Context

Collegiate student-athletes are faced with significant athletic and academic demands, causing a substantial amount of stress, which can lead to athlete burnout. Problematically, little research has been done to find ways to prevent or mitigate the effect of athlete burnout in collegiate student-athletes. Grit is one characteristic that they could use as a coping mechanism to reduce the effects of burnout and to improve overall well-being.

Objective

To determine if grit had a main or buffering effect on well-being and athlete burnout in female collegiate student-athletes.

Design

Cross-sectional study.

Setting

National Collegiate Athletics Association Division I institution.

Patients or Other Participants

A total of 174 female collegiate student-athletes.

Main Outcome Measure(s)

The Grit Scale, Athlete Burnout Questionnaire, and Warwick Edinburgh Mental Well-Being Scale were used to assess grit, athlete burnout, and well-being.

Results

Grit was a significant negative predictor for physical and emotional exhaustion (F_1,172 = 28.25, P < .001), a reduced sense of accomplishment (F_1,172 = 20.40, P < .001), and sport devaluation (F_1,172 = 40.32, P < .001). Additionally, grit was a significant positive predictor of well-being (F_1,172 = 29.68, P < .001). The moderated regression with grit did not reveal significant results.

Conclusions

We provide new information on considerations for reducing athlete burnout and improving well-being in female collegiate student-athletes. Athletic trainers and sports medicine stakeholders should consider intervention strategies for improving grit to mitigate athlete burnout and diminished well-being while continuing to explore their effectiveness.

Context

Eating disorders (EDs) are a cluster of behavioral conditions characterized by uneasy thoughts and behaviors that grow into severe or persistent eating disturbances. The demands on student-athletes may create mental and physical stressors that increase the likelihood of EDs and disordered eating.

Objective

To examine the ED risk through eating attitudes and behaviors in male and female student-athletes and across various sport types (endurance, aesthetic, power, ball or team, or technical sports).

Design

Cross-sectional study.

Setting

Collegiate athletics.

Patients or Other Participants

National Collegiate Athletic Association Division I and II student-athletes (n = 2054; males = 631; females = 1423) from 40 institutions.

Main Outcome Measure(s)

Participants completed a web-based demographic survey and the Eating Attitudes Test-26 (EAT-26). Multiple χ² analyses examined participants classified as at risk for EDs. Independent-samples t tests and a 1-way analyses of variance compared sex and sport type across EAT-26 totals and subscale (Dieting, Bulimia, and Oral Control) scores.

Results

Overall, 25.3% (n = 520/2054) of student-athletes were classified as at risk for EDs. Differences were found between sex and ED risk (χ²_1,2054 = 32.9, P ≤ .01; 17.3% [n = 109/631] males, 28.9% [n = 411/1423] females) and across ED risk and sport type (χ²_4,2054 = 13.4, P = .01). When examining females only, we observed differences across ED risk and sport type (χ²_4,1423 = 13.4, P ≤ .01). No differences were evident across ED risk and sport type for males. Differences were seen between sex and binge eating (χ²_1,2054 = 6.8, P = .009), sex and diet pill use (χ²_1,2054 = 19.6, P ≤ .01), and sport type and diet pill use (χ²_4,2054= 12.2, P = .016), excessive exercise (χ²_4,2054 = 32.1, P ≤ .01), and losing more than 20 lb (9 kg) in the last 6 months (χ²_4,2054 = 10.2, P ≤ .037).

Conclusions

Student-athletes in the collegiate setting are at risk for EDs. Medical professionals, such as athletic trainers, need to be educated on the potential risk factors that may lead to EDs. Protocols for prevention, screening and recognition, and referral should be developed for student-athletes at risk for EDs.

Context

Exercise dependence (EXD) is a compulsive and addictive behavior that can negatively affect physical and mental health, leading to significant impairment or distress. Exercise dependence has been associated with symptoms of eating disorders (EDs). Student-athletes are an at-risk population for EXD and EDs given the physical and psychological demands of competitive sports.

Objective

To examine the EXD and ED risks in student-athletes across sex and sport category and to determine the association between EXD and ED.

Design

Cross-sectional study.

Setting

Collegiate athletics.

Patients or Other Participants

National Collegiate Athletic Association Division I and II student-athletes (n = 1885; age = 19.8 ± 1.4 years; females = 69.6%, n = 1312; males = 30.4%, n = 573).

Main Outcome Measure(s)

A web-based survey including demographics, the Exercise Dependence Scale-21, the Eating Attitudes Test-26, and questions about pathogenic behaviors.

Results

Overall, 4.9% (n = 92) of the student-athletes were categorized as at risk for EXD (females = 4.8%, n = 63/1312; males = 5.1%, n = 29/573), with differences across sex and sport categories (all: χ²_8,1885 = 99.1, P < .001). The ED risk in student-athletes (Eating Attitudes Test-2, pathogenic behavior use, or both) was 22.7% (n = 428; females = 25.5%, n = 334/1312; males = 16.4%, n = 94/573), with differences by sex (χ²_4,1885 = 10.1, P = .039). Multiple logistic regressions indicated a significant association between the risks of EXD and ED for all student-athletes; athletes at risk for EXD were also at greater risk for EDs (odds ratio = 5.104; 95% CI = 3.237, 8.046) than nondependent-asymptomatic athletes (odds ratio = 2.4068; 95% CI = 1.5618, 3.7089).

Conclusions

Although physical activity has become a public health intervention to improve overall health in populations, EXD can be considered a problem related to physical activity. Exercise dependence can negatively affect physical and mental health, whereas EDs may be psychiatric disorders influenced by EXD, as exercise can be a compensatory behavior to achieve weight loss. To minimize the overall risk of EDs in student-athletes, additional education and awareness are needed. Special attention should be given to any student-athletes, in particular females, who display signs of EXD.

Context

The National Athletic Trainers’ Association recommends including mental health screening measures as part of the preparticipation examination for all student-athletes (SAs). Despite this recommendation, most mental health screening tools have not been validated in the SA population.

Objective

To validate and examine the clinical utility of 2 depression screening tools in the collegiate SA population.

Design

Cross-sectional mixed-methods study.

Setting

Two Northeastern United States university athletics programs.

Patients or Other Participants

A total of 881 (men = 426, 48.4%; women = 455, 51.6%; mean age = 19.7 ± 1.4 years) National Collegiate Athletic Association Division II collegiate SAs completed the Patient Health Questionnaire-9 (PHQ-9) and Center for Epidemiologic Studies Depression Scale (CES-D); 290 SAs participated in a Mini-International Neuropsychiatric Interview.

Main Outcome Measure(s)

Depression symptoms were measured using 2 self-report depression screening tools, the PHQ-9 and CES-D, during the fall preparticipation examination. The SAs were selected using a random stratified sampling technique to participate in a Mini-International Neuropsychiatric Interview as the reference standard comparison for the receiver operating characteristic analysis.

Results

A cutoff score of 6 on the PHQ-9 corresponded to 78% sensitivity, 75% specificity, 17.3% positive predictive value, 98.1% negative predictive value (NPV), 3.2 positive likelihood ratio (+LR), and 0.3 negative likelihood ratio (−LR). A cutoff score of 15 on the CES-D corresponded to 83% sensitivity, 78% specificity, 19.7% positive predictive value, 98.6% NPV, 3.7 +LR, and 0.22 −LR.

Conclusions

This was the first study to validate depression screening tools in the collegiate SA population. The results suggest cutoff scores on the PHQ-9 and CES-D in SA may need to be lower than those recommended for the general population and provide strong evidence for use as screeners to rule out depression. Referral and confirmatory testing should be implemented to confirm the presence of depression for SAs scoring at or above the cutoff thresholds. Given its brevity, inclusion of a suicidality or self-harm question and evidence of −LR and NPV strength, the PHQ-9 is a practical and effective screener for the SA population.

Context

Lack of education, stigma, and negative self-attitudes are key barriers to help-seeking in Gaelic footballers. With the prevalence of mental health issues in Gaelic footballers and the increased risk of experiencing mental health challenges after injury, mental health literacy (MHL) interventions are necessary.

Objectives

To design and implement a novel MHL educational intervention program in Gaelic footballers.

Design

Controlled laboratory study.

Setting

Online.

Patients or Other Participants

Elite and subelite Gaelic footballers divided into intervention (n = 70; age = 25.1 ± 4.5 years) and control (n = 75; age = 24.4 ± 6.0 years) groups. In the intervention group, 85 participants were recruited, but 15 dropped out after completing baseline measures.

Interventions

A novel educational intervention program, “GAA [Gaelic Athletic Association] and Mental Health—Injury and a Healthy Mind,” was designed to address the key components of MHL and was underpinned by the Theory of Planned Behavior and the Help-Seeking Model. The intervention was implemented online via a brief 25-minute presentation.

Main Outcome Measures

Measures of stigma, help-seeking attitudes, and MHL were completed by the intervention group at baseline, immediately after viewing the MHL program, and at 1 week and 1 month after the intervention. The control group completed the measures at similar time points.

Results

Stigma decreased, and attitudes toward help-seeking and MHL increased in the intervention group from baseline to after the intervention (P < .05), with significant differences sustained at 1-week and 1-month follow-ups. Our results showed differences in stigma, attitudes, and MHL between groups across time points. Intervention participants provided positive feedback, and the program was appraised as informative.

Conclusions

Remote online delivery of a novel MHL educational program can effectively decrease mental health stigma, improve attitudes toward help-seeking, and increase the recognition and knowledge of mental health issues. Gaelic footballers with improved MHL may be better equipped to manage their mental health and cope with stressors, leading to improved mental health outcomes and overall mental well-being.

Context

Although 84% of patients expected to return to activity within 1 year of anterior cruciate ligament (ACL) reconstruction (ACLR), as few as 24% will return to their preinjury level of activity. By considering a patient’s perceptions of reengagement in activity after ACLR, clinicians and researchers may be better equipped to implement interventions that are patient centered.

Objective

To describe the validation of the ACL Reasons survey, a tool to aid clinicians and researchers in understanding patient perceptions of barriers to physical activity (PA) engagement after ACLR.

Design

Cross-sectional study.

Patients or Other Participants

The ACL Reasons survey was administered via Qualtrics to 78 patients 6 to 24 months after primary, unilateral ACLR. Patients were categorized as active, more challenging, or less active based on their responses to the ACL Reasons.

Main Outcome Measure(s)

Development of the ACL Reasons survey occurred via an iterative process of drafting and revising based on feedback from a team of external expert reviewers. Tegner activity level, Marx activity score, the Knee injury and Osteoarthritis Outcomes Score (KOOS), ACL Return to Sport after Injury score, and Tampa Scale of Kinesiophobia score were compared among groups using analysis-of-variance and Kruskal Wallis tests.

Results

Groups differed based on Tegner activity level (P < .001), Marx activity score (P = .01), KOOS pain score (P = .02), KOOS symptom score (P = .04), KOOS sports and recreation score (P < .001), KOOS quality of life score (P < .001), ACL Return to Sport after Injury score (P < .001), and Tampa Scale of Kinesiophobia score (P < .001), with the less active group performing worse on each. Knee symptoms, fear of knee symptoms or movement, and fear of injury were the most common reasons for the change in PA engagement.

Conclusions

These results support the validity of the ACL Reasons survey as a tool for identifying barriers to PA engagement after ACLR. This tool may help facilitate communication between patients with ACLR and their health care providers to enhance patient-centered care.

Context

Patellofemoral pain (PFP) is a common source of knee pain in active individuals, accounting for a large number of knee injuries examined in sports medicine clinics. As a chronic condition, PFP can affect mental health. However, this effect has not yet been studied in individuals with PFP.

Objective

To determine how subjective physical and mental health measures in individuals with PFP differed from those measures in pain-free individuals.

Design

Case-control study.

Setting

Laboratory.

Patients or Other Participants

Volunteers for the study were 30 people with PFP (19 women, 11 men; age = 20.23 ± 3.32 years, height = 166.69 ± 6.41 cm, mass = 69.55 ± 13.15 kg) and 30 matched pain-free individuals (19 women, 11 men; age = 20.33 ± 3.37 years, height = 169.31 ± 9.30 cm, mass = 64.02 ± 11.00 kg).

Main Outcome Measure(s)

Current and worst pain levels in the past 24 hours were determined using a visual analog scale (VAS). The Anterior Knee Pain Scale, Fear Avoidance Belief Questionnaire, and Lower Extremity Functional Scale were administered. Physical and mental health measures were obtained using a modified 12-item Short Form Health Survey. Scores for 2 subscales on the modified Short Form-12 were weighted and calculated: physical component and mental component.

Independent t tests were calculated to compare variables between groups. Coefficient correlations were used to measure the associations between the variables.

Results

Individuals with PFP reported lower levels of physical (pain free: 56.13 ± 1.63, PFP: 50.54 ± 7.10, P < .001) and mental (pain-free: 53.32 ± 4.71, PFP: 48.64 ± 10.53, P = .03) health. In the PFP group, we found moderate negative correlations between the VAS score for current pain and mental health (r = −0.52, P < .01) and between the VAS score for worst pain in the past 24 hours and mental health (r = −0.46, P = .01) and between activity limitations in individuals with PFP and fear avoidance beliefs (r = −0.61, P < .01).

Conclusions

Our results should encourage clinicians, especially musculoskeletal rehabilitation professionals, to acknowledge the importance of a whole-person approach when treating or planning rehabilitation programs for individuals with PFP.

Context

Developing effective interprofessional teams is vital to achieving quality care for those dealing with behavioral health concerns. Athletic trainers (ATs) play a vital role, as they are often the first health care providers to interact with student-athletes participating in intercollegiate athletics. However, research regarding how behavioral health providers view the AT’s role on interprofessional behavioral health teams is limited.

Objective

To explore behavioral health providers’ perceived role of ATs in collaborative behavioral health care.

Design

Qualitative study.

Setting

Individual interviews.

Patients or Other Participants

Nine behavioral health care providers (women = 6, men = 3; age range = 30–59 years, years in clinical practice = 6–25) from National Collegiate Athletic Association Power 5 schools were interviewed.

Data Collection and Analysis

Participants were contacted via publicly available information on their university websites. Participants engaged in individual, audio-only interviews using a commercially available teleconferencing platform. All interviews were recorded, transcribed, and returned to participants for member checking. A phenomenological approach with inductive coding and multianalyst triangulation was performed to analyze the transcripts for common themes and subthemes.

Results

Conclusions

Collaborative care models can enhance providers’ abilities and maximize support of student-athlete wellness. In this study, we demonstrated that behavioral health providers working within a collaborative care model with ATs had overall positive experiences with such collaboration and that clear role delineation and responsibilities helped to foster high-quality patient care.

Context

Researchers have demonstrated that job demands impair tactical athletes’ mental health. Mental health stigmas in this population and limited resources may prevent individuals from receiving care. Athletic trainers (ATs) are often the first, and sometimes the only, contact for mental health concerns. Previous literature indicated that ATs desired more psychosocial training and experience.

Objective

To investigate ATs’ preparedness and experiences managing patients with mental health conditions in the tactical athlete setting.

Design

Consensual qualitative research study.

Setting

One-on-one, semistructured interviews.

Patients or Other Participants

Fifteen ATs (men = 7, women = 8; age = 36 ± 10 years; experience in tactical athlete setting = 4 years [range, 6 months–20 years]; military = 12, law enforcement = 2; fire service = 1).

Main Outcome Measure(s)

Interviews followed a 9-question protocol focused on job setting preparation, mental health training, and perceived role managing patients with mental health concerns. Interviews were audio recorded and transcribed verbatim. A 3-person coding team convened for data analysis following the consensual qualitative research tradition. Credibility and trustworthiness were established using a stability check, member checking, and multianalyst triangulation.

Results

Four domains emerged surrounding ATs’ mental health management experiences with tactical athletes: (1) population norms, (2) provider preparation, (3) provider context, and (4) structure of job responsibilities. Most ATs felt their educational experiences lacked comprehensive mental health training. Some participants described formal employer resources that were optional or mandatory for their job, whereas others engaged in self-education to feel prepared for this setting. Participants shared that unfamiliar experiences, such as divorce and deployment, influenced their context as providers. Most ATs had no policy related to mental health care and referral, indicating it was outside their responsibilities or they were unsure of role delineation.

Conclusions

For ATs working with tactical athletes, our respondents suggested that additional mental health education and training are necessary. They also indicated that improvement is needed in job structure regarding role delineation and the establishment of policies regarding behavioral health.

Context

Burnout, a state of physical or emotional exhaustion, is a concern within athletic training, as between 17% and 40% of athletic trainers (ATs) report high levels of burnout. Adverse childhood experiences (ACEs) are linked with higher levels of burnout in other health professions.

Objective

To compare burnout with ACEs in ATs.

Design

Cross-sectional study.

Setting

Web-based survey.

Patients or Other Participants

One thousand ATs were selected at random to participate in the study. Of these, 78 ATs started the survey, and 75 ATs completed it.

Main Outcome Measure(s)

Burnout, as measured by the Copenhagen Burnout Inventory (CBI) overall and subscale scores, was compared across groups based on the number of adverse experiences as measured by the ACEs survey. Multiple analysis of variance tests were used to determine the association between ACEs score and overall, personal, work-related, and patient-related burnout.

Results

At least 1 adverse experience was reported by 37 (49.33%) participants. Those with ≥4 ACEs had higher odds of describing overall, personal, and work-related burnout than those with 0 to 3 ACEs. Moderate burnout (CBI score ≥ 50.00) was noted in 27 (36.00%, overall), 44 (58.67%, personal), 34 (45.3%, work related), and 15 (20.00%, patient related) ATs. Participants with 4 ACEs had higher overall burnout (67.11 ± 19.89; F_6,68 = 2.59, P = .03) than those with 0 (40.53 ± 17.12, P = .04), 1 (38.42 ± 20.99, P = .04), or 7 (19.08 ± 12.09, P = .03) ACEs. The same pattern existed with personal burnout, as participants with 4 ACEs (76.67 ± 17.33) had higher scores (F_6,68 = 3.40, P = .00) than those with 0 (46.60 ± 17.49, P = .02), 1 (42.78 ± 21.48, P = .01), or 7 (27.08 ± 20.62, P = .03) ACEs. No other differences were observed.

Conclusions

Between 20.00% and 58.67% of ATs surveyed reported some form of burnout. Higher levels of overall and personal burnout were found in those with 4 ACEs. Although we expected to see lower levels of burnout in those with fewer ACEs, it was surprising that those with 7 ACEs had some of the lowest CBI scores. Athletic trainers with childhood trauma may find it beneficial to engage in self-regulation exercises to reduce or limit triggers and burnout. Additionally, employers should explore developing trauma-informed workplaces to better support employees.

Context

Although the return to sports during COVID-19 has been associated with improvements in mental health and quality of life (QOL), whether these benefits are primarily due to increases in physical activity (PA) is unknown.

Objective

To determine whether PA increases were responsible for the improvements in mental health and QOL among adolescents who returned to sport during the COVID-19 pandemic.

Design

Cross-sectional study.

Setting

Wisconsin secondary schools.

Patients or Other Participants

A total of 559 adolescent athletes (age = 15.7 + 1.2 years, females = 43.6%) from 44 schools completed a survey in October 2020.

Main Outcome Measure(s)

Demographic information, whether they had returned to sport participation, school instruction type, anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-9), QOL (Pediatric Quality of Life Inventory 4.0), and PA (Hospital for Special Surgery Pediatric Functional Activity Brief Scale). Mediation analysis was used to assess whether the relationships between sport status and anxiety, depression, and QOL were mediated by PA.

Results

At the time of the study, 171 (31%) had returned to play and 388 (69%) had not. Athletes who had returned to play had less anxiety (3.6 ± 0.4 versus 8.2 ± 0.6, P < .001) and depression (4.2 ± 0.4 versus 7.3 ± 0.6, P < .001) and higher QOL (88.1 ± 1.0 versus 80.2 ± 1.4, P < .001) and more PA (24.0 ± 0.5 versus 16.3 ± 0.7, P < .001). Physical activity explained a significant, but small, proportion of the difference in depression (22.1%, P = .02) and QOL (16.0%, P = .048) but not anxiety (6.6%, P = .20) between athletes who had and those who had not returned to play.

Conclusions

Increased PA was responsible for only a small portion of the improvements in depression and QOL among athletes who returned to sports. This suggests that most of the mental health benefits of sport participation for adolescents during the COVID-19 pandemic were independent of the benefits of increased PA.

Context

The abrupt cessation of school and sport participation during the COVID-19 pandemic may have negative implications for adolescent mental health.

Objectives

To (1) compare mental, physical, and social health and behaviors during pandemic-related stay-at-home mandates with the same measures collected 1 to 2 years earlier and (2) evaluate the relationships between physical activity and sleep during the pandemic and changes in anxiety, fatigue, and peer relationships between assessment times.

Design

Cohort study.

Setting

Pediatric sports medicine center.

Patients or Other Participants

A total of 39 high school athletes (25 adolescent girls, 14 adolescent boys; age = 16.2 ± 0.9 years).

Main Outcome Measure(s)

Patient-Reported Outcome Measurement System anxiety, fatigue, and peer relationships short forms and the Pittsburgh Sleep Quality Index were completed twice (initial assessment in May 2018 or 2019, follow-up assessment in May or June 2020). Frequency and duration of physical activity and frequency of interaction with other individuals (family, peers, sport coaches, etc) were self-reported at follow-up assessment for the 2 weeks before school or sport closure and the 2 weeks before questionnaire completion.

Results

Higher levels of anxiety (5.5 ± 4.0 versus 3.6 ± 3.4 points; P = .003) and fatigue (5.4 ± 3.7 versus 2.3 ± 2.5 points; P < .001) and worse sleep quality (6.6 ± 2.9 versus 4.3 ± 2.3 points; P < .001) were observed during the pandemic compared with previous assessments. Reductions in physical activity were noted between assessments (exercise duration: 86.4 ± 41.0 versus 53.8 ± 30.0 minutes; P < .001). Sleep quality but not physical activity during the pandemic predicted changes in fatigue (P = .03, β = 0.44 [95% CI = 0.06, 0.83]) and peer relationships (P = .01, β = −0.65 [95% CI = −1.16, −0.15]) from initial to follow-up assessment.

Conclusions

Mental and physical health declined during stay-at-home mandates compared with assessments 1 to 2 years earlier. Physical activity behaviors and sources of social interaction underwent changes after school and sport cessation. Sleep quality may have provided some protection against declining adolescent mental health during the pandemic, although this relationship requires further investigation.

Background

People with a history of COVID-19 may experience persistent neuropsychological disruptions such as lower satisfaction with life, depression, and anxiety. Although student-athletes are at low risk for severe COVID-19 complications, the effect of COVID-19 on mental health has not been elucidated.

Objective

To compare patient-reported mental health outcomes for incoming collegiate athletes with (COVID+) or without (COVID−) a history of COVID-19.

Design

Case-control study.

Setting

Laboratory.

Patients or Other Participants

A total of 178 student-athletes, consisting of 79 in the COVID+ group (44.3%; age = 18.90 ± 0.16 years) and 99 in the COVID− group (55.6%; age = 18.95 ± 0.16 years).

Main Outcome Measure(s)

Participants completed the Satisfaction With Life Scale (SWLS), the Hospital Anxiety and Depression Scale (HADS), and the State-Trait Anxiety Inventory (STAI). Unadjusted 1-way analyses of variance were conducted across all patient-reported outcomes. Analyses of covariance were calculated to determine the interaction of COVID-19 group, sex, and race and ethnicity on outcomes. Post hoc Bonferroni testing was performed to identify specific differences between groups. A χ² analysis was computed to compare the number of athletes in each group who met the standard clinical cut points.

Results

We observed a between-groups difference for HADS depression (P = .047), whereby athletes in the COVID+ group had higher ratings (2.86 ± 0.26). We found group differences for the SWLS (P = .02), HADS anxiety (P = .003), and STAI state anxiety (P = .01) such that all scores were higher for the COVID+ group in the adjusted model. Post hoc testing revealed that female student-athletes in the COVID+ group had worse HADS anxiety (P = .01) and STAI trait anxiety (P = .002) scores than individuals in all other groups. We did not demonstrate differences between groups in the percentage of responses below established diagnostic thresholds.

Conclusions

Incoming collegiate student-athletes who reported a previous COVID-19 diagnosis displayed higher depression scores, suggesting that clinicians may need to provide appropriate identification and referral for mental health conditions. However, we were encouraged that most participants, regardless of a history of COVID-19 diagnosis, had mental health scores that did not exceed established diagnostic threshold values.

Context

Despite the many challenges posed by the COVID-19 pandemic, athletic programs have sought ways to persevere and deliver sport programming. This process has strained the psychosocial health of all sport stakeholders but especially those entrusted with promoting the health of participants and enforcing safety protocols. Athletic trainers (ATs) have been a major influence in striving to achieve these goals by expanding their typical roles to lead in promoting the safe delivery of sport programs.

Objective

To examine the psychosocial lived experiences of ATs as they practiced during the COVID-19 pandemic.

Design

Qualitative study.

Setting

National Collegiate Athletic Association Divisions I, II, and III.

Patients or Other Participants

A total of 27 ATs practicing at the collegiate level (Divisions I, II, and III) who were actively involved in planning and implementing return-to-sport protocols during the COVID-19 pandemic.

Data Collection and Analysis

Semi-structured interviews were conducted via Zoom. Inductive conventional content analysis identified emerging themes that characterized participants’ narratives. Three members of the research team were involved in the analysis process and used field notes, continuous member checking, peer review, and multiple-researcher triangulation to establish data credibility and confirmability.

Results

Three higher-order themes related to ATs’ psychosocial lived experiences emerged: (1) internalized experience, (2) interpersonal interactions, and (3) AT identity. Several subthemes were also identified to further organize elements that characterized or differentiated participants’ lived experiences.

Conclusions

Athletic trainers encountered significant challenges in maintaining their psychosocial health during the pandemic as they strived to assist others in this regard. Providing effective psychological and social support resources and strategies for ATs may not only allow them to better support themselves but may also enhance their ability to deliver professional services and promote psychosocial health among their athletes and other stakeholders in their respective sport systems in the future.