Radar Items: Fall Sports

Sports Psychiatry

By: Dr. Carla Edwards, Sports Psychiatrist

Fall is perhaps the busiest season of change throughout the entire year. The sun seems lower in the sky, temperatures cool, leaves dazzle with their new hues before finding their way to the ground, and students return to school. In the sports world, summer sports leagues wrap up and Fall sports begin. Sometimes (particularly in the youth sports world), seasonal transitions overlap simultaneously with the resumption of classes. This makes for an incredibly busy, and stressful, time for athletes and their families. It is important for sports medicine practitioners to be mindful of the potential impact of these stressors when athletes present to your clinic. Let’s explore these concepts according to stage of sport competition:

Youth Sports:

Although modern sports facilities can accommodate most sports year round, certain sports have their main seasons during the Summer. These include baseball, softball, soccer, golf, lacrosse, tennis, football, and cricket. Many youths find ways to stay active with hockey through the spring and summer as well—typically playing on different teams than during their main competitive season. Young athletes who are talented enough to play on high level sports teams in the summer may conclude their season in September. For the last several weeks of the summer, they are spending several evenings and weekends practicing and playing playoff games and tournament. Concurrently, they are beginning practice with their Fall sports teams (which can be the same sport or something completely different). Sometimes there are team tryouts during this period, and of course return to school occurs during this time. For the 12-14 year old age group, physical growth occurs over different trajectories. This bears importance for youth boys’ when hitting is permitted in their leagues. Balancing the desire to deliver big hits whil properly executing the skill can make the difference in terms of injuries sustained in youth hockey related to body contact.

Tip: When you are seeing a youth athlete in the early Fall:

1. explore the extent of all sports they are currently involved in,
2. ask what levels they are playing, and
3. record their training and competition schedule.

Ask about:

1. team dynamics,
2. bullying or maltreatment
3. their experiences of their coaches
4. if their parents support them
5. the “car ride home”
6. do they take any days completely off
7. do they hang out with non-sports friends
8. is sports still fun?

This is a good opportunity to explore healthy balance, unhelpful parental styles, and early sport specialization. It is also a prime opportunity to educate the parents about how much practice is enough, as many kids are expected to practice then sports and skills for many hours at home in addition to regular team-based training.

High School Sports:

This is a great sports setting that provides opportunities for athletes to participate in many sports. Most “rep” or elite athletes view school sports as a fun time to play sports with their friends. Young athletes who play school sports may also be involved in club and elite sports concurrently; and thus, is it important and to review the same questions with these athletes as you would for youth athletes. This population experiences additional pressures on academics as then prepare for application to post secondary institutions.

These youth and young adult student athletes are often on the go and away from home for most of the day. Factoring in healthy and nutritious snacks and meals are extremely important for adequate fueling. Always ask about fueling!

Tip: Remember, if a youth student athlete required surgical repair that will interrupting their main sport for ~1 year (ie ACL repair), they will be missing all of the school sports for that year. That may cause some distress and would benefit from exploration and connection with a mental health practitioner.

Collegiate and Varsity Sports:

This is ultimate test for student athletes. Adding to the stress of playing at higher level sport, living away from family (for most students), and navigating campus, varsity and collegiate athletes experience a significant increase in independence and personal responsibility. While varsity programs provide an instant community for athletes, settling into their role in the varsity team environment can be very daunting. Specific challenges may include:

• difference in role
• difference in playing time
• toxic team environment
• difficult balance of classes, practice, and travel
• more structure around sport but less around academics
• figuring out the balance between social, school, and sport responsibilities
• pressure to party

Key features that should be explored with every athlete all the time (but especially during busy overlapping seasons) are adequate fuelling, adequate sleep, balance with self care and rest, and inclusion of other activities that promote development of other parts of their identities outside of sport.

In addition to the above radar items to bring to patient encounters, it is also important to revisit previous mental health concerns with athletes who have struggled. This is particularly important in the varsity or collegiate settings if the athlete has had mental health struggles that affected their safety, stability or function (1). Athletes who have screened positivity for mental health conditions should have additional screening with instruments such as the Sport Mental Health Assessment Tool-1 (2). If there are, or have been, significant mental health concerns, an athlete’s suitability to participate in sports training and competition (including travel) can be determined with the use of the framework created by Edwards (1).

By mid-season, schedules generally settle down and athletes get into routine. Be mindful of the potential impact on mental health for athletes who must miss significant training and competition related to serious injury or surgery. The potential for depression and suicidal behaviours increase in this population, particularly if their absence if expected to exceed 6 weeks, they lose their position to a teammate, they do not achieve pre-operative function, and sports was a major contributor of their identity. It is recommended that athletes be referred to mental health professionals in these circumstances.(3)

Last thoughts

Athletes thrive in sports and, for some, the more the better! This can lead to significant chaos in millions of households each September with the crossover of several sport seasons. It can also lead to exhaustion, burnout, injuries, and loss of enjoyment in the sports. Sports Medicine practitioners are in an ideal position to explore the athlete’s approach and attitude toward their schedule and provide preventative education and guidance. It is also important to involve mental health professionals when certain indicators are identified—including mental health decompensation, requirement for more in-depth review and screening, and circumstances that will remove the athlete from the sport environment for an extensive period of time.

Final Tips:

1. Youths and young adults are often involved in many sports. When these sport seasons overlap in transition it is important to explore and emphasize adequate sleep, nutrition and rest.
2. Athletes who have struggled with mental health concerns previously should undergo careful screening prior to subsequent seasons
3. Young adults sthletes who will miss 6 weeks or more of sport due to illness, injury, or surgery are at an elevated risk for depression and suicidal behavior and should be referred to a mental health professional.

References

1. Edwards, C. D. (2023). Mental health considerations for athlete removal from play and return to play planning. Sports Psychiatry: Journal of Sports and Exercise Psychiatry. https://doi.org/10.1024/2674-0052/a000058
2. Gouttebarge V, Bindra A, Blauwet C, et al International Olympic Committee (IOC) Sport Mental Health Assessment Tool 1 (SMHAT-1) and Sport Mental Health Recognition Tool 1 (SMHRT-1): towards better support of athletes’ mental health. British Journal of Sports Medicine 2021;55:30-37.
3. Smith, A. M., & Milliner, E. K. (1994). Injured athletes and the risk of suicide [Article]. Journal of Athletic Training, 29(4), 337-341.