Social support from the athletic trainer and symptoms of depression and anxiety at return to play.

CONTEXT: Few empirical studies have examined social support from athletic trainers (ATs) and its buffering effect during injury recovery. OBJECTIVE: To examine the effect of social support received from ATs during injury recovery on reported symptoms of depression and anxiety at return to play among a cohort of collegiate athletes. DESIGN: Cohort study. SETTING: Two Big 10 Conference universities. PATIENTS OR OTHER PARTICIPANTS: A total of 594 injuries sustained by 387 collegiate athletes (397 injuries by 256 males, 197 injuries by 131 females) on 9 sports teams. MAIN OUTCOME MEASURE(S): Data were collected during the 2007-2011 seasons. Social support was measured using the 6-item Social Support Questionnaire. Symptoms of depression were assessed using the Center for Epidemiological Studies Depression Scale. Anxiety was measured by the State-Trait Anxiety Inventory. We used generalized estimation equation regression models to examine the effect of the social support from ATs on the odds of symptoms of depression and anxiety at return to play. RESULTS: In 84.3% (n = 501) of injury events, injured athletes received social support from ATs during their recovery. Of these, 264 (53.1%) athletes reported being very satisfied with this social support. Whether or not athletes received social support from ATs during recovery did not affect the symptoms of depression or anxiety experienced at return to play. However, compared with athletes who were dissatisfied with the social support received from ATs, athletes who were very satisfied or satisfied with this social support were 87% (95% confidence interval = 0.06, 0.30) and 70% (95% confidence interval = 0.13, 0.70) less likely to report symptoms of depression at return to play, respectively. Similar results were observed for anxiety. CONCLUSIONS: Our findings support the buffering effect of social support from ATs and have important implications for successful recovery in both the physical and psychological aspects for injured athletes.

Evaluation of Period of PURPLE Crying, an abusive head trauma prevention program.

The Period of PURPLE Crying program is used to educate parents and caregivers about normal infant crying and the dangers of infant shaking. We evaluated nurse-led, hospital-based implementation of the program using a nonexperimental, posttest-only design. New mothers rated the program as useful, and the program was effective in teaching mothers about normal infant crying, the dangers of infant shaking, and soothing and coping techniques. The findings support the feasibility and need for broad dissemination of the program.

Influence of symptoms of depression and anxiety on injury hazard among collegiate American football players.

The purpose of this study was to examine the effect of depression and anxiety symptoms on the prospective injury hazard among collegiate American football athletes. An open cohort of intercollegiate football players (n = 330) from two Division I universities were enrolled and followed during the 2008-2010 seasons. Of 330 enrolled players, 121 (36.7%) sustained at least one injury during the participation period. A total of 66 players (20.0%) reported experiencing symptoms of depression and 109 (33.0%) reported anxiety at the time of enrollment. Depression was associated with increased likelihood of injury (hazard ratio (HR) = 1.81, 95% confidence interval (CI): 1.65, 1.98). Anxiety had an opposite effect and was protective from injury hazard (HR= 0.79, 95% CI: 0.66, 0.93). Football players who experienced depression at enrollment were 10% less likely to remain injury-free than those who did not have depressive symptoms. Evidence from this study suggests injury prevention efforts need to include strategies targeting psychological risk factors.

Postinjury anxiety and social support among collegiate athletes: a comparison between orthopaedic injuries and concussions.

CONTEXT: When an athlete is injured, the primary focus of the sports medicine team is to treat the physical effects of the injury. However, many injured athletes experience negative psychological responses, including anxiety, regarding their injury. OBJECTIVE: To compare the anxiety and social support of athletes with concussions and a matched group of athletes with orthopaedic injuries. DESIGN: Cross-sectional study. SETTING: Athletic training room. PATIENTS OR OTHER PARTICIPANTS: A total of 525 injuries among athletes from 2 Big Ten universities were observed. Of these, 63 concussion injuries were matched with 63 orthopaedic injuries for the athlete's sex, sport, and time loss due to injury. MAIN OUTCOME MEASURE(S): Clinical measures included the State-Trait Anxiety Inventory (which measures both state and trait anxiety) and the modified 6-item Social Support Questionnaire. RESULTS: The group with concussions relied on their family for social support 89% of the time, followed by friends (78%), teammates (65%), athletic trainers (48%), coaches (47%), and physicians (35%). The group with orthopaedic injuries relied on their family for social support 87% of the time, followed by friends (84%), teammates (65%), athletic trainers (57%), coaches (51%), and physicians (36%). We found no differences for the State-Trait Anxiety Inventory (t = -1.38, P = .193) between the concussed and orthopaedic-injury groups. Social Support Questionnaire scores were significant predictors for postinjury state anxiety. Specifically, increased scores were associated with decreased postinjury state anxiety (ß = -4.21, P = .0001). CONCLUSIONS: Both the concussed athletes and those with orthopaedic injuries experienced similar state and trait anxiety and relied on similar sources of social support postinjury. However, athletes with orthopaedic injuries reported greater satisfaction with support from all sources compared with concussed athletes. In contrast, concussed athletes showed more significant predictor models of social support on state anxiety at return to play.

Epidemiology of overuse and acute injuries among competitive collegiate athletes.

CONTEXT: Although overuse injuries are gaining attention, epidemiologic studies on overuse injuries in male and female collegiate athletes are lacking. OBJECTIVE: To report the epidemiology of overuse injuries sustained by collegiate athletes and to compare the rates of overuse and acute injuries. DESIGN: Descriptive epidemiology study. SETTING: A National Collegiate Athletic Association Division I university. PATIENTS OR OTHER PARTICIPANTS: A total of 1317 reported injuries sustained by 573 male and female athletes in 16 collegiate sports teams during the 2005-2008 seasons. MAIN OUTCOME MEASURE(S): The injury and athlete-exposure (AE) data were obtained from the Sports Injury Monitoring System. An injury was coded as either overuse or acute based on the nature of injury. Injury rate was calculated as the total number of overuse (or acute) injuries during the study period divided by the total number of AEs during the same period. RESULTS: A total of 386 (29.3%) overuse injuries and 931 (70.7%) acute injuries were reported. The overall injury rate was 63.1 per 10 000 AEs. The rate ratio (RR) of acute versus overuse injuries was 2.34 (95% confidence interval [CI] = 2.05, 2.67). Football had the highest RR (RR = 8.35, 95% CI = 5.38, 12.97), and women's rowing had the lowest (RR = 0.75, 95% CI = 0.51, 1.10). Men had a higher acute injury rate than women (49.8 versus 38.6 per 10 000 AEs). Female athletes had a higher rate of overuse injury than male athletes (24.6 versus 13.2 per 10,000 AEs). More than half of the overuse injuries (50.8%) resulted in no time loss from sport. CONCLUSIONS: Additional studies are needed to examine why female athletes are at greater risk for overuse injuries and identify the best practices for prevention and rehabilitation of overuse injuries.

Social support patterns of collegiate athletes before and after injury.

CONTEXT: Social support has been identified as an important factor in facilitating recovery from injury. However, no previous authors have prospectively assessed the change in social support patterns before and after injury. OBJECTIVE: To examine the preinjury and postinjury social support patterns among male and female collegiate athletes. DESIGN: Prospective observational study. SETTING: A Big Ten Conference university. PATIENTS OR OTHER PARTICIPANTS: A total of 256 National Collegiate Athletic Association Division I male and female collegiate athletes aged 18 or older from 13 sports teams. MAIN OUTCOME MEASURE(S): Injury incidence was identified using the Sports Injury Monitoring System. Social support was measured using the 6-item Social Support Questionnaire. Data on preinjury and postinjury social support patterns were compared. RESULTS: Male athletes reported more sources of social support than female athletes, whereas female athletes had greater satisfaction with the support they received. Athletes' social support patterns changed after they became injured. Injured athletes reported relying more on coaches (P = .003), athletic trainers (P < .0001), and physicians (P = .003) for social support after they became injured. Athletes also reported greater postinjury satisfaction with social support received from friends (P = .019), coaches (P = .001), athletic trainers (P < .0001), and physicians (P = .003). CONCLUSIONS: Our findings identify an urgent need to better define the psychosocial needs of injured athletes and also strongly suggest that athletic trainers have a critical role in meeting these needs.

Incidence and characteristics of school bus crashes and injuries.

OBJECTIVE: Studies of school bus crashes have focused on the biomechanics of catastrophic collisions, with very few examining crash incidence. METHODS: Crashes in the state of Iowa were examined from January 2002 through December 2005. School bus crashes were identified through the Iowa Crash Data, a comprehensive database of all reported crashes in the State of Iowa. School bus mileage data were provided by the Iowa Department of Education. School bus crash, fatality, and injury rates were calculated and differences in crash and injury characteristics between school buses and other vehicles were examined. RESULTS: The school bus crash, fatality and non-fatal injury rates were 320.7, 0.4 and 13.6 per 100 million bus miles travelled, respectively. School bus crash fatality and injury rates were 3.5 and 5.4 times lower than overall all vehicle crash fatality and injury rates, respectively. Drivers of other vehicles were more likely to have caused the crash than the bus driver (P<0.001). CONCLUSIONS: School buses experience low crash rates, and the majority of crashes do not lead to injury. Buses are among the safest forms of road transportation, and efforts to educate drivers of other vehicles may help reduce crashes with buses.