Relationships among Student-Athletes' Identity, Mental Health, and Social Support in Japanese Student-Athletes during the COVID-19 Pandemic

Differences in Mental Health Characteristics of Japanese Athletes in Outpatient Clinics Pre- and Post-Covid-19: A Repeated Cross-Sectional Observational Study

Purpose

To investigate the differences in characteristics between Japanese athletes who visited mental health outpatient clinics before and after the COVID-19 pandemic.

Patients and Methods

Athletes who visited various healthcare facilities between 2018 and 2022 were considered. The independent variable was the timing of outpatient mental health clinic visits-either before or after COVID-19. The primary outcome was the F classification based on the International Statistical Classification of Diseases and Related Health Problems 10th Revision. We collected data on clinical psychiatric diagnoses, age, sex, referral pathway, and sports-related information such as the type of sport, level of contact, individual/team sport, involvement duration, and athletic competition level. Between-group comparisons were performed among the pre- and post-COVID-19 groups using the t-test, Mann-Whitney test, and chi-square test.

Results

Eighty-six athletes (37 before COVID-19 and 49 after COVID-19) were deemed eligible for the study. No significant differences were detected between the pre- and post-COVID-19 groups. However, subgroup analyses revealed a significant increase in anxiety-related disorders among female athletes and in participation in individual sports among male athletes in the post-COVID-19 group compared with the pre-COVID-19 group.

Conclusion

The increased anxiety among female athletes and the increased participation in individual sports among male athletes suggest that these groups should be a high-priority target for early intervention and prevention strategies. This study contributes to our understanding of how COVID-19 has affected the mental health of athletes seeking medical treatment in Japan, and it highlights which segments of the Japanese athlete population may be more vulnerable to mental health issues in the post-COVID-19 era. Although the sample size is small, this study also provides valuable insights for practitioners on how to target specific segments of the athlete population for the implementation of interventions aimed at mitigating the development of mental health issues after COVID-19.

The progression and mechanisms of mental illness symptoms in university student-athletes during the COVID-19 pandemic

A few studies have examined mental illness symptoms in university student-athletes during the COVID-19 pandemic, but the limited use of longitudinal design limits the understanding of the progression of these symptoms and the mechanisms by which they developed. The present research aims to describe the trajectory of variation of mental illness symptoms (anxiety, depression, alcohol consumption disorders, and eating disorders) throughout the pandemic, to test causality between perceived stress and symptoms, and to identify individual characteristics (sociodemographic, perceived stress, and social support) influencing the trajectories of mental illness symptoms. On three occasions during the pandemic, 211 university student-athletes were surveyed. Latent growth models and random intercept crossed-lagged panel models were performed. Results indicate that anxiety and depressive symptoms significantly decreased throughout the COVID-19 pandemic while alcohol consumption disorder symptoms significantly increased and eating disorder symptoms did not change significantly. Second, perceived stress was a significant cause of anxiety and depressive symptoms during this pandemic. Conversely, eating disorder symptoms significantly predicted perceived stress. Finally, average perceived stress and average social support availability throughout the COVID-19 pandemic, and identifying as a visible minority, significantly predicted the trajectory of depressive symptoms, allowing for the identification of a sub-population at higher risk. Based on these findings, teaching stress management strategies should be an essential component of programs to prevent mental illness symptoms in university student-athletes. Reducing environmental stressors and their consequences among this population should also be prioritised.

The adapted French version of the Academic and Athletic Identity Scale (AAIS-FR): Evidence of validity and reliability and relationships with sport well-being

BACKGROUND

Effectively managing their athletic and academic projects is a major challenge for student-athletes. The salience of the identity they develop in each of these contexts can affect their well-being and is therefore an important variable to consider. Examining these mechanisms in countries and student-athlete support systems other than the United States is also important.

AIM

This study aims to both translate and evaluate the psychometric properties of a French version of the Academic and Athletic Identity Scale, the AAIS-FR, and to examine the additive and interactive relationships of the two identities with sport burnout and engagement.

METHODS

Participants were 359 French student-athletes (50.42% female) who were competing at various levels (ranging from regional to international).

RESULTS

Results from analyses using a slightly modified version of the original scale provided evidence of construct (i.e., factor structure) and concurrent (i.e., expected relationships between both identities and several correlates identified in previous work) validity, as well as reliability (i.e., internal consistency) and invariance across gender and sport competition levels of the AAIS-FR. In addition, regression analyses revealed a favourable relationship between athletic identity and sport well-being (i.e., positive with engagement and negative with burnout), no relationship between academic identity and sport well-being, and no interaction between the two identities.

CONCLUSION

While further research is needed to provide additional evidence for the validity of the AAIS-FR, researchers can still use this tool to measure the salience of the two identities of French-speaking student-athletes.

Overcoming adversity during the COVID-19 pandemic: Longitudinal stability of psychosocial resource profiles of elite athletes and their association with perceived stress

Previous research has demonstrated that psychosocial resources are associated with elite athletes' perceived stress. However, these resources have mainly been studied separately. Using a person-oriented approach, this study aimed to identify meaningful profiles of athletes' psychosocial resources, their stability over time, and their relationship with perceived stress during the COVID-19 pandemic. To identify such patterns, separate latent profile analyses (LPA) at two measurement points T1 (June 2020) and T2 (March 2021) and a subsequent latent transition analysis (LTA) were conducted with athletic identity, resilience, perceived social support, and self-esteem for a sample of 373 Swiss elite athletes. Perceived stress was analyzed at and between T1 and T2 with a mixed-design ANOVA. For LPA, theoretical considerations and statistical criteria led to a solution of four profiles: (1) Athletic Identifiers With Above-Average Resources (nT1 = 235; nT2 = 240), (2) Below-Average Athletic Identifiers With Below-Average Resources (nT1 = 84; nT2 = 90), (3) Variable Athletic Identifiers With Below-Average Internal and Clearly Below-Average External Resources (nT1 = 14; nT2 = 7), and (4) Athletic Identifiers With Below-Average Internal and Above-Average External Resources (nT1 = 40; nT2 = 36). For LTA, both structural and individual stability was demonstrated. A large and significant main effect of perceived stress was observed for resource profiles, while there was no significant main effect for measurement point nor interaction effect. Direct comparisons revealed that Athletic Identifiers With Above-Average Resources perceived significantly less stress than the other profiles at both time points. In conclusion, regardless of psychosocial resource profile, the perceived stress of elite athletes was stable during the COVID-19 pandemic, but exhibiting a pattern with high psychosocial resources seems to buffer against stress compared to a lack of specific resources. Therefore, sport federations and practitioners should provide tailored support programs to help athletes build all these resources.

Changes in Quality of Life Among Collegiate Athletes During COVID-19

BACKGROUND

The COVID-19 pandemic has had a significant effect on the mental health of athletes. How this has affected quality of life (QoL), specifically in the college population, is poorly defined.

HYPOTHESIS

During the COVID-19 pandemic, the mental and physical QoL will have decreased in collegiate athletes as compared with before the pandemic.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Division I athletes from a total of 23 varsity teams at a single institution completed surveys between 2018 and 2022. QoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12). VR-12 scores were separated into mental component scores (MCS) and physical component scores (PCS). Separate linear mixed effects models evaluated changes in MCS and PCS from pre-COVID to during COVID overall, as well as differences in changes by sex and sport type (individual, team).

RESULTS

For all athletes, the PCS increased (54.6 [95% CI 54.4-54.7] vs 55.1 [54.9-55.3]; P < 0.01) and the MCS decreased (55.2 [54.9-55.5] vs 53.5 [53.1-53.8]; P < 0.01) from pre-COVID to during COVID. When evaluating for sex, women demonstrated a greater increase in PCS (0.57 ± 0.22; P = 0.01) and greater decrease in MCS (1.06 ± 0.38; P < 0.01). With respect to sport type, individual sports demonstrated a greater decrease in MCS (1.46 ± 0.39; P < 0.01), but no interaction was identified for PCS (0.42 ± 0.23; P = 0.07).

CONCLUSION

Collegiate athletes demonstrated a decrease in their self-reported mental QoL during the COVID-19 pandemic, as compared with before the pandemic. This effect was most evident in women and in individual sports. Athletes also reported an increase in physical QoL during COVID that was also larger in women, but not related to sport.

CLINICAL RELEVANCE

This study demonstrates the impact of the COVID-19 pandemic on collegiate athletes' QoL, including negative effects on mental health. It also identifies cohorts of athletes (women, individual) who may be more significantly affected.

Implications of the COVID-19 pandemic on athletes, sports events, and mass gathering events: Review and recommendations

Since the coronavirus disease 19 (COVID-19), which caused several respiratory diseases, was formally declared a global pandemic by the World Health Organization (WHO) on March 11, 2020, it affected the lifestyle and health of athletes, both directly through cardiorespiratory and other health related effects, and indirectly as the pandemic has forced the suspension, postponement, or cancellation of most professional sporting events around the world. In this review, we explore the journey of athletes throughout the pandemic and during their return to their competitive routine. We also highlight potential pitfalls during the process and summarize the recommendations for the optimal return to sport participation. We further discuss the impact of the pandemic on the psychology of athletes, the variance between the team and individual athletes, and their ability to cope with the changes. Moreover, we specifically reviewed the pandemic impact on younger professional athletes in terms of mental and fitness health. Finally, we shaded light on the various impacts of mass gathering events and recommendations for managing upcoming events.

The Effect of the COVID-19 Pandemic on the Mental and Emotional Health of Athletes: A Systematic Review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has caused the cancellation or postponement of virtually every sporting event, resulting in training disruptions, income loss, and career uncertainties for athletes around the world. At present, the effect of the COVID-19 pandemic on the mental and emotional health of athletes is not well understood.

PURPOSE

To investigate the effect of the COVID-19 pandemic on the mental and emotional health of athletes and to identify risk factors associated with poor mental health outcomes.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

The PubMed, Embase, and Cochrane Library databases were searched to identify all articles reporting on athletes' mental and emotional health during the COVID-19 pandemic. Articles were selected based on relevant inclusion and exclusion criteria. Study characteristics, athlete demographics, and COVID-19 mental health data (sex-, type of sport-, and level of play-specific differences) were collected from each included article and analyzed.

RESULTS

A total of 35 studies were included in the final analysis, comprising athletes around the world and across numerous sports and levels of play. Most studies utilized at least 1 validated mental health questionnaire and assessed for outcomes such as depression, anxiety, stress, motivation, and athletic identity. Overall, athletes reported worse mental and emotional health during the COVID-19 pandemic, although these effects were attenuated by home training programs and quarantine training camps. Female sex and more elite levels of play were associated with an increased risk for poor mental health outcomes. Type of sport was associated with mixed results, with individual and team sports carrying different increased risks for poor mental and emotional health. Nearly all studies recommended the need for increased psychological support of athletes during the COVID-19 pandemic.

CONCLUSION

The effect of the COVID-19 pandemic on the mental and emotional health of athletes is complex and multifaceted. Increased social interactions with coaches and teammates, continued access to training facilities and mental health professionals, and active utilization of healthy coping mechanisms can improve mental health outcomes for athletes in the era of COVID-19.

Symptoms of depression and anxiety among elite high school student-athletes in Sweden during the COVID-19 pandemic: A repeated cross-sectional study

The COVID-19 pandemic precipitated numerous changes in daily life, including the cancellation and restriction of sports globally. Because sports participation contributes positively to the development of student-athletes, restricting these activities may have led to long-term mental health changes in this population. Using a repeated cross-sectional study design, we measured rates of depression using the Patient Health Questionnaire-2 and anxiety using the Generalized Anxiety Disorder-2 scale in student-athletes attending elite sport high schools in Sweden during the second wave of the pandemic (February 2021; n = 7021) and after all restrictions were lifted (February 2022; n = 6228). Depression among student-athletes decreased from 19.8% in 2021 to 17.8% in 2022 (p = .008, V = .026), while anxiety screening did not change significantly (17.4% to 18.4%, p > .05). Comparisons between classes across years revealed older students exhibited decreases in depressive symptoms, while younger cohorts experienced increases in symptoms of anxiety from 2021 to 2022. Logistic regressions revealed that being female, reporting poorer mental health due to COVID-19, and excessive worry over one's career in sports were significant predictors of both depression and anxiety screenings in 2022. Compared to times when sports participation was limited, the lifting of restrictions was associated with overall reduced levels of depression, but not anxiety.

Athlete Identity and Mental Health of Student Athletes during COVID-19

The purpose of our study is to evaluate athletic identity (AI) and mental health measures of youth and young adult athletes during the COVID-19 pandemic. This cross-sectional study recruited athletes aged 11-25 years from universities, high schools, and middle schools in California and New York. Participants were emailed a link to an anonymous, cross-sectional electronic survey. The measure included the athletic identity measurement scale (AIMS), the Patient Health Questionnaire-4 (PHQ-4), and demographic variables. Chi-square, Fisher's Exact Test, and linear regression were used to examine the relationships between AI, symptoms of anxiety, and symptoms of depression by age, gender, and race. The survey was completed by 653 participants. AI was stratified by tertiary percentiles. The odds of positively scoring for symptoms of anxiety were 60% higher for participants in college compared with high school (OR: 1.60, 95% CI: [1.09, 2.35]). Conversely, the odds of scoring positively for symptoms of depression were 68% higher for participants in high school compared to college (OR: 1.68, 95% CI: [1.09, 2.59]). The odds of scoring positively for symptoms of depression were higher for athletes who scored as high AI, compared to those who scored as moderate (OR: 1.72, 95% CI: [1.11, 2.68]) or low (OR: 1.93, 95% CI: [1.20, 3.12]). The odds of scoring positively for symptoms of anxiety on the PHQ-4 were 3.2 times higher for participants who identified as female (OR: 3.19, 95% CI: [2.31, 4.41]), and the odds of scoring positively for symptoms of depression were 2.4 times higher for participants who identified as female (OR: 2.35, 95% CI: [1.56, 3.54]). Female athletes experienced symptoms of depression and anxiety at significantly higher rates than male athletes during the COVID-19 pandemic. High school students experienced fewer symptoms of anxiety, but greater symptoms of depression as compared to the collegiate group, while college students experienced greater odds of symptoms of anxiety. Athletes in the high AI group were more likely to report symptoms of depression than moderate or low identity groups. Female athletes reported lower AI than male athletes, but still had greater symptoms of anxiety and depression.

Symptoms of mental illness among university student-athletes during the second wave of the COVID-19 pandemic lockdown in Canada

The COVID-19 pandemic lockdown disrupted the university sports season and had negative consequences on the academic and personal life of university student-athletes, resulting in several psychological challenges. The goal of this study is to document the symptoms of mental illness among university student-athletes during the second wave of the COVID-19 pandemic lockdown in Canada. It aims to (a) assess the prevalence of mental illness symptoms (anxiety, depression, disordered eating, and dangerous drinking) among university student-athletes and (b) identify which sociodemographic and sports characteristics, pandemic impacts, and levels of perceived stress most influence these symptoms. A total of 424 university student-athletes completed an online survey, which included questions on mental illness and the impact of the pandemic lockdown. The results revealed a notable prevalence of the symptoms of mental illness; depressive symptoms are reported by 37.9% of the participants, anxiety symptoms by 24.9%, dangerous drinking symptoms by 10.1%, and disordered eating by 8.6%. In addition, being female [OR = 0.56, 95% CI (0.33, 0.95)] or a member of a visible minority group [OR = 2.63, 95% CI (1.02, 6.78)] are significantly associated with the presence of depressive symptoms. Low academic motivation has a significant negative influence on the presence of depressive [OR = 3.37, 95% CI (1.82, 6.25)] and anxiety symptoms [OR = 2.75, 95% CI (1.35, 5.62)]. However, the presence of perceived stress was strongly associated with depressive [OR = 7.07, 95% CI (3.26, 15.35)], anxiety [OR = 6.51, 95% CI (3.30, 12.84)], and dangerous drinking symptoms [OR = 5.74, 95% CI (2.51, 13.14)]. This study advocates for specific mental illness prevention and treatment resources tailored to the unique needs of university student-athletes. Accordingly, partnerships and practical interventions to support university student-athletes' mental health are presented.

Favorable Adaptation during SARS-CoV-2-Pandemic as Told by Student-Athletes-A Longitudinal and Behavioral Study

(1) Background: The aim was to explore the impact of adaptive responses (resilience factors) on student-athletes' behaviors during a stressful period of life during the SARS-CoV-2-pandemic of 2020 and 2021. (2) Methods: A constructivist-based grounded theory (CGT) was used guided by a biopsychosocial approach. Based on purposeful sampling, 22 male and female student-athletes were divided into four focus group interviews (FGI) seven months after the outbreak of the SARS-CoV-2-pandemic (October 2020) and 18 of these were followed up by FGI seven months later (May 2021). The mean age was 17.65 and they represented golf and handball. (3) Results: The CGT contained four main categories seven months after the SARS-CoV-2-pandemic outbreak: Social support, Self-discipline, Physical practice and recovery and Management of everyday life. Fourteen months after the SARS-CoV-2-pandemic outbreak, four additional main categories emerged: More extensive social support, Belief in the future, Self-awareness and Responsibility and problem-solving. (4) Conclusions: The CTG suggests that student-athletes' favorable adaptations to the stressful SARS-CoV-2-pandemic period 2020-2021 are based on a gradually developed ability to take responsibility for one's own actions, insight into the importance of deepened social interaction, belief in a positive post-COVID future and increased awareness of physical activity and its relation to perceived health.

Competencies That Japanese Collegiate Sports Coaches Require for Dual-Career Support for Student Athletes

The purpose of this study was to clarify coaches' competencies (COM) regarding dual-career (DC) support for student athletes in Japan. The questionnaire survey was conducted at 31 universities with an online survey URL that was distributed to 300 collegiate athletic coaches. In total, there were 152 respondents (female, 19; male, 133; mean age, 43.15 ± 12.07 years; coaching experience, 12.83 ± 9.72 years). The online survey adopted a Japanese-translated version of the Dual-Career Competency Questionnaire (DCCQ), which has been translated into nine languages and is widely used in European counties. The scale consists of six factors and 33 items, each rated on a five-point scale of importance (IM) and possession (PO). The Japanese version of the DCCQ was validated through a confirmatory factor analysis, and the internal consistency of the items was confirmed by calculating the Cronbach's alpha coefficient. In addition, we examined differences between the IM and PO for DC support by t-tests and by calculating effect sizes. The validity and reliability of the Japanese version of the DCCQ were confirmed based on the goodness-of-fit index and Cronbach's alpha coefficients, respectively. Our examination of the differences between IM and PO in DC support revealed that coaches perceived the importance of DC support but did not possess the necessary COM to offer DC support. That finding was similar to those of previous European studies. In particular, the Japanese coaches who participated in our online survey recognized the importance of COM in terms of "collaboration with various stakeholders and departments" for DC support but did not feel as though they held sufficient COM in that regard. In other words, the improvement of DC support requires the development of a coaching program that fosters COM to work with various stakeholders. This key insight provides a direction and specific focus for programs to improve coaches' DC support for student athletes.

The Collegiate Athlete Perspective on Return to Sport Amidst the COVID-19 Pandemic: A Qualitative Assessment of Confidence, Stress, and Coping Strategies

(1) Background: The COVID-19 pandemic has created challenges for college athletes as they return to sport and campus life. Emerging literature highlights some of these challenges, but no studies have used a primarily qualitative approach to assess the impact of the pandemic on college athletes. The purpose of this study was to better understand factors affecting college athletes' return to sport and campus life amidst the COVID-19 pandemic. (2) Methods: Semi-structured interviews were conducted with varsity athletes who participated in the 2020-2021 season at a single university. Qualitative analysis was performed using the Strauss and Corbin method to derive codes, categories, and themes. Additionally, Athletic Coping Skills Inventory-28 (ACSI-28) scores were recorded and analyzed using descriptive statistics. (3) Results: A total of 20 student athletes were interviewed, revealing that confidence and motivation, increased stress and anxiety, and adaptive coping strategies were common themes affecting their experiences returning to sport and campus life. Results from the ACSI-28 showed an average score of 49.5 and a range of 24-66. (4) Conclusions: Semi-structured interviews revealed factors impacting return to sport and student life. These findings can help inform how to better support college athletes throughout the remainder of the current pandemic and moving forward.

Impact of COVID on Sports Injury Patterns, Changes in Mental Well-Being, and Strategies to Prepare for Future Pandemics in Sport

ABSTRACT

This review describes the available evidence of the acute respiratory syndrome coronavirus 2 (SARS-CoV-2, referred to COVID-19) pandemic on musculoskeletal injury patterns and prevalence in athletes. A brief overview of the epidemiology of COVID-19 and prevalence in active populations from youth through professional are provided. Responses to COVID-19 regarding sport participation at regional, national, and international organizations are summarized. Downstream effects of complete or partial training shutdown on injury risk and mental health are discussed. Strategies to maintain athletic potential and overall well-being include maintaining safe access to training facilities and resources, implementation of injury prevention programs, organization of athlete support networks, and incorporation of resilience and coping training.

Social Support and Post-Injury Depressive and Anxiety Symptoms among College-Student Athletes

Social support can positively influence both physical and psychological recovery from sport-related injury. However, few studies have examined the influence of the quantity, quality, and timing of social support on athletes’ psychological health following injury. This study examined the effects of changes in social support on post-injury depressive and anxiety symptoms among college-student athletes. We conducted a prospective cohort study among Division I college-student athletes. Participants completed surveys at baseline and at multiple time points post-injury until return to play (RTP). A total of 597 injuries sustained by 389 student athletes (n = 400 (67.0%) males; n = 238 (39.9%) football players; n = 281 (47.1%) freshman) were included. The overall amount of social support increased from baseline to 1-week post-injury (p < 0.05) and then remained unchanged until RTP. The overall satisfaction with the support received increased from baseline to 1-week post-injury (p < 0.05) but decreased (p < 0.05) from 1-week post-injury to RTP. Increases in satisfaction with the support received were associated with decreases in post-injury depressive (β = −0.404), p < 0.0001) and anxiety symptoms (β = −0.406), p < 0.0001). Interventions involving social support may help hasten college-student athletes’ psychological recovery from injury.