Race and Socioeconomic Status Influence the Benefits of Returning to Sports During COVID-19

ABSTRACT

Purpose: It is unknown whether certain populations of athletes benefit more from returning to sport following COVID-19 restrictions than others. The purpose of this study was to determine whether socioeconomic status (SES), race, or gender moderate the benefits of returning to sports during COVID-19. Method(s) Adolescents who participated in sports before COVID-19 reported sport participation, anxiety (GAD-7), and depression (PHQ-9) inMay 2021. The interactions of return to sport (yes [PLY], no [DNP]) and (1) sex, (2) race (white, nonwhite), and (3) SES (low vs high county household income) to predict anxiety and depression were evaluated, adjusted for age, school instruction, and concern about COVID-19. Result(s) Four thousand eight hundred seventy-four participants were included (16.1 +/- 1.3 years;52% female;PLY = 4456;DNP = 418). DNP had greater symptoms of anxiety (7.8 60.6 v 5.6+/-0.5, P<0.001) and depression (8.8+/-0.6 v 5.76 0.6, P < 0.001) and had significantly more non-white athletes (36% v 19%, P < 0.001), but no significant differences were identified with respect to gender, instructional delivery method, median county household income, or age. Compared with white athletes, adolescent athletes from racial minority groups who returned to sports had relatively greater decreases in anxiety (interaction estimate (b) = -1.18 +/- 0.6, P = 0.036) and depression (b=-1.19+/-0.6, P=0.045). Similarly, athletes from counties with lower household incomes who returned to sports had relatively greater decreases in anxiety (b= -1.23 +/-0.5, P = 0.017) and depression (b=-1.21+/-0.6, P=0.032). The benefits of returning to sports for female athletes were similar to male athletes with respect to anxiety (b = -0.16 +/-0.5, P = 0.76) and depression (beta = 0.49 +/- 0.6, P = 0.37). Conclusion(s) In this nationwide sample of adolescent athletes, returning to sport during COVID-19 was associated with significant mental health benefits for adolescent athletes. However, the greatest benefits were seen among athletes from racial minority groups and areas of lower household income. No differences in the mental health benefits of returning to sports were identified between male and female athletes. Significance: Restriction from sports may disproportionately impact the mental health of certain groups of adolescent athletes. Expanding access to sports for traditionally underserved groups can potentially provide significant mental health benefits.