Depression and Anxiety Following Injury Among Collegiate Athletes

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1 Depression and Anxiety Following Injury Among Collegiate Athletes Ryan F. Pittsinger, M.S., Gang Cheng, M.S., Erin O. Heiden, MPH, Ni Zhang, M.S., Tracey Covassin, Ph.D., Jingzhen Yang, Ph.D. Injury Prevention Research Center College of Public Health, The University of Iowa

2 Overview Introduction Methods Results Discussion Conclusions

3 Introduction Athletic injury can have a tremendous impact on an athlete s psychological status (Tibbert, et al., 2008). Previous literature indicates that athletes experience increased levels of depression and anxiety after injury (Nippert & Smith, 2008). There is a lack of prospective empirical research that directly examines the effects of injury on depression and anxiety among collegiate athletes.

4 Study Objectives Describe post-injury symptoms of depression and anxiety by demographic characteristics. Compare the differences in symptoms of depression and anxiety before and after injury. Examine the factors (e.g., injury severity) influencing post-injury symptoms of depression and anxiety.

5 Methods Study Design: Prospective study Injuries identified using an ongoing injury surveillance system (SIMS). Baseline survey and 1-week post-injury follow-up survey. Population: 242 injured Division-I collegiate athletes from 9 sports teams at two universities during the seasons.

6 Methods Measures: Symptoms of depression CESD Anxiety Trait and State Anxiety Statistical Analysis: Descriptive analysis Generalized Estimating Equations (GEE) modeling, adjusting for baseline depression, anxiety, and other covariates.

7 Results - Post-injury Depression and Anxiety by Gender and Race Athlete Injury Post-Depression Post-Anxiety N (%) N (%) N (%) N (%) Total 242 (100) 348 (100) 104 (29.9) 140 (40.2) Gender Male 156 (64.5) 219 (62.9) 66 (30.1) 103 (47.0) * Female 86 (35.5) 129 (37.1) 38 (29.5) 37 (28.7) Race Caucasian 196 (81) 281 (80.7) 75 (26.7) 105 (37.4) Non-Caucasian 45 (18.6) 66 (19) 29 (43.9) * 34 (51.5) * * P-value < 0.05 in the chi-square tests.

8 Results - Post-injury Depression and Anxiety by Sport Athlete Injury Post- Depression Post-Anxiety N (%) N (%) N (%) N (%) Sport 242 (100) 348 (100) 104 (29.9) 140 (40.2) Men s Baseball 13(5.4) 16(4.6) 4(25) 5(31.3) Men s Basketball 7(2.9) 10(2.9) 3(30) 7(70) Men s Football 85(35.1) 103(29.6) 34(33) 54(52.4) Men s Wrestling 51(21.1) 91(26.1) 25(27.5) 37(40.7) Women s Basketball Women s Field Hockey 22(9.1) 36(10.3) 6(16.7) 7(19.4) 15(6.2) 23(6.6) 7(30.4) 7(30.4) Women s Soccer 22(9.1) 25(7.2) 7(28) 9(36) Women s Softball 12(5.0) 23(6.6) 7(30.4) 6(26.1) Women s Volleyball 15(6.2) 21(6.0) 11(52.4) 8(38.1)

9 Results - Post-injury Depression and Anxiety by School Year 60% 50% 51.1% 40% 41.3% 41.3% 37.6% 30.9% 30% 20% 24.7% 28.8% 24.8% Post-Depression Post-Anxiety 10% 0% Freshman Sophomore Junior Senior

10 Results - Injury Severity Number and Percent of Time Loss 32 (9%) 43 (13%) 27 (8%) 17 (5%) 130 (37%) One Week One Month Three Months Six Months One Year Missing 99 (28%)

11 Results - Post-injury Depression and Anxiety by Injury Severity 60% 56.3% 52.9% 50% 46.5% 40% 39.4% 39.5% 40.6% 35.3% 30% 20% 25.4% 31.5% 21.2% Post-Depression Post-Anxiety 10% 0% One Week One Month Three Months Six Months One Year

12 Results - Significant Correlations Between Depression and Anxiety Post- Depression Pre-Anxiety Post-Anxiety Pre-Depression 0.38 (<.0001) 0.36 (<.0001) 0.30 (<.0001) Post- Depression (0.0055) 0.75 (<.0001)* Pre-Anxiety (0.0177)

13 Results - Adjusted OR Post-Depression Post-Anxiety OR 95% CI OR 95% CI Pre-Depression Yes vs. No 2.15* 1.11, , 3.14 Pre-Anxiety Yes vs. No , , 2.51 Adjusted for university, gender, race, school year, previous injury, injury severity, and life events

14 Results - Adjusted OR Post-Depression Post-Anxiety Gender Ethnicity Academic Year Injury Severity OR 95% CI OR 95% CI Male vs. Female , * 1.30,3.69 Caucasian vs. Non- Caucasian , ,1.52 Freshmen vs. Other 2.49* 1.21, ,1.52 Time loss > one month vs. Time loss one Month 2.22* 1.30, * 1.02,2.83 *Adjusted for university, gender, race, school year, previous injury, injury severity, life events, pre-depression and pre-anxiety

15 Discussion/Conclusion About 30% injured athletes experience symptoms of depression and 40% injured athletes experience anxiety. Although pre- and post-injury depression and preand post-injury anxiety are correlated, correlation between post-injury depression and post-injury anxiety is much stronger. Injury severity impacts post-injury depression and anxiety.

16 Discussion/Conclusion Identification of post-injury depression and anxiety and associated factor could aid in developing an effective intervention. Such interventions could have important implications for athletes who participate in either professional or recreational sports. Our study calls for more attention to the psychological aspects of recovery for injured athletes.

17 Acknowledgments The present study was funded by the CDC. We would like to thank the Injury Prevention Research Center at the University of Iowa for the continued support. Thanks to all of the athletic training staff, students, and athletes that have participated and made this study possible.

ATHLETIC TRAINING INFORMATION AND PROCEDURES. Jaime Dickerson, MA, ATC Athletic Trainer

ATHLETIC TRAINING INFORMATION AND PROCEDURES Jaime Dickerson, MA, ATC Athletic Trainer 973-661-8995 jdickerson@nutleyschools.org PHYSICAL INSTRUCTIONS ALL FORMS MUST BE TURNED IN TOGETHER!! All incoming