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 sex34 (24%)91 (66%)< 0.001Age (years)15.1 (1.7)15.4 (1.2)0.07Height (cm)170.7 (14.6)167.9 (8.2)0.05Weight (kg)64.6 (17.0)63.2 (15.0)0.46Average time training per week (hours)11.6 (4.9)11.7 (5.0)0.85Varsity athlete52 (36%)43 (31%)0.36History of bone, muscle, ligament, or tendon injury73 (51%)40 (29%)< 0.001History of acute fracture or dislocation65 (46%)35 (26%)< 0.001History of stress fracture12 (9%)7 (5%)0.26History of concussion35 (25%)27 (20%)0.29Organized Sports Played in the Past Year †Football: 74Basketball: 42Soccer: 29Wrestling: 12Gymnastics: 10Martial arts: 10Cheerleading: 6Diving: 2Extreme Sports: 1Rugby: 1Water Polo: 1Track & Field: 28Cross Country: 20Poms: 17Volleyball: 15Softball: 14Swimming: 13Tennis: 10Baseball: 7Golf: 7Dance: 5Marching Band: 4Football (flag/touch): 2Horseback riding: 1Racquetball: 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 DomainContact/Collision Sport Group No/Limited Contact Sport GroupP valueMedian [IQR]Mean (95% CI) Median [IQR]Mean (95% CI)Mobility0 [0, 0]0.09 (0.03, 0.15) 0 [0, 0]0.21 (0.12, 0.31)0.013Anxiety0 [0, 2]1.55 (1.15, 1.94) 2 [0, 6]3.26 (2.69, 3.83)< 0.001Depressive symptoms0 [0, 1]0.82 (0.53, 1.12) 0 [0, 2]1.88 (1.34, 2.41)0.005Fatigue1 [0, 3]1.67 (1.27, 2.06) 1 [0, 3]2.16 (1.69, 2.62)0.087Peer relationships15 [13, 16]13.6 (12.9, 14.2) 15 [12, 16]13.0 (12.3, 13.7)0.183Pain Interference0 [0, 2]1.32 (0.91, 1.73) 0 [0, 2]1.53 (1.04, 2.02)0.81Pain scale0 [0, 2]1.08 (0.82, 1.33) 0 [0, 1]0.89 (0.60, 1.18)0.06Table 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 -0.1060.065-0.235, 0.0220.10 Anxiety* -1.0720.387-1.834, -0.3100.006 Depressive Symptoms* -0.8070.344-1.484, -0.1300.020 Fatigue -0.1870.346-0.868, 0.4940.59 Peer relationships 0.4340.576-0.700, 1.5680.45 Pain Interference -0.1180.369-0.845, 0.6100.75 Pain scale 0.1850.221-0.251, 0.6210.40 *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.