Mental Health in Injured Athletes: A Narrative and Conceptual Review of Risk-Stratified Psychological Monitoring After Musculoskeletal Injury and Concussion

Athletic injury is a biopsychosocial event rather than a purely mechanical one. Athletes recovering from musculoskeletal injury or sport-related concussion may experience depressive symptoms, anxiety, sleep disruption, fear of reinjury, role disruption, and reduced psychological readiness for return to sport. This article is explicitly presented as a narrative and conceptual review, not as a systematic or scoping review. Its aims are threefold: to synthesize the literature on mental health outcomes after athletic injury; to identify patterns by injury type, age group, competition level, and career stage; and to introduce a conceptual prototype, the Athlete Mental Health Change Index (AMHCI). The reviewed evidence supports several cautious conclusions. First, musculoskeletal injury is consistently associated with short-term psychological distress and impaired return-to-sport confidence. Second, concussion is associated with mood and recovery-related psychological symptoms, while repetitive head-impact exposure and later-life psychiatric outcomes remain associated in some studies but are limited by heterogeneous methods, recall bias, and confounding. Third, psychological response is moderated by premorbid mental health, coping style, athletic identity, social support, and environmental pressure to return prematurely. The AMHCI is presented as a provisional, hypothesis-generating framework rather than a validated clinical instrument. Its five domains and weighting coefficients were derived from theory and an illustrative literature review, not from Delphi consensus, content validity testing, pilot testing, or psychometric calibration. Accordingly, the model should not be used for diagnostic or return-to-sport decision-making without future validation. A validation roadmap is proposed, including assessment of content validity, factor structure, reliability, convergent validity, predictive validity, and threshold calibration.