Which psychosocial factors are associated with return to sport following concussion? A systematic review

BackgroundPsychosocial factors predict recurrent injury and return to preinjury level of performance following orthopedic injury but are poorly understood following concussion. Current management protocols prioritize physical measures of recovery. Therefore, the objective of this study was to describe the psychosocial factors associated with return to sport (RTS) and how they are measured in athletes who sustained a concussion.MethodsMEDLINE, Embase, APA PsycINFO, CINAHL, and SPORTDiscus were searched through February 2, 2021. Eligible studies included original peer-reviewed publications describing psychosocial factors associated with RTS following a diagnosed concussion. The primary outcome was scales or measures employed and/or key thematic concepts.ResultsOf the 3615 studies identified, 10 quantitative cohort studies (Oxford Centre for Evidence-Based Medicine Level-3) representing 2032 athletes (85% male; high-school and collegiate collision/contact athletes) and 4 qualitative studies representing 66 athletes (74% male; 70% American football; aged 9–28 years) were included. We identified 3 overarching themes and 10 outcome measures related to psychosocial factors associated with RTS following concussion: (a) fear (e.g, of recurrent concussion, of RTS, of losing playing status); (b) emotional factors (e.g, depression, anxiety, perceived stress, mental health, disturbance mood); and (c) contextual factors (e.g, social support, pressure, sense of identity).ConclusionAlthough current medical clearance decisions prioritize physical measures of recovery, evidence suggests diverse psychosocial factors influence RTS following concussion. It remains unclear which psychosocial factors contribute to a successful RTS, including the influence of sex/gender and age. Future studies should evaluate the association of psychological readiness with physical measures of recovery at medical clearance, preinjury level of performance, and risk of recurrent concussion to support RTS clinical decision-making.     

Self-Narrative Profiles of Elite Athletes and Comparisons on Psychological Well-Being

Further research is needed on factors related to the emotional health of elite athletes. Previous research has linked self-narratives of people or their narrative identities to their psychological well-being. However, no study has yet examined self-narratives among elite athletes. Purpose: This study examined whether specific profiles or narrative identities of athletes emerge through multiple self-narrative indicators; these profiles were compared on measures of psychological well-being (e.g., depression, anxiety, postfailure shame levels, and life satisfaction). Method: Self-report data were collected from a sample of elite athletes (n = 99, Mdn age = 22 years, 52% male, 53% individual sports) competing at a National Collegiate Athletic Association Division 1, professional, or Olympic level. Results: Latent profile analysis revealed 3 profile types that significantly differed on measures of psychological well-being. Athletes with a performance-based narrative identity (high perfectionism, fear of failure, and contingent self-worth) demonstrated the highest levels of psychological disruptions (highest levels of depression, anxiety, and shame; lowest levels of life satisfaction), whereas a purpose-based narrative identity (high purpose, global self-worth, positive view of self after sport) was associated with the highest level of psychological well-being (lowest levels of depression, anxiety, and shame; highest levels of life satisfaction). Athletes in the mixed-type profile class reported better psychological well-being compared with the performance-based profile class but not the purpose-based profile class. Conclusions: Our findings provide initial evidence that particular self-narrative profiles of elite athletes contribute to their own psychological well-being in a significant way. Possible implications for practitioners are also discussed.     

Relationships between talent development environments and mental toughness: The role of basic psychological need satisfaction

ABSTRACT

Although the talent development environment and mental toughness are critical for athletes to realise their athletic potential, there is a dearth of literature on whether the talent development environment can enhance mental toughness among those athletes who are identified with athletic potential (i.e., talented athletes). Drawing on self-determination theory (Deci & Ryan, 2000), this research examined the relationships between the talent development environment, basic psychological needs satisfaction and mental toughness. Talented athletes (n = 261) completed a survey measuring key features of the talent development environment, needs satisfaction and mental toughness. The results of structural equation modelling indicated that three environmental factors (i.e., long-term development focus, holistic quality preparation and communication) were positive predictors of needs satisfaction, which then positively predicted mental toughness. The talent development environment may be considered for promoting talented athletes’ mental toughness.     

Family contributions to sport performance and their utility in predicting appropriate referrals to mental health optimization programmes

ABSTRACT

Limited research has examined the contributions of sport-specific family relationship problems to athlete mental health. In the current study we examined the extent to which collegiate athletes’ family problems (as measured by the Student Athlete Relationship Instrument factors, SARI) predict athletes’ general mental health distress and specific mental health symptoms that are relatively common in athletes (i.e. depression, anxiety, and drug and alcohol use). The study included 85 collegiate athletes (intramural, n?=?26; club sport, n?=?12; NCAA Division I, n?=?47). We hypothesized that both general mental health distress and commonly evidenced mental health symptoms would be predicted by athletes’ responses to the SARI factors (Poor Relationship and Lack of Support, General Pressure, Pressure to Quit or Continue Unsafely, Embarrassing Comments, and Negative Attitude). Results indicated that all of the aforementioned SARI factors predicted athletes’ ratings of depression and general mental health distress levels. Only the General Pressure SARI factor predicted athletes’ anxiety and drug use. Alcohol use was not predicted by any of the SARI factors. Receiver operating characteristic (ROC) analyses indicated that sport-specific problems in family relationships provided a good classification of athletes at risk for general mental health distress, depression, and anxiety. Practice implications are discussed in light of the results.     

Mentale Toughness im Sport

The present article reviews the previous literature on mental toughness in sport. The review demonstrates that qualitative researchers have been able to establish conceptual clarity and provide guidance for operationalizing the concept. As a consequence, several quantitative questionnaires have been developed beyond the Psychological Performance Inventory (PPI). Meanwhile, there is preliminary evidence for the validity and reliability of these instruments. Moreover, researchers showed that mental toughness is associated with higher achievement levels or performance outcomes in elite athletes. Regarding the underlying mechanisms, prior research indicated that mentally tough athletes use more positive coping strategies. Although researchers agree that mental toughness is a rather stable construct, experimental research showed that mental skill training influenced mental toughness in a positive fashion. To date, there is a great need for more quantitative, longitudinal and experimental research. Also, a biopsychological approach offers an interesting avenue for future studies.     

A mixed methods approach to compare elite sport policies of nations. A critical reflection on the use of composite indicators in the SPLISS study

Abstract

This paper discusses the utility of mixed methods research in international comparative studies on elite sport policies and (quantitative) composite indicators (CIs) in particular. It illustrates how complex and large amounts of data in 15 nations have been objectified into easily understood formats, CIs. Using a nine Pillar model, data were collected through a research inventory and surveys completed by 3142 elite athletes, 1376 coaches and 241 performance directors. Ninety-six critical success factors and 750 sub-factors were aggregated into a CI. The paper shows how CIs are helpful in identifying a possible (non) relationship between elite sport policies and success, in facilitating interpretation and comparison, and in understanding differences and convergences in elite sport systems. However, there are a number of drawbacks, for example, understanding elite sport policies as part of a broader social, cultural and political context. Complementary qualitative analysis is necessary and has been used to interpret elite sport policies of nations.     

上海市部分优秀运动员心理健康现状及相关因素的比较研究

以上海市195名优秀运动员为调查对象,通过问卷调查、访谈、数理统计等研究方法,揭示其心理健康状况,对其相关因素进行分析探讨,结果表明,所调查的上海市优秀运动员中绝大多数人心理健康状况良好;上海市部分优秀运动员在人际关系因子上要好于全国正常成人常模,在躯体化因子上要差于全国正常成人常模;优秀男运动员心理健康水平要好于优秀女运动员;大专及大专以上文化水平的优秀运动员心理健康水平要好于高中文化水平的优秀运动员。     

Psychological resilience in sport performers: a review of stressors and protective factors

Abstract

Psychological resilience is important in sport because athletes must utilise and optimise a range of mental qualities to withstand the pressures that they experience. In this article, we discuss psychological resilience in sport performers via a review of the stressors athletes encounter and the protective factors that help them withstand these demands. It is hoped that synthesising what is known in these areas will help researchers gain a deeper profundity of resilience in sport, and also provide a rigorous and robust foundation for the development of a sport-specific measure of resilience. With these points in mind, we divided the narrative into two main sections. In the first section, we review the different types of stressors encountered by sport performers under three main categories: competitive, organisational and personal. Based on our recent research examining psychological resilience in Olympics champions, in the second section we discuss the five main families of psychological factors (viz. positive personality, motivation, confidence, focus, perceived social support) that protect the best athletes from the potential negative effect of stressors. It is anticipated that this review will help sport psychology researchers examine the interplay between stressors and protective factors, which will, in turn, focus the analytical lens on the processes underlying psychological resilience in athletes.     

中国优秀运动员形象特征的质性研究

采用质性研究的方法,以国内外优秀运动员访谈录为主要质性材料,旨在通过对中国优秀运动员形象特征的历史演变、职业发展阶段差异、中外差异,找寻其定位标准。研究发现:1)中国优秀运动员形象特征包括荣誉观、个性观、胜负观、心理状态、教练员的影响、技战术意识、公众意识、集体观、退役选择及文化知识10个维度,随时代变迁的4个阶段和自身职业发展的3个阶段而表现出差异性;2)中国优秀运动员形象特征随时代变迁而演变,主要表现为:民族、国家荣誉观到个人理想荣誉观的形象变迁;内敛胜负观到张扬胜负观的形象变迁;赛场调节到赛场霸气的形象变迁;3)中、外优秀运动员形象特征的差异性主要表现在编码结果趋势化和语义差异的文化内涵两个方面。     

Effect of nutritional intervention on body composition and performance in elite athletes

Abstract

Strength training and positive energy intake are the most important factors related to lean body mass (LBM) gain. Most studies investigating weight-gain interventions are based recreationally active subjects and less is known about optimal weight-gain protocols in elite athletes. The purpose of this study was to evaluate the effect of nutritional guidance in an 8- to 12-week weight-gain period in elite athletes. Thirty-nine elite athletes were randomised to either a ‘nutritional counseling group’ (NCG, n=21, 19.1±2.9 years, 70.9±8.9 kg) or ‘ad libitum group’ (ALG, n=18, 19.6±2.7 years, 75.0±5.9 kg). All athletes continued their sport-specific training which included an additional four strength-training sessions per week. NCG followed a meal plan providing a positive energy balance, while the ALG athletes had an ad libitum energy intake. Body weight (BW), body composition, one repetition maximum (1RM), 40 m sprint and counter movement jump (CMJ) were measured pre- and post-intervention. Energy intake was higher in the NCG than in the ALG (3585±601 vs. 2964±884 kcal) and consequently BW increased more in NCG than in ALG (3.9±0.6% vs. 1.5±0.4%). Fat mass (FM) increased more in NCG than in ALG (15±4 vs. 3±3%), but gain in LBM was not different between groups. All 1RM results improved in both groups (6–12%), whereas 40 m sprint and CMJ remained unchanged, except for a significant decrease in 40 m sprint for the athletes in NCG. Athletes with nutritional guidance increased BW more, however, excess energy intake in a weight-gain protocol should be considered carefully due to undesirable increases in body fat.     

Australian Elite Athlete Development: An Organisational Perspective

The purpose of this paper is to examine and map the process of Australian elite athlete development from an organisational perspective, that of 35 national sporting organisations (NSOs). Research on elite development has focused on the significance of economic and cultural factors (macro-level studies) and the role of sport science and athletes’ close environment (micro-level studies) in fostering success. In an effort to depict elite athlete development processes in a more inclusive way, this paper offers an evaluation of the ways elite athletes are nurtured from an Australian NSOs perspective adopting a meso-level approach (e.g., programs). The study is based on a document analysis examining 74 annual reports from 35 NSOs over a period of four years, before and after the Sydney Olympic Games and offers a generic framework of the Australian elite athlete development process. The resulting framework shows that various interested groups are involved with nurturing elite athletes through either initiating or implementing specially designed programs or other strategies that cultivate success, and helps broaden the definition of elite development. The implications of successful elite athlete development include increased finances and public profile for sports as well as the creation of pathways to increase interest in sport.     

Young,talented and injured: Injury perceptions,experiences and consequences in adolescent elite athletes

Even though injury is common in elite sports, there is still a lack of knowledge of young athletes’ injury perception both during and after injury. The aim of this mixed-method study was, therefore, to explore, in-depth, data on injury consequences and adolescent elite athletes’ perceptions and experience of injury. Three hundred and forty adolescent elite athletes (age range 15–19), from 16 different sports, were bi-weekly monitored over 52 weeks using a valid questionnaire. Twenty athletes from the same cohort were interviewed in focus groups about injury experience and perceptions. The results show that the average bi-weekly prevalence of injury was 38.7% (95% CI 37.3–40.1), with 30.0% (n?=?102) of the athletes injured for more than half of all reporting times. An overarching theme from the focus groups highlighted the risk among young athletes of a loss of identity while injured. The findings support several suggestions that may improve the rehabilitation process and enhance rehabilitation outcomes: (a) provide clear pathways to the medical team, (b) recognize the identity loss, (c) involve the injured athletes with the rest of the teammates and (d) educate athletes about how to interpret pain signals. Future research should explore and evaluate the effectiveness and generalization of such interventions.     

高水平武术运动员心理健康现状及影响因素

以参加全国运动会武术比赛的195名优秀运动员为调查对象，采用SCL-90问卷调查，发现优秀武术运动员各项因子分值大于3的仅占2％～9%；9个因子得分优秀男运动员低于优秀女运动员（P〈0．05）；C组（普通高校武术特长生）和B组（体工队退役队员）运动员对文化知识的迫切度高于A组（体工队现役队员）武术运动员。优秀武术运动员心理健康状况良好；运动员的心理健康状况与性别、文化层次有关，建议在训练中根据运动员性别进行心理调整，并不断提高运动员的文化水平，以创造优异的运动成绩。     

Breast pain affects the performance of elite female athletes

ABSTRACT

Although breast pain is problematic for many active women, no published research has investigated breast pain experienced by elite female athletes. This study aimed to examine the extent that mastalgia and exercise-induced breast pain affected the sporting performance of elite female athletes during training and competition. A custom-designed online survey with questions related to sport participation, as well as the frequency, severity and perceived performance effects of mastalgia and exercise-induced breast pain, was distributed to sporting organisations, coaches, medical staff and teams/clubs throughout Australia. Five hundred and forty female athletes competing nationally or internationally across 49 different sports participated in the survey. Sixty-three percent of respondents reported experiencing breast pain associated with their menstrual cycle and 33% reported that this pain worsened during activity. Forty-four percent of athletes reported experiencing exercise-induced breast pain during training or competition. Both types of breast pain were also reported to negatively affect sporting performance (20% and 32%, respectively). Mastalgia associated with the menstrual cycle and exercise-induced breast pain should be acknowledged as potential problems affecting the sporting performance of elite female athletes. Awareness around the impact of breast pain and the development and implementation of breast pain management strategies are essential for this population.     

我国优秀男子龙舟运动员身体素质评价模型的研究

运用文献资料法,数理统计法,专家访谈法等多种研究方法,对2009年全国龙舟锦标赛、中华龙舟大赛总决赛、2010年亚运会全国选拔赛中各单项前六名的30支优秀男子龙舟队伍的运动员身体素质指标进行研究,通过研究分析,确立我国优秀男子龙舟运动员身体素质的评价模型。结果表明:1)我国优秀男子龙舟运动员的身体素质主要由力量、耐力、柔韧、速度、灵敏5个因子构成,其中力量因子和耐力因子的载荷贡献率较大。2)我国优秀男子龙舟运动员的身体素质特征表现为:力量较大,速度快,耐力突出,反应灵敏,柔韧性很好等特点。3)根据各素质指标测得数据统计分析,按其的权重比例构建评价体系模型,为我国优秀男子龙舟运动员的科学选材和训练提供重要的参考依据。     

Doping control in sport: An investigation of how elite athletes perceive and trust the functioning of the doping testing system in their sport

Doping testing is a key component enforced by anti-doping authorities to detect and deter doping in sport. Policy is developed to protect athletes’ right to participate in doping-free sport; and testing is a key tool to secure this right. Accordingly, athletes’ responses to anti-doping efforts are important. This article explores how the International Standards for Testing, which face different interpretations and challenges when policy is implemented, are perceived by elite athletes. Particularly, this article aims to investigate how elite athletes perceive the functioning of the testing system (i.e., the efforts of stakeholders involved in testing) in their own sport both nationally and worldwide. Moreover, it seeks to identify whether specific factors such as previous experience of testing and perceived proximity of doping have an impact on athletes’ perceptions of the testing system. The study comprises a web-based questionnaire (N = 645; response rate 43%) and uses qualitative findings to elaborate on and explain quantitative results. Results showed that two-thirds of the athletes reported the national testing programme in their sport to be appropriate. A majority of the athletes who had an opinion on the subject regarded testing programmes in some countries as not extensive enough or believed that in certain countries doping control was downgraded to win medals. Past experience of testing seemed to have a positive influence on trust in the concrete measures; however, if athletes experienced flaws during the control procedures, this could increase distrust and cause worry. The proximity of doping in an athlete's sport influenced the athlete's perception of the testing system. Particularly, athletes who need the testing system to be effective and to function well across the world show greater distrust of or dissatisfaction with the current testing system. The athletes’ diverging views indicate that contemporary anti-doping policy is simultaneously met with support, (dis)trust and frustration. By integrating the views and experiences of Danish elite athletes, this study confirms that the current testing system is confronted with obstacles, and it contributes knowledge about some of the challenges WADA faces when policy is implemented. Implications of results and recommendations for anti-doping authorities are outlined in the paper.