More than just physical: Addressing mental health in sports injuries

When we take a surface-level look at athletes as a patient population, clinicians consider them a low-risk population for disease and disorders when compared to the general population. Athletes tend to be more conditioned, more health-conscious and more compliant when given advice on improving their health and ability.

Athletes appreciate their physical health and their ability to thrive in the sports and hobbies they enjoy. They tend to participate in these activities because they help them maintain their physical and mental health. Injuries ultimately affect them not just on a physical level, but also on a mental level. A physician’s understanding of the scope at which injuries affect an athlete is crucial to their recovery.

An athlete’s cognitive and emotional response to an injury, return to activity, concerns of reinjury or incompetency all affect their compliance with treatment as well as their response to rehabilitation. A physician’s role in guiding treatment includes listening to athletes’ concerns about treatment and recovery, as these concerns are identifiable triggers for unmasking mental health conditions, such as major depression in athletes.

Injury to athletes

Injury rates vary by age, gender, level of competition and activity. There are 3.5 million children age 14 or younger injured every year. When we look at older adolescent athletes and college athletes, prevalence rates range, starting at 34% and going as high as 65%. Even when it comes to the notorious weekend warriors, overall injuries can occur eight times per 1,000 hours played.

When athletes get injured, they often need to take time off from their sport. Less severe injuries can take a week or two of rest to recoup. Greater injuries can lead to chronic problems for the rest of an athlete’s career and even life. Up to 50% of college athletes, specifically Division 1 athletes, who suffered severe injuries continue to have a lower quality of life and chronic lifelong pain.

It can be extremely frustrating knowing that an injury that can occur at any time in an athlete’s career can have such long-lasting effects. Even with appropriate rehab, for more serious injuries, returning to full health mentally and physically can be a significant and lifelong challenge.

Mental aspect of being injured

A major aspect of being injured, and one that is significantly less studied than physical injury time, rates and returns, is the mental and emotional aspect of being an injured athlete. An athlete’s psychological and emotional response to injury can either amplify or obstruct their ability to physically recover. Likewise, when athletes can no longer participate in the activities that they once enjoyed, they use their idle time for other activities, some of which could potentially harm their physical and mental health further.

Adolescents are more likely to suffer from negative consequences once injured, such as polysubstance abuse, injury-induced stress, underlying mental health issues and substance use. These concerns can lead to poor decision-making among athletes. This is where physicians can hold a pivotal position in the injured athlete’s life to prevent this decline.

Studies have shown that about 34% of current elite athletes experience anxiety and/or depression, and about 19% suffer from alcohol abuse. In young athletes, prevalence of depression may be as high as 40% in female athletes and 14% in male athletes. Those with more severe injuries experience higher degrees of depressive symptoms.

Concussive injuries are especially concerning, as their nature acutely presents the injured athlete with mental health symptoms such as altered mentation, forgetfulness and irritability. Furthermore, some studies have suggested that 36.5% of adolescent and collegiate athletes exhibited long-term psychological symptoms following a sports-related concussion with the most severe results occurring in orthopedic injuries and injuries that delayed return-to-play.

Additionally, many athletes experience post-concussive depression; compared to athletes without concussion, those with sports-related concussions were found to have a significantly higher degree of depression symptoms.

What physicians can do to prevent this decline

Routinely scheduling appointments with the athlete to “touch base” on both their physical and mental health can play a huge role in the athlete’s healing process. Even potentially using a PHQ-9 and GAD-7 to monitor an athlete’s mental health can be a simple, yet effective way to see the athlete’s condition and open a path to a conversation about how they are progressing post-injury.

Clinicians can also engage in psychologically informed practice by incorporating patient beliefs, attitudes and emotional response into post-injury management to encourage athletes to engage in an effective treatment plan. Examples of this can be setting goals with a patient to motivate them and providing pain education to help athletes conceptualize complex pain to remove fear associated with pain and returning to play.

Referrals to sports psychologists can be a great step to provide patients with more targeted help with post-injury emotional and mental difficulties. Sports psychologists can also help prevent athletes from making poor decisions while they are injured.

Physicians can also encourage injured athletes to stay on the sidelines, pick up new hobbies and continue to focus on rehabilitation. These are all great alternatives to fill the free time the newly injured athlete may have.

A pivotal role

Sports and athletics are an important aspect of health for many individuals. Injuries place not just physical but also mental tolls on these individuals. As physicians, we can help prevent further decline after an injury. A primary care physician can play a pivotal role for these individuals by scheduling routine visits and providing resources, such as a referral to a sports psychologist, that may be unknown to the injured patients.

Ultimately, we may be the reason our athletes continue to believe in their health and make the right choices going forward as they continue their recovery journey.

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