Factors Influencing Mental Health Outcomes of University Personnel During the COVID-19 Pandemic

Background: Previous research links the COVID-19 pandemic to negative effects on physical and mental health; however, little is known about how those effects can be mitigated. Additionally, college campuses experience mental health issues regularly, which were heightened during the pandemic. Purpose: The purpose of this study was to describe the current status of mental health within a university community and identify factors associated with excessive worry during the COVID-19 pandemic, such as mental health, resilience, grit, and other demographic factors. Methods: A questionnaire examining five domains (demographics, COVID-19 distancing behaviors, physical, mental, and social and economic health) was created, validated, and distributed to a college campus in the Southeastern United States. Unadjusted and adjusted ordinal logistic regression models were used to examine the cross-sectional association between worry and mental health measures while controlling for resilience and grit. Results: Participants (n=162) experienced varying levels of stress, anxiety, and depression with moderate levels of resilience (mean=3.76±0.59) and grit (mean=3.32±0.38) and some level of pandemic-related worry. Participants with mild anxiety and stress, and moderate/severe anxiety, stress, and depression were more worried, mitigated by resiliency. Conclusion: Resiliency is an important mitigating factor for mental health; college/university campuses should prioritize establishing resilience within their community

Reporting of Concussion Symptoms By a Nationwide Survey of United States Parents of Middle School Children

This cross-sectional study assessed concussion symptom knowledge of parents of middle school (MS) children (aged 10–15 years) through a free-response item that solicited concussion symptoms and compared findings to a pre-validated scale-based measure. A self-administered online questionnaire was sent to a panel of randomly selected United States residents who were recruited by a third-party company, aged ≥ 18 years, and identified as parents of MS children. Via a free-response item, parents listed what they believed were concussion symptoms. Multiple sections later, parents identified potential concussion symptoms via a scale measure, which featured 25 items (22 actual symptoms, three distractor symptoms) with three response options: yes, no, maybe. Free-response item responses were coded into specific symptoms. The 1062 eligible parents that provided complete data commonly identified the symptoms of dizziness (90.2%), blurred vision (87.4%), and balance problems (86.4%) on the scale-based measure. However, these and other symptoms were less commonly identified via the free-response item (dizziness: 44.4%; blurred vision: 16.5%; balance problems: 3.5%). Concussion symptoms commonly reported via the scale-based measure were reported less frequently within the free-response item. Future research must explore strategies to help clinicians working with parents and their children to measure and assess concussion symptom reporting and knowledge

Association Between Sensation-Seeking Behaviors and Concussion-Related Knowledge, Attitudes, Perceived Norms, and Care-Seeking Behaviors among Collegiate Student-Athletes

There are limited data connecting personality and behavioral tendencies and traits related to concussion care-seeking/disclosure behaviors and minimal research exists surrounding the relationship between risky behaviors, sensation-seeking, and concussion-related outcomes. This study examined the association between sensation-seeking and a student-athlete’s concussion-related knowledge, attitudes, perceived social norms, and concussion care-seeking/disclosure behaviors (intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury). The current study utilized a retrospective cohort of collegiate student-athletes at a single National Collegiate Athletic Association Division I institution. Separate multivariable linear regression models estimating mean differences (MD) and 95% Confidence Intervals (CI) estimated the association between sensation-seeking and concussion knowledge, concussion attitudes, and perceived social norms. Separate multivariable binomial regression models estimating adjusted prevalence ratios (PR) and 95%CI estimated the association between sensation-seeking and intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury. All models were adjusted for sex, sport participation, and concussion history. Higher sensation-seeking was significantly associated with less favorable concussion attitudes (adjusted MD = -1.93; 95%CI = -3.04,-0.83), less favorable perceived social norms surrounding concussion (adjusted MD = -1.39; 95%CI = -2.06,-0.72), and continuing to play while experiencing concussion symptoms (adjusted PR = 1.50; 95%CI = 1.10, 2.06). Student-athletes with increased sensation-seeking could be at risk for failing to disclose a concussion, decreasing athlete safety and resulting in less optimal care post-injury. Results will inform future theory-based concussion education programs which consider behavioral tendencies and traits as well as sport culture to promote concussion care-seeking/disclosure and individualized interventions based on risky behavior engagement

The Identification and Comparison of Factors Impacting Musculoskeletal and Concussion Injury Disclosure

Context: Despite increased risk of Musculoskeletal (MSK) injury following a concussion, little is known about the determinants of such risk. Moreover, previous reports of increased risk of MSK injury following a concussion have neglected to account for the high level of undisclosed concussions. Objective: This study explored the association between intention to disclose a possible concussion and intention to disclose MSK injuries. Design: Cross-sectional Setting: Online survey Patients or Other Participants: One hundred and seven NCAA Division 1 athletes (79% Female, age=19.4±1.4) Main Outcome Measure(s): Online survey exploring determinants such as injury knowledge, attitudes, perceived social norms, and perceived behavioral control surrounding concussive and musculoskeletal injury disclosure. Results: A significant association between high intention to disclose a concussion and high intention to disclose a MSK injury (χ2=19.276, p\u3c0.001, Cramer\u27s V=0.482) was observed. Spearman rank correlations suggested no correlation between the behavior of concussion non-disclosure (25%) and MSK injury non-disclosure (52%). Multivariate binomial regressions indicated perceived social norms were the strongest determinant (β =1.365, p= .002) of high intention to disclose concussion, while attitudes toward MSK injury (β =1.067, p=.005) and perceived social norms (β = 1.099, p=.013) were the strongest determinants of high intention to report MSK injury. Conclusions: Individuals with high intention to report concussion symptoms also demonstrated high intention to report MSK injury. Strong positive associations were observed between known determinants of intention to disclose concussion and adapted versions of those same determinant domains in MSK injury disclosure intention. As those with high intention to disclose concussion also demonstrated high intention to disclose MSK injury, intention to disclose injuries generally may play a role in explaining the increase in MSK injury following a concussion

Determinants of Intention to Disclose Musculoskeletal Injury in Adolescent Athletes

Context: Although research indicates that the key to minimizing the effect of musculoskeletal injury, improving care, and mitigating long-term effects is to improve early injury care seeking, little is known about barriers to early musculoskeletal injury disclosure and care seeking. Objective: To identify which determinants predicted sport-related musculoskeletal (MSK) injury disclosure by adolescent athletes. Design: Cross-sectional study. Setting: Online survey. Patients or Other Participants: A total of 564 adolescent athletes (58% male, age = 15.81 ± 1.8 years). Main Outcome Measure(s): Online survey exploring determinants of age, gender, race, socioeconomic status, injury knowledge, attitudes, perceived social norms, and perceived behavioral control surrounding MSK injury disclosure, intention to disclose MSK injury, and actual behavior of disclosing MSK injury. Results: Of the respondents, 457 (80.2%) reported having sustained ≥1 (mean = 3.2 ± 2.2; range = 1–10) MSK injuries related to sport. Those who endorsed having experienced an MSK injury disclosed not reporting or purposefully hiding 77% of their suspected MSK injuries. Several factors influenced a high intention to disclose MSK injury. Specifically, for each unit increase in total MSK injury knowledge (Exp[β] = 1.061, β=0.054, P = .020, 95% CI = 1.031, 1.221) and attitude (Exp[β] = 1.070, β = 0.064, P \u3c .001, 95% CI = 1.027, 1.115) score, 6% and 7% increases in the likelihood of a high intention to disclose an MSK injury, respectively, were observed. Moreover, for each unit increase in the social norm score (Exp[β] = 1.178, β=0.164, P \u3c .001, 95% CI = 1.119, 1.241), an 18% increase in the likelihood of a high intention to disclose an MSK injury was noted. Conclusions: Designing interventions geared toward increasing the knowledge of signs and symptoms of MSK injury, improving attitudes surrounding disclosure, and better understanding the social context of disclosing MSK injuries may improve MSK injury disclosure behavior and reduce the associated social and economic burdens of these injuries

Concussion knowledge, attitudes, and norms: How do they relate?

BackgroundRelationships between the constructs of concussion-related knowledge, attitudes, and norms and their influence on observed care-seeking behaviors have previously been examined. Current models posit that these constructs serve as potential mediators of care-seeking behaviors; however, the dynamics between them have yet to be reconciled.MethodsA cross-sectional, online survey explored relationships among the latent constructs of concussion-related knowledge, attitudes, and norms in parents of middle school children who participate in sports in multiple settings. A just-identified and two overidentified path models were explored and compared in an effort to understand such relationships.ResultsA total of 426 parents of United States middle school students were surveyed and included in analyses (mean age = 38.7±9.9 years; 55.6% female; 51.4% white/non-Hispanic; 56.1% with at least a bachelor's degree). All parents had middle school aged children who participated in sport in both the club and school settings. The best fitting model was a just-identified model with concussion-related norms influencing concussion-related knowledge and attitudes, and concussion-related knowledge influencing attitudes. This model accounted for 14% of the variance in attitude and 12% of the variance in knowledge.ConclusionsStudy findings suggest that the constructs of concussion-related knowledge, attitudes and norms are directly related to one another, yet the dynamics of such relationships may be complex. As such, a parsimonious interpretation of these constructs may not be appropriate. Future research should work to further reconcile the dynamics between these constructs, and the impact these dynamics may have in influencing care-seeking behaviors beyond serving as mediators

The Epidemiology of Ankle Sprains In United States High School Sports, 2011/12-2018/19 Academic Years

Context:Continued monitoring of ankle sprain rates and distributions is needed to assess temporal patterns and gauge how changes in incidence may be associated with prevention efforts. Objective:Describe the epidemiology of ankle sprains in 15 high school sports during the 2011/12–2018/19 school years. Study Design: Descriptive epidemiology study. Setting: Online injury surveillance from high school sports. Patients:High school athletes who participated in practices and competitions during the 2011/12–2018/19 school years. Methods: A convenience sample of high school athletic trainers (ATs) provided injury and athlete-exposure (AE) data to the National High School Sports-Related Injury Surveillance Study (HS RIOTM). Ankle sprain rates per 10,000AE with 95% confidence intervals (CI) and distributions were calculated. Yearly rates were examined overall, by event type, injury mechanism, and recurrence. Results: Overall, 9,320 ankle sprains were reported (overall rate=2.95/10,000AE; 95%CI: 2.89–3.01). The highest sport-specific rates were reported in girls\u27 basketball (5.32/10,000AE), boys\u27 basketball (5.13/10,000AE), girls\u27 soccer (4.96/10,000AE), and boys\u27 football (4.55/10,000AE). Most ankle sprains occurred during competition (54.3%) and were due to contact with another person (39.5%) and non-contact (35.0%). Also, 14.5% of injuries were noted as recurrent. Across the included academic years, ankle sprain rates generally increased. Compared to the 2011/12 academic year, rates in the 2018/19 academic year overall were 22% higher; non-contact-related and recurrent ankle sprain rates also generally increased, with 91% and 29% increases, respectively. Conclusions:: Time trends suggest ankle sprain rates have increased across the past decade, particularly among those with non-contact-related mechanisms; this contrasts previous research suggesting decreases in incidence. Findings may pinpoint specific etiological factors that should direct prevention efforts. This includes considering both person-contact and non-contact mechanisms through mitigating illegal contact through rule changes and enforcement, alongside bracing and proprioceptive and balance training programs

Concussion-Related Decision-Making By Certified Athletic Trainers: Implications For Concussion Prevention and Care

Concussions are a common sport-related injury that require appropriate initial care. Athletic trainers, often a primary source of healthcare for student-athletes, are key individuals involved in initial concussion diagnostic and management decisions. Challenges exist within the athletic environment that may hinder the consistency, efficacy, and/or effectiveness of concussion-related decision-making by athletic trainers, thereby impacting secondary concussion prevention and patient health. The purpose of this study was to identify factors that impact the intentions of athletic trainers to make appropriate concussion-related decisions under various circumstances. Overall, 1029 participants completed a survey examining educational precursors (quantity and quality of healthcare communication educational focus), demographic precursors (age, gender, educational degree, and employment setting), theory-based mediators (attitudes, perceived norms, and personal agency), and external mediators (knowledge, salience, and communication/collaboration practices) on appropriate concussion-related decision-making intentions. Data were analyzed using a two-step structural equation modeling approach. Quality of healthcare communication educational focus indirectly impacted appropriate concussion-related decision-making intentions via perceived behavioral control and communication/collaboration practices. Additionally, several factors impacted intentions to make appropriate concussion-related decisions directly including employment setting, self-efficacy, and general attitudes towards decision-making and concussions. Concussion prevention is aided by the initial and appropriate action taken by a healthcare professional to reduce immediate consequences; however, this action may be influenced by stakeholder relationships. These influential factors of decision-making may place athletes at further injury risk and negatively impact overall athlete health. As such, a sound theoretical framework incorporating the complexity of factors that may influence decision-making is needed

Sport culture and communication among middle school athletes, parents, and staff: A qualitative study

Middle school (MS) is an intermediary level of education between elementary and secondary school that typically includes students aged 10–15 years. There is limited research within the MS sport setting, particularly related to sport-related injury prevention. This qualitative study aimed to better understand the sport culture within MS sports and the communication strategies used among invested groups (i.e., athletes, parents, staff inclusive of coaches and school nurses). Semi-structured interviews were conducted with 19 athletes, 20 parents, and 18 staff (e.g., coaches, school nurses) from seven MS in two school districts during the 2018/19 and 2019/20 school years. Topics focused on understanding school- and sport-related factors related to education, safety, and communication. Analysis used a consensual qualitative research tradition, in which the research team discussed individually developed themes and categories from transcribed interviews, with the goal of coming to a consensus and creating a codebook. Throughout the coding process, the research team would reconvene to discuss coding decisions until consensus was reached. This study focuses on the themes of sport culture and communication. Dominant categories identified within sport culture related to participants noting why they were interested in MS sports, and their struggles with their perceived roles and engagement (e.g., helping parents stay engaged, finding coaches, oversight of school nurses). Competitiveness and safety could have conflicting roles and priority. Dominant categories identified within communication centered around limited communication between coaches and parents. Technological assistance (e.g., phone apps, websites) was available, but often varied by school and sport. Concussions were seldom discussed unless during the preseason meeting or when one occurred. Findings highlight that the MS sport settings may struggle with incorporating primary prevention into their cultures and ensuring reliable communication among individuals. Novel and tailored approaches to injury prevention are needed to help ensure buy-in and proper implementation