Current concepts and practical applications for recovery, growth, and peak performance following significant athletic injury.

For decades, physicians, athletic trainers, and other health care professionals have worked to standardize the recovery process following injury to enhance patient outcomes and to help set appropriate goals for return to competition. Traditionally, these efforts have focused primarily on physical and/or physiological aspects of healing with little consideration for psychological aspects. Concurrently, mental health professionals who work with athletes have developed strategies to enhance performance and minimize negative influences of mental aspects of recovery while promoting approaches that include mental as well as physical recovery. Several strategies have emerged that further encourage a multi-faceted and interdisciplinary approach when helping injured patients return to participation. While important in a healthy population, the practical applications of these strategies are likely more critical for an athlete working through the recovery process with an ultimate goal of returning to competition. Despite these realities, both practical experience and a dearth of literature point to the traditional athletic healthcare providers' common focus on physical aspects of recovery and psychological professionals' focus primarily on mental aspects has resulted in sub-optimal outcomes compared to the likely benefits of an integrated approach. This article is intended to characterize current concepts in the fields of sport psychology and mental health concerning the importance of mental aspects of recovery in returning to play. Next, the authors will examine how modern theories can influence practice and discuss how these strategies can be effectively integrated and leveraged to enhance recovery and the athlete's enjoyment of the rehabilitation and ultimately restoration process.

The Strong, Silent Type(ology): Examining Intersections of Alexithymia and the Drive for Muscularity.

This study used latent profile analysis to explore the interrelations of drive for muscularity (DM) and alexithymia among 505 men. Four unique classes of men emerged: (1) low endorsement of DM and alexithymia, (2) moderate endorsement of alexithymia and DM, (3) moderate endorsement of alexithymia and high endorsement of attitudinal and behavioral DM, and (4) high endorsement of DM attitudes and alexithymia, and low endorsement of DM behaviors. We explored relations between class membership and avoidant attachment, social pressure to be muscular, help-seeking attitudes, and body appreciation, using Class 1 as the reference group. Alexithymia and attitudinal DM, in the absence of behavioral DM, appear to be a particularly unhealthful constellation of alexithymia and DM.

Sexual orientation, bullying for being labeled gay or bisexual, and steroid use among US adolescent boys.

Use of anabolic-androgenic steroids is a public health concern for adolescent boys. This study examined bullying based on being labeled gay/bisexual and steroid use among US adolescent boys, including sexual orientation disparities. Data from 2660 boys from the 2015 Youth Behavior Risk Survey were used. Among heterosexual boys, steroid use was higher among those who reported being bullied due to being labeled gay or bisexual. No such relationship existed among non-heterosexual boys. The results speak to the need to address issues of masculinity in clinical work with boys and young men.

Men's Mental Health Help-Seeking Behaviors: An Intersectional Analysis.

Men seek mental health treatment less often than women. The present study sought to elucidate identities and individual difference characteristics that are associated with enhanced or decreased mental health help-seeking in a large national sample of U.S. men. Using data from 4,825 U.S. men aged 20 to 59 years, main effects of race/ethnicity, sexual orientation, age, income-poverty ratio, relationship status, depression symptoms, and body mass index were explored within the sample of men as well as intersections of these predictors with racial/ethnic group identity. While the results of main effects testing generally supported prior research (i.e., greater mental health care help-seeking among White men, nonheterosexual men, men not in relationships, older men, and more depressed men), when examined associations across racial/ethnic groups, the direction and strength of these associations showed notable variation-variation unaccounted for in prior research. These findings highlight the need for future theory building and research that accounts for this variation at the intersection of race/ethnicity and these specific predictors of help-seeking behavior among men.

Racial Disparities in Substance Use by Sport Participation Among High School Students.

OBJECTIVE: The purpose of this study was to assess the association between team sport participation and substance use, and racial/ ethnic disparities, among U.S. adolescents. METHOD: Data from 6,721 male and 6,761 female high school students in the 2013 Youth Behavior Risk Survey were used. Logistic regression was used to assess the relationship between team sport participation and substance use across gender and race/ethnicity. RESULTS: Among males, participation in team sports was associated with increased risk for use of smokeless tobacco (odds ratio [OR] = 1.81, 95% CI [1.42, 2.32]), alcohol (OR = 1.30, 95% CI [1.11, 1.52]), and steroids (OR = 1.69, 95% CI [1.26, 2.27]), and decreased risk for use of smoked tobacco (OR = 0.80, 95% CI [0.65, 0.99]) and inhalants (OR = 0.67, 95% CI [0.53, 0.85]). Among females, participation in team sports was associated with increased risk for use of smokeless tobacco (OR = 1.49, 95% CI [1.03, 2.18]) and diet pills (OR = 1.31, 95% CI [1.02, 1.68]), and decreased risk for use of smoked tobacco (OR = 0.60, 95% CI [0.50, 0.72]), cocaine (OR = 0.66, 95% CI [0.46, 0.94]), and prescription drugs (OR = 0.77, 95% CI [0.67, 0.89]). When examined within specific racial/ethnic groups, these patterns were not consistent. CONCLUSIONS: High school athletes are at increased risk for use of smokeless tobacco as well as alcohol, steroids, and diet pills. At the same time, they are at lower risk for use of smoked tobacco, inhalants, and cocaine, compared with non-athlete peers. Specific intersections of race/ethnicity and gender demonstrated deviations from these patterns.

"The Worst Experience of My Life": The Internship Crisis and Its Impact on Students.

OBJECTIVE: The objective of the present study was to understand how internship applicants perceive themselves as being affected by the ongoing imbalance between the number of internship spots available and the number of applicants to internship. METHOD: The present study undertook a qualitative, and supplemental quantitative, analysis of 1,076 internship applicant responses to an item included in the 2011 postmatch survey asking participants how the internship crisis has affected them. RESULTS: Results indicated that the internship application process in general was viewed overwhelmingly negatively. Respondents described personal stress and system issues in their responses. Respondents described reciprocal stresses; applications spur on stresses, which are compounded by fears of not matching. Such fears cast negative light on training. Participants also described resiliencies that buffered against stresses and perceptions of discrimination or bias that add to stress. CONCLUSIONS: The implications of these findings for supporting students, working to resolve the internship crisis, and adapting policy are discussed.

Moderated mediation of the relationships between masculinity ideology, outcome expectations, and energy drink use.

OBJECTIVE: The consumption of energy drinks is a growing health-risk behavior for young men in the United States. The present study investigated the relationship between masculinity ideology, outcome expectations, energy drink use, and sleep disturbances. METHOD: The authors recruited 467 adult males from universities and the Internet who provided data on their endorsement of traditional masculinity ideology, outcome expectations for use of energy drinks, use of energy drinks, and sleep disturbances. A theoretical model positing moderated mediation was tested using structural equation modeling and conditional process modeling. RESULTS: The results supported the hypothesized model in which endorsement of traditional masculinity ideology was linked with increased outcome expectations for benefits of energy drinks, which in turn was linked with increased energy drink consumption, and which finally was linked with greater sleep disturbance symptoms. The relationship between masculinity ideology and energy drink outcome expectations was moderated by age (significant for younger men but not for older men), and the relationship between energy drink outcome expectations and energy drink use was moderated by race (significant for White men but not for racial minority men). CONCLUSION: The present study adds to the literature on potential negative health implications of the endorsement of traditional masculinity ideology by offering a link between predictors of energy drink use (masculinity ideology, outcome expectations) and health outcomes of energy drink use (e.g., sleep disturbance).