health survey (Conley et al., 2014). The medical history and mental health survey will allow the researchers to include and exclude athletes from the study. A psychological health form, composed by the researchers, will be taken by the athletes for a base-line and as the primary mental health assessment tool after injury. This form will be composed of two separate surveys taken from the NCAA consensus statement on best mental health practice; the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS) and the Beck Anxiety Inventory (Baer et al., 2000; Beck & Steer, 1993). Included with each survey is specific instructions on how to analyze the results and these will be followed by the researchers.
The study will extend for approximately 12 months to include all collegiate athletes over their individual sport season at the same Division II university. Injuries included are acute, non-traumatic, non-surgical, musculoskeletal injuries that prevent the athlete from participating in their sport for at least one day. These will include but are not limited to: grade 1 or 2 sprain, grade 1 or 2 strain, non-displaced fracture (ex. scaphoid fracture), or subluxation of any joint. Athletes with a family medical history of psychological health issues will be included, as well as those who had previous orthopaedic surgery and were cleared for participation by their physician. Exclusion criteria includes athletes with known psychological health conditions, concussion or mild traumatic brain injury (MTBI), traumatic injuries, injuries needing surgical intervention, chronic injuries, injury involving spinal column/cord or nerves, non-union fracture, dislocation of any joint, and injuries occurring out of the regular season for each sport.
At the time of injury, the athlete will complete a psychological health form within 24 hours of the injury, at 7 days after injury, and bi-weekly until the athlete returns to play, and a final psychological health form at the time of full return to play. Return to play will be decided by the discretion of the athletic trainer that is treating the individual athlete. Only data from athletes who meet the inclusion criteria will be analyzed.
Paired sample t-test and repeated measures ANOVA will be applied to compare how gender or sport affects the athlete’s psychological health after injury. How the different seasons can affect psychological disorders and the differences of off-season, pre-season and post-season injury will also be analyzed. All data will be entered into and analyzed with SPSS version 25 (IBM, 2017). Through the Beck Anxiety Inventory and HANDS Questionnaire we can assess athletes changes from pre and post injury data collections (Beck & Steer, 1993; Baer et al., 2000). The expected outcome is that the season, especially winter will have the greatest psychological health changes among the injured athletes and potential differences among gender may be noticed, similar to the current literature.