Burnout and Substance Use in Collegiate Athletic Trainers

CONTEXT: The Smith Cognitive-Affective Model of Athletic Burnout suggests that athletic trainers (ATs) suffering from burnout may engage in substance use as a coping behavior. Increases in self-reported burnout symptoms are often associated with increases in heavy episodic drinking and tobacco use among various health care providers. However, this relationship has not been examined thoroughly. OBJECTIVE: To investigate the prevalence of substance use in ATs and identify relationships between symptoms of burnout and substance use among ATs. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 783 certified ATs working full time in the collegiate or university setting were sampled for this study. Graduate assistant and other part-time ATs were excluded. The survey was distributed via the National Athletic Trainers\u27 Association membership directory e-mail broadcast service. MAIN OUTCOME MEASURE(S): A 100-item online questionnaire consisting of items from previously used scales was used for this study. The survey included the Maslach Burnout Inventory and questions on substance use from the Monitoring the Future study. Multiple regression analyses were performed to analyze the survey data. All independent (Maslach Burnout Inventory subscales) and dependent (use of alcohol, tobacco, and marijuana) variables were mapped to the Smith Cognitive-Affective Model of Athletic Burnout to determine which dimensions of burnout altered the odds of self-reported substance use. RESULTS: Almost half (46.3%) of participants admitted to at least 1 binge-drinking episode. However, the use of cigarettes, smokeless tobacco, marijuana, and energy drinks during the previous month was less pronounced in the sample. Emotional exhaustion (B = .008, P = .023) and personal accomplishment (B = -.016, P = .02) were significantly correlated with binge drinking. Emotional exhaustion (Exp[B] = 1.017, P \u3c .001) was also significantly positively correlated with energy-drink consumption. CONCLUSIONS: Some ATs engaged in heavy episodic drinking. Emotional exhaustion and a decreased sense of personal accomplishment were significantly correlated with this behavior

Stressed Fracture: The Relationship Between Coping Strategies and Workload in Secondary School Athletic Trainers

Purpose: The work environment for an athletic trainer (AT) working in a secondary school is typified by heavy workloads and job-related stress. Occupational stress can have negative effects on productivity, absenteeism, employee turnover, and quality of life. Research suggests that personal and situational factors can influence the coping process adopted by an individual. The approach-avoidance framework suggests that people cope with a stressor by either attempting to reduce it or removing oneself from that stressor. Previous research on other healthcare professionals suggested that use of avoidance coping was correlated with higher levels of job stress and those who perceived greater social support possessed lower work-related stress. However, the relationship between coping strategies and perceived social support has not been examined in ATs. The purpose of this study was to examine the relationship among coping strategies, perceived social support, and workload in secondary school ATs. Method: This was a cross-sectional study completed via an online survey. Three hundred, ninety-two (392) secondary school athletic trainers (35.7 ± 11.1 years old) from all NATA districts responded to the survey. Outcomes included the Brief COPE, Multidimensional Scale of Perceived Social Support, and average hours worked. Results: The average workload reported was 44.10 ± 12.96 hours a week over the school year (i.e., fall and spring). The regression model showed that avoidant coping (B=0.34, 95% CI=0.12, 0.56, p=.005) was directly associated with the average number of hours worked (adjusted R2=.07). Approach coping (B=-0.28, 95% CI=-0.43, -0.12, p=.007) was indirectly associated with the average numbers of hours worked. However, perceived social support did not display a significant association with any variable of interest. Conclusions: Our findings suggest that a relationship between average workload and coping strategies adopted by secondary school ATs may exist. Increased workloads were related to increases in avoidance coping strategies. Further research in this area is needed to determine how coping strategies affect patient care

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

Athletic Trainer Burnout: A Systematic Review of the Literature

Objective: To identify the causes, effects, and prevalence of burnout in athletic trainers (ATs) identified in the literature. Data Sources: EBSCO: SPORTDiscus and OneSearch were accessed, using the search terms athletic trainer AND burnout. Study Selection: Studies selected for inclusion were peer reviewed, published in a journal, and written in English and investigated prevalence, causes, effects, or alleviation of AT burnout. Data Extraction: The initial search yielded 558 articles. Articles that did not specifically involve ATs were excluded from further inspection. The remaining 83 full-text articles were reviewed. Of these 83 articles, 48 examined prevalence, causes, effects, or alleviation of AT burnout. An evaluation of the bibliographies of those 48 articles revealed 3 additional articles that were not initially identified but met the inclusion criteria. In total, 51 articles were included in data collection. Data Synthesis: Articles were categorized based on investigation of prevalence, causes, effects, or alleviation of burnout. Articles were also categorized based on which subset of the athletic training population they observed (ie, athletic training students, certified graduate assistants, high school or collegiate staff members, academic faculty). Conclusions: Burnout was observed in all studied subsets of the population (ie, students, graduate assistants, staff, faculty), and multiple causes of burnout were reported. Suggested causes of burnout in ATs included work-life conflict and organizational factors such as poor salaries, long hours, and difficulties dealing with the “politics and bureaucracy” of athletics. Effects of burnout in ATs included physical, emotional, and behavioral concerns (eg, intention to leave the job or profession)

Burnout in Secondary School Athletic Trainers, Part I: Correlations With Situational Variables

Burnout is a psychological syndrome that is found at higher rates in health care professionals, including athletic trainers. Situational variables such as social support, salary, work–family conflict, and workload have been associated with burnout in collegiate athletic trainers. The purpose of this study was to see whether such relationships exist within a sample of secondary school athletic trainers. Analyses suggest that increases in work–family conflict and decreases in social support were significantly correlated with increased burnout in our sample. These findings suggest that modification of work–life balance and support network are more important in combating burnout than modification of workload or salary

Burnout In and Commission of Medical Errors by Secondary School Athletic Trainers

Context: Commission of medical errors by health care providers can be costly and potentially fatal for their patients. Previous researchers found a correlation between burnout and the commission of medical errors by physicians. The Smith Cognitive-Affective Model of Athletic Burnout suggests that emotional exhaustion and decreased personal accomplishment in athletic trainers (ATs) may be associated with behavioral outcomes such as commission of medical errors, but this association has not been examined. Objective: To explore the association between burnout in and commission of medical errors by ATs. Design: Cross-sectional study. Setting: Web-based survey. Patients or Other Participants: A total of 403 certified ATs working in the secondary school setting were recruited via multiple social media pages and the National Athletic Trainers\u27 Association Research Survey Service. Main Outcome Measure(s): An online questionnaire that consisted of 97 items from previously used scales was distributed to participants. A logistic regression model with personal accomplishment and emotional exhaustion as independent variables and a dichotomous variable for commission of medical errors (yes or no) as a dependent variable was calculated. A Poisson regression model with personal accomplishment and emotional exhaustion as independent variables and number of medical errors committed as a dependent variable was also calculated. Results: Approximately 18.4% of our sample admitted to committing at least 1 medical error in the last 30 days. Both personal accomplishment (odds ratio = 1.06, P = .005) and emotional exhaustion (odds ratio = 1.02, P = .037) were significantly associated with commission of at least 1 medical error. Emotional exhaustion (B = .02, P = .002) was significantly associated with the number of medical errors committed. Conclusions: Athletic trainers committed medical errors at a rate comparable with that of other health care professionals. Burnout was directly associated with both the likelihood of an AT committing a medical error and the number of errors an AT committed

The Relationship Between Spiritual Well-Being and Burnout In Collegiate Athletic Trainers

Context: Spiritual well-being is the expression of one\u27s spirituality as measured in the dimensions of existential and religious well-being. The Smith Cognitive Affective Model of Athletic Burnout suggests that personality factors such as spiritual well-being and the use of religious coping methods may affect burnout as well as its causes and outcomes. This has not been examined in collegiate athletic trainers (ATs). Objective: To investigate the relationship between spiritual well-being and burnout in collegiate ATs. Design: Cross-sectional study. Setting: Web-based survey. Patients or Other Participants: A total of 783 certified ATs employed full time in the collegiate setting participated. Part-time employees (eg, graduate assistants, interns) were excluded. Main Outcome Measure(s): A 100-item online questionnaire was created for this study. It used items from previously developed scales, including the Spiritual Well-Being Scale, the Brief RCOPE, the Maslach Burnout Inventory, and substance-use questions from the Monitoring the Future study. Participants were able to complete the survey in approximately 10–15 minutes. Multiple regression analyses were used to analyze survey data. We mapped all independent (existential well-being, religious well-being, positive and negative religious coping) and dependent variables (situational variables, Maslach Burnout Inventory burnout subscales, substance use, and intention to leave) onto the Smith Cognitive-Affective Model of Athletic Burnout to determine which variables altered burnout levels, substance use, and intention to leave. Tests of mediation or moderation were conducted when appropriate. Results: Existential well-being was a significant positive predictor of social support and a significant negative predictor of work-family conflict, decreased sense of personal accomplishment, emotional exhaustion, depersonalization, intention to leave the profession, and binge drinking. Existential well-being also served as a mediator or moderator in several components of the model. Conclusions: Existential well-being was a protective factor against burnout as well as some of the causes and effects of burnout in collegiate ATs