Factor Structure and Gender Invariance Testing for the Sport Anxiety Scale-2 (SAS-2)

This study aimed to provide further psychometric validation of the Sport Anxiety Scale-2 (SAS-2) by assessing the factor structure, invariance across gender, and convergent and divergent validity of the SAS-2 by correlating both related (i.e., anxiety sensitivity, brief fear of negative evaluation, intolerance of uncertainty, and negative affect) and unrelated constructs (i.e., positive affect, self-confidence). A total of 542 current and former competitive athletes completed a questionnaire through Amazon’s Mechanical Turk system. All data were collected via online survey. Participants were randomly assigned to an exploratory factor analysis (n = 271) and confirmatory factor analysis group (n = 271). Results indicated that both exploratory and confirmatory factor analyses supported the three-factor model of anxiety involving somatic anxiety, worry, and concentration disruption. Additionally, this study found the SAS-2 to be reliable, gender invariant, and have strong construct validity. Our findings extend the generalizability of the SAS-2 in more varied populations of athletic backgrounds

Anxiety Sensitivity and Adolescent Sports Related Concussion

The yearly prevalence of sports-related concussion (SRC) amongst adolescents is quite high. While most adolescents recover within 4 weeks, there is a significant minority whose symptoms linger. One challenge facing clinicians is there is no single pathophysiological biomarker of concussion, so current diagnostic and treatment models are dependent on self-reporting of symptoms. Previous research has focused on factors that might be related to symptom reporting and duration symptoms, including anxiety and depression. However, few studies have focused on the psychological mechanisms that drive anxiety and depression and the unique contributions of these mechanisms to symptom reporting after concussion. One specifically promising psychological mechanism is anxiety sensitivity, the catastrophic misinterpretation of internal sensations. It is a mechanism that is well studied, related to a range of pathologies and adverse responses to biological sensations, and amenable to treatment. The present study examined the relationship that anxiety sensitivity has with the initial reporting of symptoms after adolescent SRC and rate of change in symptoms over time (6 weeks). Participants were 40 adolescents who presented for treatment following a sports injury at a specialty children’s sports medicine clinic with 20 sustaining a SRC and 20 sustaining a musculoskeletal injury. All participants filled out an online survey to their symptom severity and anxiety sensitivity across three time points during a six-week period. Anxiety sensitivity showed a moderating effect on symptoms reported for the concussed group, with those in the concussed group reporting more initial symptoms as their anxiety sensitivity scores increased. However, anxiety sensitivity was not related to rate of change (reduction) in symptoms reported overtime. Although further study is needed, the finding that anxiety sensitivity has a moderating effect on initial symptom reporting may suggest a target for early intervention. Overall, the present study serves as an early step in establishing the relationship of anxiety sensitivity with symptom reporting following adolescent SRC

Anxiety Sensitivity and Adolescent Sports Related Concussion

The yearly prevalence of sports-related concussion (SRC) amongst adolescents is quite high. While most adolescents recover within 4 weeks, there is a significant minority whose symptoms linger. One challenge facing clinicians is there is no single pathophysiological biomarker of concussion, so current diagnostic and treatment models are dependent on self-reporting of symptoms. Previous research has focused on factors that might be related to symptom reporting and duration symptoms, including anxiety and depression. However, few studies have focused on the psychological mechanisms that drive anxiety and depression and the unique contributions of these mechanisms to symptom reporting after concussion. One specifically promising psychological mechanism is anxiety sensitivity, the catastrophic misinterpretation of internal sensations. It is a mechanism that is well studied, related to a range of pathologies and adverse responses to biological sensations, and amenable to treatment. The present study examined the relationship that anxiety sensitivity has with the initial reporting of symptoms after adolescent SRC and rate of change in symptoms over time (6 weeks). Participants were 40 adolescents who presented for treatment following a sports injury at a specialty children’s sports medicine clinic with 20 sustaining a SRC and 20 sustaining a musculoskeletal injury. All participants filled out an online survey to their symptom severity and anxiety sensitivity across three time points during a six-week period. Anxiety sensitivity showed a moderating effect on symptoms reported for the concussed group, with those in the concussed group reporting more initial symptoms as their anxiety sensitivity scores increased. However, anxiety sensitivity was not related to rate of change (reduction) in symptoms reported overtime. Although further study is needed, the finding that anxiety sensitivity has a moderating effect on initial symptom reporting may suggest a target for early intervention. Overall, the present study serves as an early step in establishing the relationship of anxiety sensitivity with symptom reporting following adolescent SRC

Validity and Reliability of Baseline Testing in a Standardized Environment

Objective — The Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) is a computerized neuropsychological test battery commonly used to determine cognitive recovery from concussion based on comparing post-injury scores to baseline scores. This model is based on the premise that ImPACT baseline test scores are a valid and reliable measure of optimal cognitive function at baseline. Growing evidence suggests that this premise may not be accurate and a large contributor to invalid and unreliable baseline test scores may be the protocol and environment in which baseline tests are administered. This study examined the effects of a standardized environment and administration protocol on the reliability and performance validity of athletes’ baseline test scores on ImPACT by comparing scores obtained in two different group-testing settings. Method — Three hundred-sixty one Division 1 cohort-matched collegiate athletes’ baseline data were assessed using a variety of indicators of potential performance invalidity; internal reliability was also examined. Results — Thirty-one to thirty-nine percent of the baseline cases had at least one indicator of low performance validity, but there were no significant differences in validity indicators based on environment in which the testing was conducted. Internal consistency reliability scores were in the acceptable to good range, with no significant differences between administration conditions. Conclusions — These results suggest that athletes may be reliably performing at levels lower than their best effort would produce

Factor Structure and Gender Invariance Testing for the Sport Anxiety Scale-2 (SAS-2)

This study aimed to provide further psychometric validation of the Sport Anxiety Scale-2 (SAS-2) by assessing the factor structure, invariance across gender, and convergent and divergent validity of the SAS-2 by correlating both related (i.e., anxiety sensitivity, brief fear of negative evaluation, intolerance of uncertainty, and negative affect) and unrelated constructs (i.e., positive affect, self-confidence). A total of 542 current and former competitive athletes completed a questionnaire through Amazon’s Mechanical Turk system. All data were collected via online survey. Participants were randomly assigned to an exploratory factor analysis (n = 271) and confirmatory factor analysis group (n = 271). Results indicated that both exploratory and confirmatory factor analyses supported the three-factor model of anxiety involving somatic anxiety, worry, and concentration disruption. Additionally, this study found the SAS-2 to be reliable, gender invariant, and have strong construct validity. Our findings extend the generalizability of the SAS-2 in more varied populations of athletic backgrounds

Sleep and stress in the acute phase of concussion in youth

This study sought to address the complex interplay between both biological and psychological perceptions of stress and sleep in the acute stages following a mild traumatic brain injury. A secondary goal was to identify potential targets for intervention. Eleven acutely injured youth (mean age 12 years) were studied at home with overnight actigraphy, salivary cortisol and melatonin assays, and subjective ratings of stress and fatigue (injured group). Nine matched control youth also were assessed (control group). Results suggested longer sleep latencies (time to fall asleep) and higher levels of fatigue in the injured group exist (p ¼ 0.025 and p ¼ 0.004, respectively). In the injured group, stress and sleep onset were significantly related with most subjects meeting criteria for Acute Stress Disorder. Melatonin levels were lower at bedtime in the injured group. Saliva samples were collected via passive drool at three time points: ~1 h before bed (“bedtime” or T1), immediately upon waking (time 2: T2), and 30 min post-waking (time 3: T3). Overnight increases in cortisol (T1 to T2) were greater for the injured group; however, post-sleep changes in cortisol (T2 to T3) were reversed with control concentrations increasing. These findings are unique in using actigraphy and salivary hormone levels in an acutely injured youth while in their homes. The differences in sleep latency and the presence of injury-related stress point to potential treatment targets in acute concussion

Association Between Concussion History and Factors Relating to Cognitive, Behavioral, and Emotional Health Among American High School Athletes: A Cross-sectional Analysis

Background: The cognitive, behavioral, and emotional deficits that may be associated with sports-related concussions among adolescents are unclear. Purpose: To examine the association between reported concussion history and factors relating to cognitive, behavioral, and emotional health among a population-based sample of US high school–aged adolescents. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Participants included a representative sample of US high school student-athletes who reported a concussion history (in the past 12 months) and relevant behaviors/outcomes within 3 domains: cognitive (academics, difficulty concentrating), behavioral (drinking and driving, carrying a weapon, physically fighting, tobacco use, marijuana use, binge drinking), and emotional (symptoms of depression, suicidal thoughts/actions). The adjusted relative odds of experiencing 0 and at least 1, 2, 3, or ≥4 concussions were modeled while mutually adjusting for the behaviors of interest in addition to age, race/ethnicity, and sleep problems. Data were reported in sex stratum. Results: A total of 13,268 participants were included in the unweighted data set. Overall, 14.5% (95% CI, 12.9%-16.2%) of female and 18.1% (95% CI, 16.4%-19.8%) of male student-athletes had at least 1 concussion in the past 12 months. As compared with those who reported not engaging in any of the behaviors deleterious to health or having had any of the negative health outcomes (composite score of 0), female athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 1.94 (95% CI, 1.55-2.43), 3.13 (95% CI, 2.30-4.33), and 6.05 (95% CI, 3.75-9.75) times more likely to have a recent history of concussions after accounting for relevant factors. As compared with those having a composite score of 0, male athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 2.03 (95% CI, 1.58-2.59), 3.80 (95% CI, 2.71-5.34), and 8.23 (95% CI, 4.91-13.77) times more likely to have a recent history of concussions after accounting for relevant factors. Conclusion: Self-reported concussions among US high school athletes is related to several deleterious health behaviors and outcomes. These associations should be confirmed in longitudinal analyses