Diving Into the Health Problems of Competitive Divers: A Systematic Review of Injuries and Illnesses in Pre-elite and Elite Diving Athletes

CONTEXT

The Olympic sport of diving involves the competitive disciplines of 3 m springboard and 10 m platform. Although it is generally accepted that lumbar spine injuries are common in diving athletes, the existing literature of health problems in diving athletes remains scarce.

OBJECTIVE

To identify the incidence, prevalence, and type of health problems that occur in competitive diving athletes.

DATA SOURCES

Medline, EMBASE, SportsDiscus, PsycINFO, and Google Scholar.

STUDY SELECTION

Studies written in English investigating elite or pre-elite competitive diving (springboard, platform) injuries and/or illnesses were eligible. Two independent reviewers screened for inclusion by title, abstract, and full text in accordance with the eligibility criteria.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 4.

DATA EXTRACTION

Data extraction was completed by 1 author using a structured form. A second author then independently reviewed and verified the extracted data, any discrepancies were resolved through consensus.

RESULTS

The search identified 2554 potential articles, with 28 studies meeting eligibility criteria. The surveillance setting of most studies was restricted to competition-based events, with the reported injury incidence proportion ranging from 2.1% to 22.2%. The reported injury incidence rate ranged from 1.9 to 15.5 per 1000 athlete-exposures. Injuries to the shoulder, lower back/lumbar spine, trunk, and wrist/hand were reported most frequently. The prevalence of low back pain was reported as high as 89% (lifetime), 43.1% (period), and 37.3% (point). The illness incidence proportion ranged from 0.0% to 22.2%, with respiratory and gastrointestinal illness reported most frequently.

CONCLUSION

Up to 1 in 5 diving athletes sustain an injury and/or illness during periods of competition. A reporting bias was observed, with most cohort studies limiting surveillance to short competition-based periods only. This limits the current understanding of the health problems experienced by diving athletes to competition periods only and requires expansion to whole-of-year surveillance.

Eating disorder risk in adolescent and adult female athletes: the role of body satisfaction, sport type, BMI, level of competition, and training background

BACKGROUND

Eating disorders negatively influence athletes' health and performance. To achieve a high level of performance and conform to cultural expectations regarding an athletic body type, female athletes often restrict their diets, which can lead to eating disorders. In addition to factors related to the sports environment, adolescent athletes are subject to changes caused by the maturation process. Therefore, the same factors may have different effects on eating disorder risk among adolescent and adult athletes. This study examined the relationship between eating disorder risk, specific aspects of the sports environment (sport type, level of competition [national and international], and training background), and individual aspects (body satisfaction and body mass index) in two groups of athletes: adolescents and adults.

METHODS

The sample included 241 highly trained female athletes aged 12-30 years (M = 20.68, SD = 4.45) recruited from different sports clubs in Poland. The subgroup of adolescents consisted of 82 athletes, while the number of adult athletes was 159. The Eating Attitudes Test questionnaire was used to assess the eating disorder risk among the athletes. Body satisfaction was measured using the Feelings and Attitudes Toward Body Scale incorporated into the Body Investment Scale.

RESULTS

Eating disorder risk was prevalent among 14.6% of the adolescent and 6.9% of the adult athletes. Significant associations between eating disorder risk and the studied variables were noted only among adolescent athletes. Univariate logistic regression analysis revealed that the occurrence of eating disorder risk was associated with participation in lean non-aesthetic sports (OR = 11.50, 95% CI: 3.58-37.09). Moreover, eating disorder risk was associated with athletes' lower body satisfaction (OR = 0.80, 95% CI: 0.70-0.92). Body mass index was not included in the final regression model.

CONCLUSIONS

The study indicated that eating disorder risk in adolescent female athletes was related to sport type and body satisfaction. The findings showed that, in adolescent athletes, eating disorder risk was the most associated with practicing lean non-aesthetic sports. Coaches and athletes should be aware that eating disorder risk increases among individuals with a lower body image.

Prospective Associations between Sport Participation and Indices of Mental Health across Adolescence

Youth sport offers physical and psychosocial components that may be beneficial for adolescents' mental health, but the prospective directionality between sport participation and mental health has not been clearly established. The current study examined longitudinal associations between sport participation (individual and team sport) and mental health indices (depressive symptoms, anxiety symptoms, emotional symptoms, hyperactivity symptoms, conduct problems, peer problems, and prosocial behavior) across adolescence (ages 12-17) in a nationally representative Australian sample of 3956 participants at T1 (M_age = 12.41 years, SD = 0.49; 49% female), 3537 at T2 (M_age = 14.41 years, SD = 0.49; 49% female), and 3089 at T3 (M_age = 16.46 years, SD = 0.51; 49% female). Using random intercept cross-lagged panel modeling, several significant within-person effects were found. Notably, greater participation in team sport prospectively predicted fewer symptoms of depression and anxiety at subsequent timepoints. This study increases the understanding of how sport participation may relate to mental health among adolescents and provides critical evidence to inform policy.

Symptoms of disordered eating and participation in individual- and team sports: A population-based study of adolescents

AIM

This study aimed to investigate individual and team sports participation across sex, age, and levels of body mass index (BMI). We also wanted to explore how symptoms of disordered eating (DE) were associated with participation in individual and team sports, and to what extent BMI moderated this association.

METHODS

Data stemmed from a large population-based survey of 10,172 Norwegian adolescents aged 16 to 19 years. Self-reported participation in organized team- and individual sports were the dependent variables. Self-reported symptoms of DE using the five-item Eating Disturbance Screening (EDS-5) questionnaire comprised the independent variable. Covariates included sex, age, socioeconomic status, and BMI. We used regression analyses for associations between DE symptoms and sports participation, including the interaction between DE and BMI.

RESULTS

Boys had higher team sports participation compared with girls. Individual and team sports participation varied significantly across BMI levels for each sex. Symptoms of DE were negatively associated with team sports participation (odds ratio [OR] = 0.90, p < 0.001), and were not significantly associated with individual sports participation. BMI scores moderated the association between DE symptoms and individual sports participation (p < 0.005). DE symptoms were associated with higher individual sports participation among individuals with low BMI, and with lower participation among those with high BMI.

CONCLUSIONS

DE symptoms are important correlates of sports participation among adolescents, but the direction of these associations partly differs across the weight spectrum. Promotion of factors that counteract DE is needed alongside efforts to increase physical activity and sports participation in the general adolescent population.

Difficulties in Emotion Regulation, Alexithymia, and Social Phobia Are Associated With Disordered Eating in Male and Female Undergraduate Athletes

Investigations of disordered eating in the athlete population tend to focus on females and the influence of sport level. This leaves unanswered whether, and how, team interdependence (i.e., whether the competition is engaged with one person or as a team) may differentially impact male athletes. In the present study, we recruited a sample of non-athletes, individual athletes, and team athletes and examined the interaction of gender and teammate interdependence on established psychosocial risk factors for disordered eating, including social phobia, alexithymia, and emotion regulation. Although we identified a significant main effect of gender, there was no main effect of team type, nor was there a significant interaction of gender and team type. Using descriptive discriminant analysis, these variables significantly discriminated between genders. Women were defined by higher scores than men on drive for thinness, body dissatisfaction, and emotion recognition and men were defined by relatively higher scores on emotion dysregulation and binge eating. When we combined all athletes and compared them with non-athletes, a significant interaction of gender and athlete status emerged such that female athletes, compared to male athletes and women non-athletes, were defined by higher scores on drive for thinness, emotion dysregulation, and binge eating. Conversely, male athletes, compared to female athletes, were defined by greater difficulty identifying feelings and body dissatisfaction. Non-athletes were not well defined by the discriminant function. These results highlight that emotional processes convey risk of eating disorders in men and women, particularly in athletes, and these risk factors are not uniform.

Systematic review of risk factors for eating psychopathology in athletes: A critique of an etiological model

OBJECTIVE

The theoretical model by Petrie and Greenleaf (2007, 2012) is an admirable attempt to collate the causal factors of disordered eating in athletes. The aims of this systematic review are (a) to provide an overview of the findings from the relevant literature, (b) to assess whether the model is supported by the existing research, (c) to evaluate the different designs, methods, and measures used to test the mediators in the model, and (d) to highlight areas for improvements and future research.

METHOD

A systematic review of four major online databases identified 37 relevant papers on risk factors of disordered eating in athletes, which were reviewed and critically compared with the theoretical model.

RESULTS

There is a lack of longitudinal research with the relevant mediators in athlete populations, which makes it difficult to determine whether the potential mediators described by Petrie and Greenleaf are causal risk factors rather than simply correlates of disordered eating for athletes. Findings for all the potential mediators are inconsistent, and the range of measures used makes it problematic to draw conclusions.

CONCLUSIONS

Future research needs to use gold standard measures and longitudinal designs in order to fully test and possibly update the model.

SOCIAL PHYSIQUE ANXIETY, DISTURBED EATING ATTITUDES AND BEHAVIORS, AND PERCEIVED PRESSURE FOR THIN BODY IN COMPETITIVE RHYTHMIC AND AEROBIC GYMNASTS

This study investigated social physique anxiety (SPA), disturbed eating attitudes and behaviors (DEAB), and perceived pressure for thin body by the “significant others” (coach, parents, peers, experts) in 41 female rhythmic gymnastics (RG) and 49 aerobic gymnastics (AG) athletes at competitive level. Moreover, the potential impact of gymnasts' BMI was examined and controlled. Results showed that BMI associated with gymnasts’ SPA, DEAB and perceived pressure, so its effect was controlled. There were no significant differences between RG and AG regarding SPA and DEAB, whereas AG athletes had higher parental pressure for thin body than RG athletes. When RG and AG data were merged, a high percentage (40%) of gymnasts presenting DEAB was revealed. Gymnasts with DEAB had significantly higher SPA and perceived pressure for thin body than those with normal eating attitudes and behaviors. These results underline the need for interventions involving “significant others” and aiming at DEAB prevention in female gymnasts.

Perfectionism, Body Satisfaction and Dieting in Athletes: The Role of Gender and Sport Type

Athletes are often at a greater risk for disordered eating development due to their perfectionistic tendencies, as well as physical performance- and appearance-related demands of various sports in which they compete. Therefore, the purpose of this study was to examine the possibility of independent contributions of perfectionism and body satisfaction on dieting behaviour among male and female athletes. Two-hundred-eighty (192 male; 88 female) athletes provided their answers on the Eating Attitudes Test 26 (EAT-26), Positive and Negative Perfectionism Scale (PANPS) and modified Body Image Satisfaction Scale from Body Image and Body Change Inventory. No gender or sport type differences were observed in dieting behaviour and body satisfaction was the only significant predictor of dieting for female athletes. Mediation analysis demonstrated that body satisfaction is a mediator between both adaptive and maladaptive perfectionism and dieting. These findings emphasize the important role that body satisfaction has in disordered eating development in female athletes.

Body-related sport and exercise motives and disturbed eating attitudes and behaviours in adolescents

Motives underlying sport and exercise involvement have recently been hypothesized as potential factors influencing the positive association between sports/exercises involvement and disturbed eating attitudes and behaviours (DEAB) among adolescents. Nevertheless, very few studies have examined this hypothesis or the moderating role of gender, context of practice, performance levels and sport type on these relationships. In this study, these questions were addressed among 168 male and 167 female French adolescents involved in various types, contexts and performance levels of sport and exercise. Participants were asked to indicate their main motives for involvement in sport practice and to self-report DEAB (generic DEAB, vomiting-purging behaviours, and eating-related control) on a French adaptation of the Eating Attitudes Test-26. The results shared positive associations between body-related sport and exercise motives and most of the DEAB subscales. Furthermore, they show that the relationship between body-related sport and exercise motives and Vomiting-Purging Behaviours differs according to involvement in individual and competitive sports and exercises.

Adolescent athletes: psychosocial challenges and clinical concerns

PURPOSE OF REVIEW

To review the recent literature (over the past 18 months) regarding psychosocial challenges and clinical concerns among adolescent athletes, and to address the advances made in understanding adolescent athletes' coping processes.

RECENT FINDINGS

Coping research has moved from identifying discrete stressors and coping strategies to examining the processes of coping over time. Parents and coaches play an important role in young athletes' sport experiences and athletes' use and development of coping strategies. In terms of clinical concerns, findings regarding the prevalence of disordered eating have been equivocal. However, disordered eating may be of greater concern among athletes participating in 'leanness' sports. Sport participation may contribute to increased alcohol consumption among adolescent athletes but decreased use of drugs and smoking cigarettes, while steroid use appears to be relatively rare compared with athletes' use of alcohol and cigarettes.

SUMMARY

The reviewed studies have implications for future research by identifying opportunities for intervention and education regarding clinical and nonclinical psychosocial challenges. Researchers have emphasized the importance of athletes' social context and relationships in coping with psychosocial challenges in sport. One concern is that adolescent athletes' disordered eating and substance use may reflect maladaptive coping. Experimental and intervention research is limited; however, incorporating members of athletes' social network into future research and interventions may be a practical avenue to achieving positive outcomes among adolescent athletes.

Accountability, monitoring and surveillance: Body regulation in elite sport

Regulation of athletes’ bodies is commonplace in sporting environments, despite evidence that athletes have a higher risk of developing disordered eating than non-athletes. This article explores how athletes’ bodies are regulated in practice, building on examinations of body surveillance in other contexts. Over 40 interactions occurring during body monitoring are analysed. Athletes, pre-emptively or following an explicit request, accounted for their body regulatory behaviours, also working to produce positive athlete identities. Failing to produce an account of improvement was interactionally problematic, making visible athletes’ accountability to the institute to regulate their bodies. Implications of body regulatory practices are discussed.

Application of the Transdiagnostic Cognitive-Behavioral Model of Eating Disorders to the Athletic Population

The purpose of this study was twofold: to explore the utility of components related to the transdiagnostic cognitive-behavioral model of eating disorders within an athletic population and to investigate the extent to which the model can be applied across gender, sport type, and performance standard to explain eating psychopathology. Five hundred and eighty-eight (N = 588) male and female British athletes completed a battery of self-report instruments related to eating psychopathology, interpersonal diffculties, perfectionism, self-esteem, and mood. Structural equation modeling revealed that eating psychopathology may arise from an interaction of interpersonal diffculties, low self-esteem, high levels of self-critical perfectionism, and depressive symptoms. Analysis further highlighted that the manner in which eating psychopathology may arise is invariant across athletes’ sport type and performance standard, but not across gender. The current findings suggest that the tested components of the transdiagnostic cognitive-behavioral model are pertinent and useful in explaining eating psychopathology among athletes.