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 (β = −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.Key Words: psychology, state anxiety, trait anxiety, return to play

Key Points

• Athletes with concussions or orthopaedic injuries showed similar levels of state and trait anxiety.
• Sources of social support were similar for athletes with concussions and orthopaedic injuries.
• Compared with concussed athletes, athletes with orthopaedic injuries reported more satisfaction with social support from all sources.
• Compared with athletes who sustained orthopaedic injuries, concussed athletes showed more significant predictor models of social support on state anxiety at return to play. These differences may reflect the nature of injury, suggesting that additional research is needed to understand the relationship of social-support satisfaction and postinjury anxiety by injury type.

With approximately 444 000 National Collegiate Athletic Association athletes competing annually, athletic injuries are likely to occur. According to the association''s injury-surveillance system, about 12 500 athletic injuries are sustained each year.¹ 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.^2,3 Anxiety in athletes with orthopaedic injuries may result from the cognitive appraisal of the injury rather than from the injury itself.^4,5 In contrast, anxiety in athletes with concussions may result from both cognitive appraisal and physiologic sequelae.⁶ Social support has been shown to mediate both the physical and psychological effects of athletic injury.⁷ Yet the relationship between anxiety and social support in concussed athletes compared with athletes with orthopaedic injuries is unknown.Injured athletes may exhibit trait anxiety related to perceived loss of athleticism, lack of social support, pain, and fear of reinjury.^3,8,9 Injured athletes with high levels of trait anxiety may also experience high levels of state anxiety postinjury.¹⁰ Factors such as injury severity and time loss from practice or competition can influence whether or not athletes experience high or low levels of trait anxiety.¹¹ Although anxiety after orthopaedic injuries has received attention in the literature, considerably less research has been conducted on anxiety in concussed athletes.Concussion is often referred to as the “invisible injury.”⁶ A concussed athlete who is experiencing lingering headaches and memory difficulties does not outwardly look any different from uninjured peers. Furthermore, it may be difficult to distinguish anxiety as a symptom of concussion from anxiety as a psychological effect.^6,12In a recent study,¹³ concussed athletes did not experience as much emotional disturbance as athletes with anterior cruciate ligament injuries. Although these authors did not exclusively examine anxiety symptoms of concussed athletes versus those with orthopaedic injuries, emotional disturbances do seem to differ between the groups, which provides a framework for future studies.When working with injured athletes who are experiencing anxiety, it is important to also consider coping mechanisms that may facilitate recovery. The integrated model of psychological response to sport injury⁵ suggests that coping resources may be salient factors in an athlete''s postinjury psychological state. Seriously injured athletes will seek social support as a coping mechanism.^11,14,15 Common types of social support that are useful for injured athletes include emotional support (eg, empathy), tangible support (eg, practical assistance), and informational support (eg, problem solving).^11,15,16The social-support network for injured athletes often consists of family and friends, health professionals, coaches, teammates, and other injured athletes.^11,15,17,18 Flint¹⁸ described how modeling of successful recovery by fellow or formerly injured athletes may be a helpful form of support and confidence for currently injured athletes. This modeling may provide currently injured athletes with information that aids their ability to successfully manage the recovery process.Literature within the sport-injury domain has shown that athletes may turn to coaches and health professionals (eg, athletic trainers [ATs]) for emotional support.^7,16,17,19 Injured athletes may view ATs as an important source of emotional support given the amount of time injured athletes spend rehabilitating their injuries in the athletic training room.^7,17,19 However, this may be different for athletes with concussions. Concussions often lack any outward physical signs of a sport injury (eg, braces, crutches). Additionally, athletes with concussions may spend less time in the athletic training room than athletes with orthopaedic injuries because concussion symptoms are usually managed by the athlete, with guidance from the ATs. Thus, athletes in the athletic training room may receive a more viable sense of social support.To our knowledge, no authors have examined differences in anxiety and social support between athletes who have sustained a concussion versus an orthopaedic injury. Understanding how anxiety and social support compare between athletes with concussions and those with orthopaedic injuries is important when the clinician attempts to provide a holistic approach to rehabilitation. Persons within an athlete''s social-support network who are more aware of their roles as social-support providers can help the athlete manage postinjury anxiety. Therefore, our objective was to compare the anxiety and social support of athletes with concussions versus a matched group of athletes with orthopaedic injuries.     

Postural Stability and Neuropsychological Deficits After Concussion in Collegiate Athletes

OBJECTIVE: Postural stability and neuropsychological testing are gradually becoming integral parts of postconcussion assessment in athletes. Clinicians, however, sometimes question the viability of instituting preseason baseline testing and the value of these results in making return-to-play decisions. Our purpose was to examine the course of recovery on various postural stability and neuropsychological measures after sport-related concussion. A secondary goal was to determine if loss of consciousness and amnesia, both of which are heavily weighted in most of the concussion classification systems, affect the rate of recovery. DESIGN AND SETTING: All subjects underwent a battery of baseline postural stability and neuropsychological tests before the start of their respective seasons. Any athletes subsequently injured were followed up at postinjury days 1, 3, and 5. Matched control subjects were assessed using the same test battery at the same time intervals. SUBJECTS: We studied 36 Division I collegiate athletes who sustained a concussion and 36 matched control subjects. MEASUREMENTS: We assessed postural stability using the Sensory Organization Test on the NeuroCom Smart Balance Master System and the Balance Error Scoring System. Neurocognitive functioning was measured with several neuropsychological tests: Trail-Making Test, Wechsler Digit Span Test, Stroop Color Word Test, and Hopkins Verbal Learning Test. RESULTS: Injured subjects demonstrated postural stability deficits, as measured on both the Sensory Organization Test and Balance Error Scoring System. These deficits were significantly worse than both preseason scores and matched control subjects' scores on postinjury day 1. Only the results on the Trail-Making Test B and Wechsler Digit Span Test Backward resulted in a logical recovery curve that could explain lowered neuropsychological performance due to concussive injury. Significant differences were revealed between the control and injured groups at day 1 postinjury, but a significant decline between baseline and postinjury scores was not demonstrated. Loss of consciousness and amnesia were not associated with increased deficits or slowed recovery on measures of postural stability or neurocognitive functioning. CONCLUSIONS: Athletes with cerebral concussion demonstrated acute balance deficits, which are likely the result of not using information from the vestibular and visual systems effectively. Neurocognitive deficits are more difficult to identify in the acute stages of concussion, although concentration, working memory, immediate memory recall, and rapid visual processing appear to be mildly affected. More research is necessary to determine the best neuropsychological test battery for assessing sport-related concussion.     

Overcoming barriers to implementation of evidence-based practice concepts in athletic training education: perceptions of select educators

Context:

The need to include evidence-based practice (EBP) concepts in entry-level athletic training education is evident as the profession transitions toward using evidence to inform clinical decision making.

Objective:

To evaluate athletic training educators'' experience with implementation of EBP concepts in Commission on Accreditation of Athletic Training Education (CAATE)-accredited entry-level athletic training education programs in reference to educational barriers and strategies for overcoming these barriers.

Design:

Qualitative interviews of emergent design with grounded theory.

Setting:

Undergraduate CAATE-accredited athletic training education programs.

Patients or Other Participants:

Eleven educators (3 men, 8 women). The average number of years teaching was 14.73 ± 7.06.

Data Collection and Analysis:

Interviews were conducted to evaluate perceived barriers and strategies for overcoming these barriers to implementation of evidence-based concepts in the curriculum. Interviews were explored qualitatively through open and axial coding. Established themes and categories were triangulated and member checked to determine trustworthiness.

Results:

Educators identified 3 categories of need for EBP instruction: respect for the athletic training profession, use of EBP as part of the decision-making toolbox, and third-party reimbursement. Barriers to incorporating EBP concepts included time, role strain, knowledge, and the gap between clinical and educational practices. Suggested strategies for surmounting barriers included identifying a starting point for inclusion and approaching inclusion from a faculty perspective.

Conclusions:

Educators must transition toward instruction of EBP, regardless of barriers present in their academic programs, in order to maintain progress with other health professions'' clinical practices and educational standards. Because today''s students are tomorrow''s clinicians, we need to include EBP concepts in entry-level education to promote critical thinking, inspire potential research interest, and further develop the available body of knowledge in our growing clinical practice.     

Collegiate Athletic Trainers' Confidence in Helping Female Athletes With Eating Disorders

OBJECTIVE: To examine college athletic trainers' confidence in helping female athletes who have eating disorders. DESIGN AND SETTING: We mailed a 4-page, 53-item survey to head certified athletic trainers at all National Collegiate Athletic Association Division IA and IAA institutions (N = 236). A 2- wave mailing design was used to increase response rate. SUBJECTS: A total of 171 athletic trainers returned completed surveys for a response rate of 77%. Eleven institutions either did not identify their head athletic trainer or did not have an identifiable mailing address. Two surveys were undeliverable because of incorrect mailing addresses. MEASUREMENTS: The survey consisted of 4 subscales: (1) efficacy expectation, (2) outcome expectation, (3) outcome value, and (4) experience in dealing with eating disorders. Content validity was established by review from a national panel of experts. Reliability ranged from.66 to.73 for the subscales. RESULTS: Although virtually all athletic trainers (91%) had dealt with a female athlete with an eating disorder, only 1 in 4 (27%) felt confident identifying a female athlete with an eating disorder, and only 1 in 3 (38%) felt confident asking an athlete if she had an eating disorder. One in 4 athletic trainers (25%) worked at an institution that did not have a policy on handling eating disorders. Almost all athletic trainers (93%) felt that increased attention needs to be paid to preventing eating disorders among collegiate female athletes. CONCLUSIONS: Collegiate athletic programs are encouraged to develop and implement eating-disorder policies. Continuing education on the prevention of eating disorders among athletes is also strongly recommended.     

National collegiate athletic association division and primary job title of athletic trainers and their job satisfaction or intention to leave athletic training

Context:

Membership in the National Athletic Trainers'' Association (NATA) has declined in recent years, generating much debate about professional commitment.

Objective:

To compare the contributing factors of job satisfaction and intention to leave athletic training of certified athletic trainers (ATs) employed in National Collegiate Athletic Association (NCAA) institutions.

Design:

Cross-sectional study.

Setting:

A link to a Web-based questionnaire containing the Spector Job Satisfaction Survey (JSS) and an original Intention to Leave Survey (ITLS) was distributed by e-mail to 1003 certified members of the National Athletic Trainers'' Association.

Patients or Other Participants:

A total of 191 certified members of the NATA employed in a college or university setting in a primarily clinical capacity; representing all NCAA divisions; and having the job title of head athletic trainer, associate/assistant athletic trainer, or graduate assistant/intern athletic trainer.

Main Outcome Measure(s):

We used separate 3 × 3 factorial analyses of variance to compare the mean scores of each JSS subscale and of the ITLS with NCAA division and job title. A stepwise multiple regression was used to determine the strength of the relationships between the JSS subscales and the ITLS.

Results:

We found differences for job title in the subscales of Fringe Benefits (F_2,182 = 7.82, P = .001) and Operating Conditions (F_2,182 = 12.01, P < .001). The JSS subscale Nature of Work was the greatest indicator of intention to leave (β = −0.45).

Conclusions:

We found a strong negative correlation between various facets of job satisfaction and intention to leave athletic training. The NCAA division seemed to have no effect on an individual''s job satisfaction or intention to leave the profession. In addition, only Fringe Benefits and Operating Conditions seemed to be affected by job title. The ATs had similar levels of job satisfaction regardless of NCAA division, and their job titles were not a major factor in job satisfaction.     

Analysis of Injury Rates and Treatment Patterns for Time-Loss and Non-Time-Loss Injuries Among Collegiate Student-Athletes

OBJECTIVE: To compare the injury rates for time-loss and non-time-loss injuries among selected intercollegiate athletic programs and to describe the number of treatments associated with these injuries. DESIGN AND SETTING: A volunteer, cross-sectional cohort study of 50 collegiate athletic programs representing the 3 National Collegiate Athletic Association divisions, the National Association of Intercollegiate Athletics, and the National Junior College Athletic Association during the 2000-2002 academic years. SUBJECTS: Individuals listed on the team rosters for the participating institutions and representing the sports associated with the institution's athletic programs. MEASUREMENTS: The athletic training staff and students recorded the injury and treatment data for the participating institutions. The data included information for time-loss and non- time-loss injuries, daily treatments, and daily athlete-exposures. RESULTS: Non-time-loss injury rates were 3.5 (confidence interval = 3.4, 3.6) times the time-loss rate for men and 5.1 (confidence interval = 4.9, 5.2) times the time-loss rate for women. Non-time-loss injuries required more treatments over the course of the year than did time-loss injuries. For men's sports, 22% of the injuries resulted in loss of participation time, with 47% of the treatments associated with these injuries. For women's sports, 16% of the injuries and 34% of the treatments were associated with time-loss injuries. CONCLUSIONS: Throughout the sports medicine year, athletic training staff and students spent more time delivering treatments to athletes who were not missing participation time than to athletes who were missing time. A noteworthy difference in the workforce available to provide health care among the various levels of intercollegiate athletics may contribute to the frequency of injury and treatments reported.     

Predictors and Prevalence of Postconcussion Depression Symptoms in Collegiate Athletes

Context:

Depression is common after concussion and is associated with functional outcome and quality of life after injury. However, few baseline predictors of postconcussion depressive symptoms (PCDS) have been found.

Objective:

To describe the prevalence of depressive symptoms in a collegiate athlete sample at baseline and postconcussion, compare these levels of symptoms and change in symptoms with those of a control group with no reported concussions in the past year, and examine the baseline predictors for PCDS.

Design:

Case-control study.

Setting:

Undergraduate institution.

Patients or Other Participants:

Participants were 84 collegiate athletes (65 men, 19 women) with concussion and 42 individuals (23 men, 21 women) with no history of recent concussion who served as controls.

Main Outcome Measure(s):

The Beck Depression Inventory–Fast Screen was administered to the concussion group at baseline and postconcussion and to the control group at 2 time points.

Results:

Seventeen athletes (20%) showed a reliable increase in depression, and more athletes reported clinically important depression postconcussion than at baseline. Only 2 participants (5%) in the control group showed a reliable increase in depression. Concussed athletes were more likely to show a reliable increase in depression symptoms than control participants (χ²₁ = 5.2, P = .02). We also found several predictors of PCDS in the athletes, including baseline depression symptoms (r = 0.37, P < .001), baseline postconcussion symptoms (r = 0.25, P = .03), estimated premorbid intelligence (full-scale IQ; r = −0.29, P = .009), and age of first participation in organized sport (r = 0.34, P = .002). For the control group, predictors of depression symptoms at time 2 were number of previous head injuries (r = 0.31, P = .05) and baseline depression symptoms (r = 0.80, P < .001).

Conclusions:

A large proportion of athletes showed a reliable increase in depression after concussion, and we identified several baseline predictors. Given that depression affects quality of life and recovery from concussion, more research is necessary to better understand why certain athletes show an increase in PCDS and how these can be better predicted and prevented.Key Words: concussion, depressive symptoms, sports

Key Points

• The prevalence of clinically important depression symptoms was higher postconcussion than at baseline.
• Postconcussion depression symptoms were related to a higher level of baseline depression symptoms and baseline postconcussion symptoms, lower estimated full-scale IQ, older age at first participation in organized sport, and fewer number of games missed due to concussion.
• Nonwhite ethnicity was associated with increased postconcussion depression symptoms.
• More research is needed to better predict which athletes might have more severe depression symptoms postconcussion.

Depression after concussion has become a particularly salient issue recently given the rise in media coverage of the effects of concussions and of National Football League players committing suicide after careers that likely involved multiple concussions. The terms concussion and mild traumatic brain injury (TBI) will be used interchangeably in this article. In addition to increasing suicide risk, postconcussion depression symptoms (PCDS) have been associated with worse functional outcome, cognitive performance, and quality of life after injury.^1–5 Furthermore, depression is a mediator between concussion and physical health problems and persistent concussive symptoms after injury.⁶Whereas some researchers have offered that PCDS are due to functional limitations, anger, frustration, and the experience of loss,^7,8 others have posited that PCDS might be due to functional and microstructural changes in the brain⁹ or a combination of these changes. By examining depression symptoms before and after a single injury in younger athletes who underwent baseline testing and comparing them with a control group, the goal of our study was to help identify the individuals who are more at risk for developing depression symptoms after concussion. A better understanding of who is most vulnerable to depression after injury could help to improve both treatment and prevention of this condition.Researchers have reported that depression is relatively common after brain injury, but most investigators have focused on moderate to severe TBI or have not differentiated among levels of severity.¹⁰ Furthermore, few researchers have examined the effect of preinjury depression levels on postinjury depression symptoms. Busch and Alpern¹¹ summarized 12 studies on depression after TBI and showed the prevalence of depression after concussion was at least 35%. Rapoport et al¹⁰ found a 15% prevalence of major depression after mild TBI. After all severities of TBI, the prevalence of major depression was 14% to 29%.^10,12,13 Researchers^14–17 examining emotional responses to sport-related concussion also have reported increased levels of depression in athletes after concussive injury.However, few risk factors, or baseline predictors, of PCDS have been identified. Associated demographic factors include younger age,^1,18 a personal or family history of psychological disorders or substance abuse,¹¹ and lower levels of education.¹ Rapoport et al¹⁰ reported that the risk of major depression was lower in adults aged more than 60 years than in younger individuals with mild TBI. However, the opposite was observed in a study of mild to moderate TBI.¹⁹ Findings for sex have been mixed in general TBI,²⁰ but in a study of sex differences in depression after sport-related concussion, rates of depression symptoms among male and female athletes were similar.¹⁵ It is interesting that severity of injury has not been a consistent predictor of PCDS in general TBI,^21,22 but loss of consciousness has been related to the risk of major depression in mild TBI (odds ratio = 3.67).⁶Therefore, the purposes of our study were to (1) describe the prevalence of depression symptoms in a collegiate athlete sample at baseline and postconcussion, (2) compare these levels of symptoms and change in symptoms with those of a control group with no reported concussions in the year before the study, and (3) examine the baseline predictors for PCDS. Given the mixed literature on predictors of depression in concussion, most of our study was exploratory, with no specific hypotheses generated. However, we did hypothesize that increases in depression after concussion would occur in a greater proportion of our concussed athletes than in the control participants.     

Sex Differences and the Incidence of Concussions Among Collegiate Athletes

OBJECTIVE: To compare sex differences regarding the incidence of concussions among collegiate athletes during the 1997-1998, 1998-1999, and 1999-2000 seasons. DESIGN AND SETTING: A cohort study of collegiate athletes using the National Collegiate Athletic Association (NCAA) Injury Surveillance System; certified athletic trainers recorded data during the 1997-2000 academic years. SUBJECTS: Collegiate athletes participating in men's and women's soccer, lacrosse, basketball, softball, baseball, and gymnastics. MEASUREMENTS: Certified athletic trainers from participating NCAA institutions recorded weekly injury and athlete-exposure data from the first day of preseason practice to the final postseason game. Injury rates and incidence density ratios were computed. Incidence density ratio is an estimate of the relative risk based on injury rates per 1000 athlete-exposures. RESULTS: Of 14 591 reported injuries, 5.9% were classified as concussions. During the 3-year study, female athletes sustained 167 (3.6%) concussions during practices and 304 (9.5%) concussions during games, compared with male athletes, who sustained 148 (5.2%) concussions during practices and 254 (6.4%) concussions during games. Chi-square analysis revealed significant differences between male and female soccer players (chi(2)(1) = 12.99, P =.05) and basketball players (chi(2)(1) = 5.14, P =.05). CONCLUSIONS: Female athletes sustained a higher percentage of concussions during games than male athletes. Of all the sports, women's soccer and men's lacrosse were found to have the highest injury rate of concussions. Incidence density ratio was greatest for male and female soccer players.     

Athletic trainers' attitudes toward lesbian, gay, and bisexual National Collegiate Athletic Association student-athletes

Context:

Researchers have investigated heterosexuals'' attitudes toward homosexuals, focusing on factors such as sex, race, religion, education, and contact experiences. However, in the context of sport, this research is deficient. We found no published literature investigating athletic trainers (ATs'') attitudes toward lesbian, gay, and bisexual student-athletes (LGB).

Objective:

To determine heterosexual ATs'' attitudes toward LGB student-athletes in the National Collegiate Athletic Association.

Design:

Cross-sectional study

Setting:

E-mailed survey.

Patients or Other Participants:

A total of 964 ATs employed at member institutions.

Main Outcome Measure(s):

We measured attitudes using the Attitudes Toward Lesbian, Gay Men, and Bisexuals (ATLGB) Scale. To determine the extent to which sex, religion, and whether having an LGB friend or family member had an effect on ATs'' attitudes, we performed analysis of variance. To establish the effect of age on ATs'' attitudes, we calculated a Pearson correlation. We used an independent t test to identify differences between ATs who reported working with LGB student-athletes and ATs who did not.

Results:

With ATLGB score as the dependent factor, a main effect was noted for sex, religion, and having an LGB friend or family member (P < .01 for all comparisons). Age and total score were related (P < .01). A difference was seen in the ATLGB scores between ATs who were aware of LGB student-athletes on their teams and ATs who were not (P < .001).

Conclusions:

Many ATs hold positive attitudes toward LGB student-athletes, especially females, those who have an LGB friend or family member, and those who are aware of LGB student-athletes. Still, it is important to provide an open environment in the athletic training room for all student-athletes.     

大学新生社会支持与学校适应的相关性

目的 考察大学新生社会支持与学校适应的基本情况,并分析两者的相关关系.方法 本研究使用领悟社会支持量表及大学新生学校适应量袁对274名大一新生进行调查.结果 学校适应方面不存在生源地和是否独生子女的差异,但性别差异显著(P＜0.05,t=1.901);大学新生感受到的社会支持由高到低分别是:朋友支持、其他支持、家庭支持;社会支持与学校适应存在着显著的正相关(r＝0.577,P＜0.01);社会支持各因素对学校适应均有预测作用(b=1.121,P＜0.01;b＝1.378,P＜0.01).结论 大学新生社会支持与学校适应存在一定的联系,社会支持各因子对学校适应均有预测作用.     

Development and Preliminary Validation of the Injury-Psychological Readiness to Return to Sport (I-PRRS) Scale

Context:

Only a few scales measure confidence within sport; however, these scales are insufficient to measure confidence after athletic injuries. Therefore, better measures are needed to determine the psychological readiness of injured athletes to return to sport participation.

Objective:

To develop a scale that measures the psychological readiness of injured athletes to return to sport participation and to provide preliminary evidence of reliability and validity for the scale.

Design:

The Delphi method was used to develop the Injury-Psychological Readiness to Return to Sport scale (I-PRRS). Two 1-way analyses of variance with repeated measures and 6 Pearson product moment correlations were computed to help validate the scale.

Setting:

Athletic training clinics at 3 National Collegiate Athletic Association (NCAA) schools.

Patients or Other Participants:

Four certified athletic trainers (ATs) and professors of Commission on Accreditation of Athletic Training Education-accredited athletic training programs and 3 NCAA Division III coaches made up a panel of experts that participated in the Delphi portion of the study to develop the I-PRRS. In the second part of the study, 22 injured athletes, who missed a minimum of 1 week of practice, from 3 NCAA schools in Divisions II and III were surveyed along with their respective ATs. The injured athletes and ATs participated in the validation of the I-PRRS.

Main Outcome Measure(s):

The injured athlete completed the Profile of Mood States (POMS) short form and the I-PRRS shortly after injury, before returning to the first practice, before returning to competition, and immediately after competition. The respective AT completed the I-PRRS before and after competition. The I-PRRS is a 6-item scale that measures the psychological readiness of injured athletes to return to sport, and the POMS short form is a 30-item scale that measures mood states. I added the negative moods of the POMS and subtracted the positive moods of the POMS to calculate a Total Mood Disturbance (TMD) score.

Results:

The I-PRRS scores were negatively correlated with the TMD scores of the POMS short form at all 4 time intervals, showing concurrent validity. The I-PRRS scores were lowest after injury, increased before practice, increased again before competition, and had no change after competition. The I-PRRS as completed by the athlete and respective AT was positively correlated both before and after practice, demonstrating external validity.

Conclusions:

Preliminary evidence for reliability and validity of the I-PRRS was demonstrated. The I-PRRS can be a beneficial tool for ATs to assess an athlete''s psychological readiness to return to sport participation after injury.     

Prevalence of Disordered-Eating Behaviors in Undergraduate Female Collegiate Athletes and Nonathletes

Context: As the number of female college students participating in athletics has grown dramatically in the last few decades, sports medicine health care providers have become more aware of the unique health concerns of athletic women. These concerns include disordered eating, amenorrhea, and osteoporosis: the female athlete triad. Disordered eating appears to be central in the triad, and the literature has conflicting data regarding the influence of athletic participation on disordered-eating behaviors.Objective: To compare disordered-eating symptoms between collegiate athletes (in lean and non-lean sports) and nonathletes.Design: A volunteer, cross-sectional cohort study of female students during the 2002-2003 academic year.Setting: A National Collegiate Athletic Association Division I institution.Patients or Other Participants: Undergraduate females, including 84 collegiate athletes and 62 nonathletes.Main Outcome Measure(s): Symptoms associated with disordered eating were assessed using the Eating Disorders Inventory-2, a self-report measure of 91 items, and self-reported weight and menstrual function.Results: The athletes had significantly lower scores in body dissatisfaction (P = .01) and ineffectiveness (P = .002). No difference in mean body weight was noted between the 2 groups, but the nonathlete group had a significantly lower desired body weight (P = .004). Lean-sport athletes had a higher score on body dissatisfaction (P = .008) and lower actual (P = .024) and desired body weight (P = .002) than non-lean-sport athletes. A total of 7.1% of the collegiate athletes and 12.9% of the nonathletes were classified as having a high risk for disordered eating. Within the athlete sample, the high-risk group included 2.9% of the non-lean-sport athletes and 25% of the lean-sport athletes.Conclusions: In our study, female athletes did not exhibit more disordered-eating symptoms than women who did not participate in collegiate sports. However, our data suggest that lean-sport athletes are at greater risk for disordered eating than athletes in non-lean sports.     

大学生成人依恋与社会支持的关系

目的探讨大学生成人依恋与社会支持的关系。方法采用两种成人依恋问卷(关系问卷RQ、亲密关系体验问卷ECR)和社会支持评定量表,对423名大学生进行问卷调查。结果大学生的依恋类型分布:安全型34.0%、轻视型26.7%、倾注型22.7%、害怕型16.5%;4种依恋类型的社会支持存在显著差异(如客观支持,F=10.456,P0.001);依恋回避与社会支持各个指标之间存在显著负相关(如客观支持,r=-0.214,P0.001);依恋焦虑仅与主观支持之间存在显著负相关(r=-0.103,P0.05)。结论成人依恋影响大学生的社会支持水平。     

Understanding Visual Search Patterns of Dermatologists Assessing Pigmented Skin Lesions Before and After Online Training

The goal of this investigation was to explore the feasibility of characterizing the visual search characteristics of dermatologists evaluating images corresponding to single pigmented skin lesions (PSLs) (close-ups and dermoscopy) as a venue to improve training programs for dermoscopy. Two Board-certified dermatologists and two dermatology residents participated in a phased study. In phase I, they viewed a series of 20 PSL cases ranging from benign nevi to melanoma. The close-up and dermoscopy images of the PSL were evaluated sequentially and rated individually as benign or malignant, while eye position was recorded. Subsequently, the participating subjects completed an online dermoscopy training module that included a pre- and post-test assessing their dermoscopy skills (phase 2). Three months later, the subjects repeated their assessment on the 20 PSLs presented during phase I of the study. Significant differences in viewing time and eye-position parameters were observed as a function of level of expertise. Dermatologists overall have more efficient search than residents generating fewer fixations with shorter dwells. Fixations and dwells associated with decisions changing from benign to malignant or vice versa from photo to dermatoscopic viewing were longer than any other decision, indicating increased visual processing for those decisions. These differences in visual search may have implications for developing tools to teach dermatologists and residents about how to better utilize dermoscopy in clinical practice.     

少数民族大学生社会支持与一般自我效能感及其关系

目的:了解新疆地区少数民族大学生社会支持与一般自我效能感的现状及关系,为促进其心理健康提供理论依据。方法:采用社会支持和一般自我效能感量表对新疆地区4所大学共1196名大学生的社会支持及一般自我效能感的状况进行调查分析。结果:1少数民族大学生家庭支持和其他支持得分女生显著高于男生(t=3.601,P=0.0480.05;t=3.940,P=0.0420.05),社会支持和一般自我效能感在不同民族和专业得分差异显著(F=6.391,4.462,4.824,13.494;P0.05);2一般自我效能感与社会支持及各因子均呈正相关(r=0.152~0.854,P0.01);3社会支持及各因子对少数民族大学生的一般自我效能感具有显著的正向预测作用(Beta=0.098~0.253,t=5.428~7.313,P0.05);结论:少数民族大学生的社会支持与一般自我效能感关系密切。     

服刑人员的社会支持与主观幸福感关系

目的:本文旨在研究服刑人员的社会支持与主观幸福感的关系。方法:以肖水源的社会支持评定量表和LuLuo的中国人幸福感量表为工具,对285名服刑人员施测。结果:不同刑期的服刑人员在主观幸福感上差异显著(F=3.130,P0.05),受教育程度不同的服刑人员在主观幸福感上差异显著(F=5.357,P0.05);社会支持和主观幸福感呈显著的正相关(r=0.605,P0.001);社会支持的不同方面对主观幸福感及其维度的预测力是不同的。结论:服刑人员的社会支持与主观幸福感密切相关。加强对服刑人员的教育改造和主观支持有利于提高服刑人员的主观幸福感和改造的积极性。     

大学生社会支持、毕生发展模型与一般自我效能感的关系

目的了解大学生社会支持、SOC策略与其一般自我效能感的关系。方法采用社会支持评定量表(SSRS)、SOC问卷、一般自我效能感量表(GSES),随机抽取河海大学、南京师范大学不同年级被试857人。结果①相关分析表明,社会支持与SOC策略存在显著正相关(r=0.32,P=0.01);社会支持与一般自我效能感存在显著正相关(r=0.69,P=0.001);SOC策略与一般自我效能感存在显著正相关(r=0.49,P=0.001);②回归分析进一步表明,社会支持对一般自我效能感(F=9.275,P<0.01)和SOC策略回归效应显著(F=82.452,P<0.001);③SOC策略在社会支持的基础上对一般自我效能感回归效应显著(F=73.614,P<0.001),对社会支持和一般自我效能感起到中介作用。结论大学生社会支持的获得、SOC策略的使用影响其一般自我效能感;SOC策略在社会支持与一般自我效能感之间起中介作用。     

非典前与非典时期大学生心理幸福感与社会支持状况比较研究

目的对大学生在非典隔离期间与非典前对心理幸福感和社会支持的态度进行比较。方法非典前和非典期间用同一组问卷对同一个群体575名大学生进行调查。结果在良好的社会支持下,隔离在校园中的女大学生比男大学生和非典前相比社会支持利用度显著提高;与非典前相比,大学生对各种社会支持的态度、感受和行为方式更积极,学生生活压力显著降低。结论大学生主观上体验到的社会支持越多,并且对社会支持的利用程度越高越充分,那么他们与他人的关系越积极与亲密,越有能力选择和创造适合自身发展的环境,生活目标更加明确,生活更富有意义,最终个人不断成长与充实。     

初中生社会支持与父母教养方式的相关研究

目的探讨初中生社会支持与父母教养方式的相关性。方法采用系统分层抽样问卷调查设计。对玉溪市4所中学初一至初三年级的学生进行系统分层抽样,采用父母教养方式评价量表和社会支持评定量表对1115名初中学生进行问卷调查,之后对收集的数据进行μ检验和Pearson相关分析。结果父母教养方式评价量表中,父亲的惩罚严厉、过分干涉和拒绝、否认因子存在性别差异(μ=4.047,2.338,2.301;P<0.05);社会支持评定量表中,主观支持和对社会支持的利用度存在性别差异(μ=2.544,4.087;P<0.05)。在相关分析中,社会支持各因子与父母情感温暖与理解呈正相关(r=0.3996,0.2743,0.3062,0.3770,0.2548,0.2775;P<0.05),与父母惩罚、严厉和拒绝、否认呈负相关(r=-0.1927,-0.1092,-0.1878,-0.1821,-0.0871,-0.1513,-0.2280,-0.0853,-0.1907,-0.2151,-0.0633,-0.1574;P<0.05)。结论初中生对社会支持的利用会显著促进个体的心理承受和负荷能力,增加处理危机和冲突的水平,同时父母的教养方式对子女的社会支持有着非常重要的影响。