An Examination of Depression, Anxiety, and Self-Esteem in Collegiate Student-Athletes

Trait Courage, Attachment to God, and Mental Well-Being Among U.S. Collegiate Athletes

In recent decades, scholars and practitioners alike have devoted increased attention to the psychological well-being of student-athletes. However, to date, far less research has examined the role of virtues, religion, and spirituality in contributing to well-being in student-athlete populations. In this study, we attempt to address these gaps by (a) assessing the association between trait courage, an understudied virtue in the sporting realm, and mental well-being, and then (b) considering how student-athletes' attachment to God might moderate the association between trait courage and depressive symptoms. Drawing on a sample of 415 student-athletes from the USA, regression results illustrate that courage was not significantly associated with lower depressive symptoms among student-athletes. However, a secure attachment to God appeared to function as a compensatory resource for student-athletes lacking in courage. On the contrary, athletes with low trait courage but who reported greater avoidant attachment to God reported greater depressive symptoms. Taken together, a more positive relationship with God could help provide athletes with lower trait courage a way to find meaning and strength that helps them with emotion-regulation strategies to deal with the pressures within and beyond their sport. This study clearly shows that greater attention should be paid to the religious and spiritual development of student-athletes.

The Depression, Anxiety, and Stress of Student-Athletes from a Pre- to Post-COVID-19 World

This study explored differences in student-athletes' symptoms of depression, anxiety, and stress pre- to post-COVID-19-pandemic. The WHO reported a 25% increase in depression and anxiety rates worldwide, with young people disproportionately affected. Student-athletes face many stressors related to their sporting and academic feats, but what is not known is how the COVID-19 pandemic affected their experiences of symptoms of mental illness. A multiple-cohort cross-sectional study design was employed, and data collected using physical and online surveys. Participants (cohort 1 M age = 20.18 years, SD = 1.52; cohort 2 M age = 19.75 years, SD = 1.45) were recruited from UK universities (N = 807; 427 pre-pandemic cohort, 380 post-pandemic cohort). Results revealed statistically significant differences in mean depression (F (1, 805) = 23.92, p < 0.001), anxiety (F (1, 806) = 20.15, p < 0.001), and stress symptoms (F (1, 805) = 5.24, p = 0.022) scores between cohorts. Scores for the post-pandemic cohort were significantly higher than pre-pandemic, suggesting a worsening of symptom severity. Distributions of student-athletes across categories of symptom severity also worsened for depressive and anxiety symptoms post-pandemic and were skewed towards more severe categories. Symptoms of depression, anxiety, and stress were a concern pre-pandemic. Rates are higher in the post-pandemic cohort, suggesting a worsening of symptoms. These data add to evidence on student-athletes' symptoms of mental illness by exploring a UK sample and comparing scores pre- and post-pandemic.

Sport anxiety and subjective happiness of college athletes: a self-determination theory perspective

Introduction

Sport anxiety not only impacts the performance of college athletes but also influences their psychological well-being. The psychological well-being of sports students is crucial for both academic performance and competition, as they need to balance their academic performance with professional athletic training.

Method

Based on self-determination theory, this study examines the relationship between various factors in sport anxiety (somatic anxiety, worry, and concentration disruption) and subjective happiness, as well as the mediating role of need satisfaction in this relationship. A total of 835 college athletic students participated in the study, completing the Sport Anxiety Scale-2, Basic Psychological Needs Satisfaction Scale-in General, and Subjective Happiness Scale.

Results

An analysis of gender differences revealed that female participants scored significantly higher on somatic anxiety (t = -2.21, df = 833, p = 0.028, Cohen's d = -0.155) and worry (t = -3.17, df = 833, p = 0.002, Cohen's d = -0.223) compared to males. In the analysis by sport type, participants engaged in team sports scored significantly higher on somatic anxiety (t = 2.70, df = 833, p = 0.007, Cohen's d = 0.187), Worry (t = 1.97, df = 833, p = 0.049, Cohen's d = 0.136), and concentration disruption (t = 2.73, df = 833, p = 0.007, Cohen's d = 0.189) than those in individual sports. Additionally, in the analysis by grade level, freshman college athletes exhibited significantly lower sport anxiety compared to sophomore athletes [F(4, 830) = 4.06, p = 0.003, η p 2 =0.019]. The mediation analysis revealed that concentration disruption in sport anxiety is significantly and negatively related to subjective happiness. Additionally, need satisfaction (competence, autonomy, and relatedness) mediates the relationship between worry, as well as concentration disruption in sport anxiety and subjective happiness.

Discussion

Future research should build on the current study by employing longitudinal designs and integrating multiple objective measures to further explore the relationship between sport anxiety and subjective happiness.

Barriers To and Attitudes Toward Seeking Mental Health Services Among Collegiate Marching Band Artists

CONTEXT

Marching band (MB) artists experience stressors influencing their physical, mental, and emotional health warranting medical support, and they face challenges similar to those of other college students and athletes. Mental health illnesses exist in collegiate and MB settings, but barriers affect access to treatment.

OBJECTIVES

To examine MB artists' perceived barriers to and attitudes toward seeking care from mental health professionals. The secondary aim was to explore barriers to and attitudes about seeking mental health counseling between genders and history of pursuing mental health counseling.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 534 MB artists (women = 312, men = 222; age = 19.7 ± 1.4 years).

MAIN OUTCOME MEASURE(S)

Participants completed surveys on demographics and past medical history along with the Barriers to Help Seeking Checklist, the Attitudes Toward Seeking Professional Psychological Help-Short Form Scale (ATSPPH-SF), and the Mental Help Seeking Attitudes Scale (MHSAS). Descriptive statistics were calculated to assess demographic data. Cross-tabulations and χ2 statistics were used to evaluate individual barriers (Barriers to Help Seeking Checklist) between genders. Scales were scored 1 to 7 and 10 to 30 on the MHSAS and ATSPPH-SF, respectively. A 1-way analysis of variance measured differences in the total mean score on the ATSPPH-SF between genders.

RESULTS

The highest barrier reported was lack of time to seek services (69.1%; n = 369), followed by 47.6% (n = 254) for services not available during my free time. Average scores were 4.0 ± 0.4 on the MHSAS (indicating neutral attitudes toward seeking help) and 17.97 ± 5.48 on the ATSPPH-SF (indicating slightly positive attitudes to seeking help). No differences were seen for the total mean scores on the MHSAS and ATSPPH-SF between genders.

CONCLUSIONS

Marching band artists' barriers to and attitudes toward mental health care influenced their ability to seek care in times of need and demonstrated some similarities to those of collegiate athletes. Awareness of the obstacles MB artists face in receiving mental health care will assist health care providers in advocating for improved care in this setting.

Treble or Trouble: Mental Health Experiences of Gender-Diverse Collegiate Marching Band Artists

CONTEXT

For gender-diverse (GD) college marching band (MB) artists, the risks for anxiety and depression may be higher as they navigate the demands and stressors associated with MB, college, and their gender identity.

OBJECTIVES

To examine the risks of anxiety and depression across GD MB artists and to explore their barriers and attitudes toward seeking mental health (MH) care.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

Seventy-eight GD individuals (transgender = 12, nonbinary = 66, age = 19 ± 1 years).

MAIN OUTCOME MEASURE(S)

A survey was used to assess demographics, anxiety risk using the State-Trait Anxiety Inventory, depression risk using the Center for Epidemiologic Studies Depression Scale, and barriers and attitudes using the Barriers Towards Seeking Help Checklist, the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form, and the Mental Help Seeking Attitudes Scale. We calculated descriptive statistics and univariate analyses to evaluate scores, risks, and differences between MH and receiving assistance.

RESULTS

Participants had high state anxiety (mean = 52.0 ± 112.1), trait anxiety (mean = 55.2 ± 10.0), and symptoms of depression (mean = 30.4 ± 12.0) based on the State-Trait Anxiety Inventory and the Center for Epidemiologic Studies Depression Scale. Overall, 78.2% (n = 61 of 78) of GD MB artists were considered at risk for both state and trait anxiety and depression, and 18% (n = 11 of 61) did not seek help from an MH professional. These GD MB artists cited a lack of time (82.1%; n = 64 of 78) as the primary barrier to seeking professional help. The mean score on the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form for all GD artists was 19.5 ± 5.0, and the total score for the Mental Help Seeking Attitudes Scale was 47.8 ± 9.2, which indicated more favorable attitudes toward seeking professional help.

CONCLUSIONS

We identified high rates of clinical symptoms for depression and anxiety among GD MB artists. The data are consistent with those from other minority populations and above the normative values for cisgender students. The lack of help-seeking behaviors in nearly 15% of at-risk participants highlights the need for specialized resources for GD patients and those participating in MB.

Mental Health in First- and Second-Division Soccer Players: A Cross-Sectional Study

BACKGROUND

The benefits of sport in mental health have been broadly studied. However, few studies have examined these outcomes in high-performance athletes. We aimed to analyze the state of the mental health of the Villarreal Soccer Club's first- (FD) and second-division (SD) players and the possible mediating effects of sex and professional category.

METHODS

This was a cross-sectional study with an initial sample of 108 soccer players (final sample n = 54). Data from MINI, HARS, HDRS, BARRAT-11 and SCSRQ questionnaires were analyzed.

RESULTS

The mean age was 23.41 years (SD = 4.56) and 61.1% (n = 33) were men. A proportion of 24.1% (n = 13) stated that they had undergone mental health treatment, 7.4% (n = 4) had taken psychotropic drugs, and 2.1% (n = 1) had made a suicide attempt. Differences were observed between the FD and SD players in terms of the sensitivity to punishment (t = -2.2; p = 0.033), overall impulsivity (t = -3.1; p = 0.003), unplanned impulsivity (t = 3.4; p = 0.001), and the HDRS (U = -110.5; p = 0.004), HARS-Total (U = -104.0; p = 0.006) and HARS-Psychological subscale scores (U = -104.0; p = 0.001). Differences were also observed between the female and male SD players for the HARS-Somatic subscale (U = 136.5; p = 0.028).

CONCLUSION

The low values obtained in the clinical scales, together with the reported psychopathological histories, suggested that the Villareal players showed better mental health than the general population.

Depression, anxiety and stress among female student-athletes: a systematic review and meta-analysis

OBJECTIVE

To identify, quantify and analyse determinants of depression, anxiety and stress symptoms among female student-athletes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Five online databases (PubMed, CINAHL, PsychInfo, SportDiscus and Web of Science) searched from inception through 14 September 2023. Hand-searches and contacting authors for eligible studies.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Articles were included if they were published in English, included female student-athletes competing at National Collegiate Athletic Association institutions, and measured symptom-level depression, anxiety and/or stress.

RESULTS AND SUMMARY

We screened 2415 articles; 52 studies (N=13 849) were included in the systematic review with 13 studies qualifying for meta-analysis. Seventeen determinants were identified including injury (eg, concussions), health (eg, sleep hygiene) and social factors (eg, social support). As data specific to female student-athletes was delineated from studies that included other populations, we observed 16 studies (30.7%) reported that identifying as female was a meaningful determinant of depression, anxiety and stress in athletes. Results of the meta-analysis (k=13, N=5004) suggested a small but significant association (r=0.15, 95% CI 0.05 to 0.24, p=0.004) between other determinants and depression, anxiety, and stress among female student-athletes.

CONCLUSION

Coaches, trainers and clinicians are key contributors in supporting female student-athlete mental health, with responsibilities for integrating mental skill training, sleep hygiene education and regular assessments. Comprehensive mental health and tailored education programmes considering determinants such as injury, health and social factors specific to female student-athletes are needed to enhance mental health equity in sport.

PROSPERO REGISTRATION NUMBER

CRD42022362163.

Student-Athletes' Deteriorating Mental Health During COVID-19: Recommendations on Proactive Strategies for Addressing Unique Mental Health Needs

High school and college student-athletes face unique stressors that can negatively impact their mental health, which were exacerbated by the COVID-19 pandemic. Although mental health issues are prevalent in athletic communities, there often remains stigma around mental health and reluctance to seek psychological support. Physical injury can be the cause or the result of the psychological struggles that athletes face-holistic care for the adolescent athlete population must incorporate both elements. Pediatric psychologists, allied healthcare professionals, sports organizations, academic institutions, coaches, caregivers, and student-athletes themselves all play an active role in shaping the mental health of student-athletes and are therefore responsible for creating a culture that prioritizes mental and physical wellness. This paper aims to provide clear recommendations for the various stakeholders on how to address the unique mental health needs of student-athletes. The recommendations presented are based on a review of existing literature in the field and on-the-ground experience working with student-athletes during the COVID-19 pandemic. There are several key interventions highlighted in this paper, including changing the athletic community's culture to prioritize the holistic well-being of athletes, as well as proactively offering mental health education, resources, and programming for student-athletes, with a particular emphasis on health equity to meet the needs of students most at risk. Commitment from pediatric psychologists and allied healthcare professionals, sports organizations, academic institutions, coaches, caregivers, and student-athletes will maximize the likelihood of improving student-athletes' psychological well-being.

Influence of physical education on anxiety, depression, and self-esteem among college students

BACKGROUND

Physical education is pivotal in our country's education reform. Urban schools have notably enhanced the intensity of physical education in recent years. However, the effects of physical education on students' anxiety, depression, and self-esteem levels, as well as their interrelations, remain unexplored.

AIM

To analyze the influence of physical education on students' anxiety, depression, and self-esteem.

METHODS

This study employed a cross-sectional design. A stratified cluster sampling method was used to select 478 first-year university students. Self-administered questionnaires were used to investigate the physical education status and basic information of college students. We used the Physical Activity Rank Scale-3 (PARS-3), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Self-Esteem Scale (SES) to assess the level of exercise, anxiety, depression, and self-esteem. Multiple Logistic regression was used to analyze the factors influencing anxiety, depression, and low self-esteem. The receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the predictive ability of PARS-3 scores for anxiety, depression, and low self-esteem. Spearman's correlation was used to analyze the correlations among the PARS-3, SAS, SDS, and SES.

RESULTS

Compared with the domestic norms, SAS and SDS scores were higher, and SES scores were lower (P < 0.05). Among the participants, 210 (43.93%) had PARS-3 scores below 20, 94 (19.67%) had scores of 20-42, and 174 (36.40%) had scores above 42. After adjusting for daily sleep time, gender, being an only child, major, father's educational background, mother's educational background, and family residence, PARS-3 scores were independent influencing factors for anxiety, depression, and low self-esteem (P < 0.05). The AUC of PARS-3 scores predicting anxiety, depression, and low self-esteem were 0.805 (0.760-0.849), 0.799 (0.755-0.843), and 0.831 (0.788-0.874), respectively. The sensitivities were 0.799, 0.801, and 0.748, and the specificities were 0.743, 0.716, and 0.814, respectively. PARS-3 was negatively correlated with SAS and SDS scores (r = -0.566, -0.621, both P < 0.001) and positively correlated with SES scores (r = -0.621, P < 0.001). SES scores were negatively correlated with SAS and SDS scores (r = -0.508, r = -0.518, both P < 0.001).

CONCLUSION

The amount of physical activity is negatively correlated with anxiety and depression degree and positively correlated with self-esteem degree.

Eating Disorder Risk and Pathogenic Behaviors Among Collegiate Student-Athletes

CONTEXT

Eating disorders (EDs) are a cluster of behavioral conditions characterized by uneasy thoughts and behaviors that grow into severe or persistent eating disturbances. The demands on student-athletes may create mental and physical stressors that increase the likelihood of EDs and disordered eating.

OBJECTIVE

To examine the ED risk through eating attitudes and behaviors in male and female student-athletes and across various sport types (endurance, aesthetic, power, ball or team, or technical sports).

DESIGN

Cross-sectional study.

SETTING

Collegiate athletics.

PATIENTS OR OTHER PARTICIPANTS

National Collegiate Athletic Association Division I and II student-athletes (n = 2054; males = 631; females = 1423) from 40 institutions.

MAIN OUTCOME MEASURE(S)

Participants completed a web-based demographic survey and the Eating Attitudes Test-26 (EAT-26). Multiple χ2 analyses examined participants classified as at risk for EDs. Independent-samples t tests and a 1-way analyses of variance compared sex and sport type across EAT-26 totals and subscale (Dieting, Bulimia, and Oral Control) scores.

RESULTS

Overall, 25.3% (n = 520/2054) of student-athletes were classified as at risk for EDs. Differences were found between sex and ED risk (χ21,2054 = 32.9, P ≤ .01; 17.3% [n = 109/631] males, 28.9% [n = 411/1423] females) and across ED risk and sport type (χ24,2054 = 13.4, P = .01). When examining females only, we observed differences across ED risk and sport type (χ24,1423 = 13.4, P ≤ .01). No differences were evident across ED risk and sport type for males. Differences were seen between sex and binge eating (χ21,2054 = 6.8, P = .009), sex and diet pill use (χ21,2054 = 19.6, P ≤ .01), and sport type and diet pill use (χ24,2054= 12.2, P = .016), excessive exercise (χ24,2054 = 32.1, P ≤ .01), and losing more than 20 lb (9 kg) in the last 6 months (χ24,2054 = 10.2, P ≤ .037).

CONCLUSIONS

Student-athletes in the collegiate setting are at risk for EDs. Medical professionals, such as athletic trainers, need to be educated on the potential risk factors that may lead to EDs. Protocols for prevention, screening and recognition, and referral should be developed for student-athletes at risk for EDs.

Athletic Trainers' Perceptions of Responsibilities and Use of Psychosocial Interventions for Patients Following an ACL Injury

Following an anterior cruciate ligament (ACL) injury, mental health challenges are often concomitant with the injury and rehabilitation process. Athletic trainers are essential components within the healthcare team who should be trained in recognizing, referring, and managing mental health issues. However, more research is needed on the athletic trainer's responsibility regarding psychosocial interventions and their role within ACL patients. Our descriptive study included 153 collegiate athletic trainers who reported on previous training and responsibilities related to mental health. Of these participants, 98% reported caring for an ACL patient within the last year. The participants were further asked to explore what behavioral responses were observed within ACL injury patients, the specific psychosocial interventions deployed, the frequency of integration, and whether a referral to another provider was utilized. We identified that athletic trainers share a strong understanding of their perceived roles, with 99.3% of participants stating the obligatory feeling to support ACL patients experiencing mental health challenges and implementing personalized rehabilitation (74%) and attainable goals (70%) while also keeping the athlete involved in the team (72%). Our data suggest that athletic trainers recognize their role and continue to integrate psychosocial strategies throughout the ACL injury process.