Teammates On And Off The Field: Mental Health Following Bone Stress Injury

Bone Stress Injuries (BSIs) are common overuse injuries in athletes that result from repetitive mechanical loading and require several weeks or months away from sport. Athletes, compared to the general population, are at higher risk for depression and anxiety. Moreover, individual athletes have higher rates of depression and anxiety than team sport athletes. However, the relationship between BSI and mental health among team and individual sport athletes is unexplored. PURPOSE: To determine the relationship between number of historical BSIs and Participant Health Questionnaire (PHQ-9: indicator of depression) scores and to determine whether this relationship differs between those who participate on team vs. individual sports. METHODS: A group (n = 777) of male athletes ages 14-35 years, completed a questionnaire containing the PHQ-9 (scores of 5, 10, 15, and 20 represent mild, moderate, moderately severe, and severe depression, respectively), questions on sport participation, BSI history, and demographic information. Linear and logistic regression models were used to determine relationships between BSI and PHQ-9 scores. RESULTS: Athletes were young (mean age: 18.4 ± 3 years), with healthy body mass index (BMI) (mean BMI: 24.2 ± 5.5 kg/m2). 744 athletes had normal PHQ-9 scores (<10), and 69 had abnormal PHQ-9 scores (>10). There was no relationship between number of historical BSIs and PHQ-9 score among the entire cohort or for athletes participating in team sports. However, for athletes in individual sports (n = 146, 18.5%), each additional historical BSI represents a 65% increase in the odds of having a PHQ score indicative of moderate to severe depression [OR: 1.65 (95% CI: 1.01, 2.7)]. CONCLUSIONS: Our findings reveal that athletes competing in individual sports who sustain repeated BSIs are more likely to experience indicators of depression than those sustaining a single BSI or those competing in team sports. These findings highlight a need for multi-disciplinary care, particularly among individual sport athletes recovering from injuries requiring prolonged absence from sport.