CONTACT AND COLLISION SPORTS PARTICIPATION DURING ADOLESCENCE IS ASSOCIATED WITH REDUCED ANXIETY AND DEPRESSIVE SYMPTOMS

Abstract

Background:

Recently, participation in contact and/or collision youth sports has received attention due to concern over exposure to repetitive head impacts. However, few studies have examined the relative risks and benefits of participation in contact and/or collision sports among young athletes currently engaged in these sports.

Purposes and Hypotheses:

We sought to examine whether participation in contact and/or collision sports during adolescence would be associated with quality of life (QOL) among a sample of healthy adolescent athletes undergoing a pre-participation examination. We hypothesized QOL domains scores would be similar between contact/collision and no/limited contact sport athletes.

Methods:

We conducted a cross-sectional study of adolescent athletes undergoing a pre-participation physical examination. During the assessment, participants completed a sport participation questionnaire and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric-25 Profile, a measure of health-related quality of life. We grouped patients based on reported organized contact/collision or limited/non-contact sports participation in the past year, as delineated by Rice (2008). We compared PROMIS domain scores between groups using Mann-Whitney U tests, and used multivariable linear regression to identify the association between PROMIS domains scores and contact/collision sport participation while adjusting for covariates (sex, age, height, history of bone, muscle, ligament, or tendon injury, history of acute fracture or dislocation) in separate models.

Results:

A total of 281 adolescents participated: 143 (51%) reported contact or collision sport participation in the year prior to the study. There was a significantly greater proportion of females in the no/limited contact sport group compared to the contact/collision sport group (Table 1). There was a significantly greater proportion of contact/collision sport athletes who reported past bone, muscle, ligament, or tendon injuries and acute fracture or dislocation injuries compared to no/limited contact sport athletes (Table 1). Upon univariable comparison, those in the contact/collision sport group reported significantly lower anxiety and depressive symptom domain scores than the no/limited contact sport group (Table 2). After covariate adjustment, contact/collision sport participation was significantly associated with lower anxiety and depressive symptom domain scores (Table 3).

Conclusion:

Adolescents participating in organized contact/collision sports reported lower anxiety and depressive symptoms than adolescents participating in no/limited contact sports. These results reinforce the need to re-examine assumptions that youth contact/collision sports are necessarily associated with negative quality of life. Future prospective studies will be required to better understand any causal relationship between contact sports and psychological well-being in young athletes, both in the short- and long-term.

Table 1.

Demographic and injury history characteristics among both participant groups. Data are presented as means (standard deviation) or n (%).

Variable	Contact/Collision Sport Group (n=143)	No/Limited Contact Sport Group (n=138)	P value
Female sex	34 (24%)	91 (66%)	< 0.001
Age (years)	15.1 (1.7)	15.4 (1.2)	0.07
Height (cm)	170.7 (14.6)	167.9 (8.2)	0.05
Weight (kg)	64.6 (17.0)	63.2 (15.0)	0.46
Average time training per week (hours)	11.6 (4.9)	11.7 (5.0)	0.85
Varsity athlete	52 (36%)	43 (31%)	0.36
History of bone, muscle, ligament, or tendon injury	73 (51%)	40 (29%)	< 0.001
History of acute fracture or dislocation	65 (46%)	35 (26%)	< 0.001
History of stress fracture	12 (9%)	7 (5%)	0.26
History of concussion	35 (25%)	27 (20%)	0.29
Organized Sports Played in the Past Year †	Football: 74 Basketball: 42 Soccer: 29 Wrestling: 12 Gymnastics: 10 Martial arts: 10 Cheerleading: 6 Diving: 2 Extreme Sports: 1 Rugby: 1 Water Polo: 1	Track & Field: 28 Cross Country: 20 Poms: 17 Volleyball: 15 Softball: 14 Swimming: 13 Tennis: 10 Baseball: 7 Golf: 7 Dance: 5 Marching Band: 4 Football (flag/touch): 2 Horseback riding: 1 Racquetball: 1	-

† Participants selected all organized sports they played in the past year, so the total n adds up to > 100%.

Table 2.

Univariable PROMIS domain comparisons between contact/collision and no/limited contact sport groups.

PROMIS Domain	Contact/Collision Sport Group		No/Limited Contact Sport Group		P value
PROMIS Domain	Median [IQR]	Mean (95% CI)	Median [IQR]	Mean (95% CI)	P value
Mobility	0 [0, 0]	0.09 (0.03, 0.15)	0 [0, 0]	0.21 (0.12, 0.31)	0.013
Anxiety	0 [0, 2]	1.55 (1.15, 1.94)	2 [0, 6]	3.26 (2.69, 3.83)	< 0.001
Depressive symptoms	0 [0, 1]	0.82 (0.53, 1.12)	0 [0, 2]	1.88 (1.34, 2.41)	0.005
Fatigue	1 [0, 3]	1.67 (1.27, 2.06)	1 [0, 3]	2.16 (1.69, 2.62)	0.087
Peer relationships	15 [13, 16]	13.6 (12.9, 14.2)	15 [12, 16]	13.0 (12.3, 13.7)	0.183
Pain Interference	0 [0, 2]	1.32 (0.91, 1.73)	0 [0, 2]	1.53 (1.04, 2.02)	0.81
Pain scale	0 [0, 2]	1.08 (0.82, 1.33)	0 [0, 1]	0.89 (0.60, 1.18)	0.06

Table 3.

Effect of contact/collision sport participation on patient reported quality of life outcome measures, adjusting for sex, age, past history of bone, muscle, ligament, tendon injury, bone fracture or dislocation, and height.

	β coefficient	Standard error	95% CI	P value
Mobility	-0.106	0.065	-0.235, 0.022	0.10
Anxiety*	-1.072	0.387	-1.834, -0.310	0.006
Depressive Symptoms*	-0.807	0.344	-1.484, -0.130	0.020
Fatigue	-0.187	0.346	-0.868, 0.494	0.59
Peer relationships	0.434	0.576	-0.700, 1.568	0.45
Pain Interference	-0.118	0.369	-0.845, 0.610	0.75
Pain scale	0.185	0.221	-0.251, 0.621	0.40

^*Those in the contact/collision sport participation group reported significantly lower anxiety and depressive symptom scores than those in the limited/non-contact sport participation group after adjusting for potential confounders.