Sports Med U | Educating Minds, Elevating Potential

The psychological response to injury in student athletes: a narrative review with a focus on mental health

Putukian, M., 2016. The psychological response to injury in student athletes: a narrative review with a focus on mental health. British journal of sports medicine, 50(3), pp.145-148.

In today’s letter

• Overview of the mental barriers seen in young athletes

• Rapid Results = Depression & anxiety are common in young athletes and the biggest contributors are:

1. High success before injury

2. Severe injury requiring surgery

3. Long rehabilitation

4. Inability to return to their previous level of play

5. Being replaced by a teammate.

• 3 resources to check out to further you knowledge about menatl health in sport

• Meme of the week: Its rare! Thats why it needs to be googled 😄 

Aim of the study

The author discusses what is currently known about how young athletes respond to injuries mentally, and explore the resources available to help them towards mental health support if needed.

Did you know?

• While exercise and sports generally boost mood and self-esteem, extreme levels of activity can cause increased stress & burnout

Mental health issues such as:

1. Eating disorders

2. Depression

3. Anxiety

4. Gambling

5. Substance abuse

6. Suicide

Are significant concerns for college student, whether they are athletes or not.

• Some research shows that athletes may face higher rates of issues like performance anxiety, eating disorders, and binge drinking compared to their non-athletic peers.

• Depression isn’t uncommon among athletes—one study found that 21% of collegiate athletes reported depressive symptoms, with women, freshmen, and those experiencing pain being at higher risk.

• For some athletes, depression may be linked to performance failures as well, and those competing at elite levels might face a greater risk of depression than those in less competitive environments.

 Injuries & Emotional Response

• Injuries are a common experience for athletes, and the psychological response can range from normal reactions to more problematic ones.

Stress

• Stress can increase the likelihood of an athlete getting injured and slow down recovery after an injury.

• After an injury, how an athlete thinks, feels, and behaves are all connected and can influence each other both in the short and long term.

• Chronic stress, measured by elevated hair cortisol levels, has been found in endurance athletes, those in pain, and patients with major depression.

• Stress leads to increased muscle tension and poor coordination, which can raise the risk of injury; reducing stress can lower the rates of injury and illness.

• Adolescents with higher "mental toughness" were more resilient to stress and showed fewer depressive symptoms.

• This is why its importnat to identify general stressors for student-athletes, as well as individual stressors that can be modified to support the persons well-being.

Depression

• Physical injuries can sometimes lead to depression as well

• Athletes who are depressed or under a lot of stress are at higher risk for injury, and their emotional state can negatively impact their performance.

• When an athlete is injured, there is usually a normal emotional process that includes understanding the medical details and coping with the emotional challenges of the injury.

A Problematic Response to Injury

• Strength & conditioning coaches, physiotherapists, athletes, coaches, and administrators all need to recognise that emotional reactions to injuries are normal. However, reactions that don’t improve, get worse over time, or seem overly severe can be a cause for concern.

• An example of a problematic reaction is when injured athletes restrict their food intake because they believe they don’t "deserve" to eat while injured. This behavior can lead to disordered eating.

• Depression is another concerning response to injury. It’s particularly dangerous because it can amplify other emotional reactions and slow down the recovery process.

• Substance use and abuse are also common responses to injury. Athletes may turn to drugs or alcohol to manage their emotions, using substances like cocaine for stimulation and alcohol to counter feelings of mania or depression.

• Many athletes use alcohol and other recreational or prescription drugs as a form of self-medication to improve their mood during bouts of depression.

• In one study of 262 collegiate athletes, 21% reported high alcohol use along with problems related to their drinking.

A review of 5 college athletes who committed suicide found common factors:

1. High success before injury

2. Severe injury requiring surgery

3. Long rehabilitation

4. Inability to return to their previous level of play

5. Being replaced by a teammate.

The most significant predictor was the severity of the injury

• Other overlapping risk factors for suicide included other stressful life events , chronic mental illness, personality traits linked to maladjustment, family history of suicide, and other psychiatric concerns (like drug use or previous suicide attempts).

• Concussions can also be particularly difficult for student-athletes to handle emotionally, especially in contact sports. These injuries can result in significant time away from play or even force early retirement from the sport.

• For severe injuries like ACL tears, recovery can be easier to manage because a predictable timeline for recovery and alternative exercises like swimming or biking can be provided early in the process.

• However, concussions are tricky because recovery timelines are uncertain. Initial management involves cognitive and physical rest, but athletes often rely on physical activity to cope with stress, making this recovery process even more challenging

Obstacles To Seeking Care

• Athletes face unique obstacles when it comes to seeking care for mental health issues, and they tend to be less likely to seek help compared to non-athletes.

• Access to care is crucial, and there’s often a "teachable moment" when getting an athlete to consider treatment. Moving quickly to arrange an evaluation can make a big difference in these situations.

• Privacy can be a challenge since coaches, trainers, and physios are closely involved in athletes' lives and play an important role in their support system.

Athletes may be at higher risk for mental health problems because they’re less likely to seek help as:

1. They fear appearing weak

2. They are used to pushing through pain

3. They haven’t developed effective coping mechanisms for failure.

• Stigma (a negative stereotype or judgment attached to a person or group based on certain characteristics or conditions) is a major barrier to seeking mental health care in athletes.

• In a study of elite athletes aged 16–23, stigma was identified as the biggest hurdle, alongside a lack of mental health awareness and negative past experiences with seeking help. However, encouragement from others and positive interactions with others can facilitate help-seeking.

Helping To Seek Treatment & Support

• Coaches and physios have a responsibility to "demystify" mental health concerns and help athletes to understand that mental health is just as important to recognise and treat as an MSK injury

• A basic understanding of strategies to treat mental health and promote general wellness is essential for improving both well-being and athletic performance.

• Treatments aimed at building resilience and mental toughness can help reduce stress and potentially reduce symptoms of depression.

• A systematic review of 983 athletes identified 3 key psychological factors—autonomy, competence, and relatedness—that play an important role in positive rehabilitation and returning to pre-injury performance levels.

• Internet-based interventions could also be useful in educating athletes about mental health, common symptoms, and the benefits of seeking help, which can make mental health concerns feel less overwhelming.

• The team staff should actively support injured athletes and keep them involved with the team, ensuring they don’t feel isolated during recovery.

• One of the most impactful actions a coach can take is giving athletes "permission" to seek help, encouraging them to prioritise their mental health instead of trying to "tough it out."

3 resources to check out

And learn more about mental health in youth

1. Mental health in elite sports - LINK ⚾

2. Tips for parents & coaches - LINK 📝

3. Story from a young athlete (VIDEO) 😮‍💨

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