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.

Sleep Quality and Well-Being in Junior Elite Athletes

Abstract. Little cross-sectional and even less longitudinal research has been conducted on sleep quality and well-being in junior elite athletes. This study analyzed the relationship between subjective sleep quality and both psychological and physiological well-being in junior elite athletes using both a cross-sectional ( N = 625 athletes; 49.9 % = female; M = 16.4 years, SD = 3.5 years) and a longitudinal approach ( n = 79; 44.3 % = female; M = 16.4 years, SD = 3.5 years) over a period of M = 1.66 years ( SD = 0.87 years). The results demonstrated that both samples showed that subjective sleep quality is correlated with well-being in junior elite athletes. In addition, the results showed that athletes of prepuberty age reported significantly better sleep quality than athletes during and after puberty, and that the relationship between sleep quality and psychological well-being is stronger in female junior athletes than in male athletes. This study emphasizes the need to ensure quality sleep in junior elite athletes.

I. Shalfawi S. Progression in training volume and perceived psychological and physiological training distress in Norwegian student athletes: A cross-sectional study

This cross-sectional study examined self-reported weekly training volume and perceived training distress in Norwegian student athletes according to gender, type of sport, school program, and school year. The Norwegian version of the Multicomponent Training Distress Scale (MTDS-N) was completed by 608 student athletes (M age = 17.29 ± .94). Univariate and multivariate techniques were used in data analyses. Results revealed significant differences in weekly training volume between sport types. No significant differences in weekly training volume were found for gender, school year, or school program. However, a multivariate effect was found for gender, with females perceiving higher levels of training distress than males. A multivariate interaction effect between school year and training volume was also observed. We recommend that practitioners use a conceptual framework to periodize training and monitor training distress in student athletes, particularly in females, to preserve physiological and psychological well-being and ensure a progressive training overload leading to positive performance development.

Associations between student-athletes' self-esteem and career adaptability across the high school years

The key challenges in sustainable elite sports concern young athletes´ holistic development. Consequently, preparation for dual careers has been recommended to enhance athletes' well-being and equip them for life after sports. The aim of this study was to examine the developmental associations between self-esteem and career adaptability among adolescent athletes across the high school years and investigate the role of gender in these developmental trajectories. A total of 391 student-athletes were followed up four times from the beginning of high school (T1) to its end (T4) using the Dual-Career Form of the Career Adapt-Abilities Scale and the Self-Esteem Questionnaire. The results indicated that individual differences in student-athletes' self-esteem and career adaptability were relatively stable across the high school years and were thus modeled via the between-persons factors capturing differences between individuals across time. The results further showed that the overall levels of self-esteem and career adaptability were positively associated. Males showed higher overall levels of career adaptability and self-esteem than females. This study suggests that it is important to facilitate youth athletes' self-regulation resources by involving them in vocational developmental tasks. Further, gender differences should be considered when supporting student-athletes' development.

Effects of Physical Activity and Training Routine on Mental Health During the COVID-19 Pandemic and Curfew

This research aimed to explore the effects of physical activity and training routine on mental health during the COVID-19 pandemic and the proclaimed emergency state and curfew. To measure the mental health components of psychological distress and subjective well-being, two studies were conducted on different samples: Study 1 during the beginning of curfew in Serbia (N = 678) and Study 2 during the ending phase (N = 398). The results of Study 1 showed that elite athletes as well as those with high level of physical activity experienced the lowest distress. Furthermore, effects of the changes in the training routine on distress among physically active individuals depended on the level of sports participation with elite athletes who reduced trainings showing lower anxiety compared to recreational athletes who reduced trainings as well or kept the same training routine. Thus, we could conclude that in the early stage of the pandemic, elite athletes showed better mental health and adaptability to the crisis situation. Results of Study 2 showed that although all the participants had decreased well-being during the curfew, compared to the period before the pandemic and the curfew, there were no differences in well-being between elite and recreational athletes, who had higher well-being compared to non-athletes. However, this effect held both before and during the curfew showing that physically active individuals did not additionally benefit from this decrease compared to the non-active. Furthermore, athletes who became physically inactive showed lower well-being compared to those who kept the same training routine. Thus, in the later stage of the pandemic, prolonged physical inactivity had negative effects on mental health.

Effects of College Athlete Life Stressors on Baseline Concussion Measures

CONTEXT

Concussion baseline testing helps injury evaluation by allowing postinjury comparisons to preinjury measures. To facilitate best practice, common neurocognitive, balance, and symptom report metrics used in concussion baseline testing merit examination relative to participant life stressors.

OBJECTIVE

The purpose of this study was to determine if life stressors are associated with college athlete neurocognitive function, postural control, and symptom scores at preseason baseline assessment.

DESIGN

All study variables were collected in a single laboratory session where athletes completed valid and reliable psychometrics as well as a computerized neurocognitive and balance assessments.

SETTING

Sports medicine research center on an American university campus.

PARTICIPANTS

A convenience sample of 123 college student-athletes: 47 females (age = 18.9 [4.3] y) and 76 males (age = 19.4 [1.6] y).

MAIN OUTCOME MEASURES

Participants were categorized into low, moderate, or high life stressors groups using scores from the Social Readjustment Rating Scale-Revised. Dependent variables included outcomes from the CNS Vitals Signs test, the Sensory Organization Test, and the graded symptom checklist indexing neurocognition, balance, and symptom severity, respectfully.

RESULTS

One-way analysis of variance revealed that the moderate life stressors group performed significantly worse than the low life stressors group on the baseline verbal memory domain of the CNS Vital Signs (F2,119 = 3.28; P = .04) only.

CONCLUSION

In the current college athlete sample, few baseline concussion assessment variables were found to be significantly associated with life stressors. Considering the clinical significance of these variables, psychological life stressors may not be a confounding factor in concussion evaluation.

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.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Are adolescent elite athletes less psychologically distressed than controls? A cross-sectional study of 966 Norwegian adolescents

Introduction

Psychological distress is increasing among adolescents and clusters with other mental health problems such as eating problems. The aim of this study was to investigate the prevalence of psychological distress among young elite athletes and age-matched controls and whether prevalence figures may be attributed to perfectionism and eating problems.

Methods

First-year athletes from all Norwegian elite sport high schools (n=711) and 500 students from randomly selected ordinary high schools were eligible for this cross-sectional study. In total, 611 athletes and 355 student controls provided self-report data about psychological distress, perfectionism, and eating problems (ie, body dissatisfaction and a drive for thinness), as well as their physical training/activity.

Results

A significantly higher proportion of controls scored above the cutoff point for marked psychological distress. Physical activity above the recommended levels for this age group predicted psychological distress among the controls, while the opposite was found in the student elite athlete sample. In both samples, perfectionistic concerns, ie, concern over mistakes, predicted overall psychological distress. However, among elite athletes, perfectionistic concerns were particularly associated with clinically significant psychological distress. Moreover, the impact of eating problems was negligible.

Conclusion

Results from this study highlight the need to target the maladaptive perfectionistic concerns to prevent psychological distress among young athletes as well as among their age-matched nonathlete counterparts.

Depressive symptoms in high-performance athletes and non-athletes: a comparative meta-analysis

OBJECTIVE

To assess whether a difference exists in the prevalence of mild or more severe depressive symptoms between high-performance athletes and non-athletes.

DESIGN

Comparative OR meta-analysis.

DATA SOURCES

We searched PsycINFO, PubMed, MEDLINE, CINAHL, SPORTDiscus and Google Scholar, as well as the reference lists of reviews of mental health issues in high-performance athletes.

ELIGIBILITY

We included studies that compared high-performance athletes and non-athletes, included a validated measure of depressive symptoms and included the prevalence of individuals who indicated at least mild depressive symptoms.

RESULTS

Five articles reporting data from 1545 high-performance athletes and 1811 non-athletes were examined. A comparative OR meta-analysis found high-performance athletes were no more likely than non-athletes to report mild or more severe depressive symptoms (OR=1.15, 95% CI=0.954 to 1.383, p=0.145). Male high-performance athletes (n=940) were no more likely than male non-athletes (n=605) to report mild or more severe depressive symptoms (OR=1.17, 95% CI=0.839 to 1.616, p=0.362). For females, high-performance athletes (n=948) were no more likely than non-athletes (n=605) to report mild or more severe depressive symptoms (OR=1.11, 95% CI=0.846 to 1.442, p=0.464). Overall, male high-performance athletes (n=874) were 52% less likely to report mild or more severe depressive symptoms than female high-performance athletes (n=705) (OR=0.48, 95% CI=0.369 to 0.621, p<0.001).

SUMMARY/CONCLUSIONS

High-performance athletes were just as likely as non-athletes to report depressive symptoms. Researchers need to move beyond self-report measures of depressive symptoms and examine the prevalence of clinically diagnosed depressive disorders in athletes.

Sleep in athletes and the effects of Ramadan

Sleep is now considered as a new frontier in performance enhancement. This article presents background content on sleep function, sleep needs and methods of sleep investigation along with data on the potential effects of Ramadan fasting on sleep in normal individuals and athletes. Accumulated sleep loss has negative impacts on cognitive function, mood, daytime sleepiness and performance. Sleep studies in athletes fasting during Ramadan are very rare. Most of them have demonstrated that during this month, sleep duration decreased and sleep timing shifted. But the direct relation between sleep changes and performance during Ramadan is not yet elucidated. Objective sleep patterns can be investigated using polysomnography, actigraphy, and standardised questionnaires and recorded in daily journals or sleep logs. The available data on sleep indicate that team doctors and coaches should consider planning sleep schedule and napping; implementing educational programmes focusing on the need for healthy sleep; and consider routine screening for sleep loss in athletes of all age groups and genders.