Chelsi Day, PsyD Lindsey McGuire, PhD, LAT, ATC Yvette Ingram, PhD, LAT, ATC Chelsi Day, Psy.D Licensed Clinical and Sport Psychologist 1. 2. 3. Illustrate that Athletes are dealing with psychological issues We should be screening for these issues Design your athletic health care team with this in mind      Frontal lobe of brain still forming (25) Typical age of onset for schizophrenia (15-25) Typical age of onset for bipolar disorder (early 20s) Suicide is the 3rd leading cause of death for individuals aged 15-24 (CDC) Increased rate of depressive symptoms, often related to adjustment disorder. Particularly in first-year students.  University/college counseling centers ◦ Typically affiliated with psychology department or health services center. ◦ Often free to students or low fee. ◦ Approximately 9% of college students use counseling services provided by institution.  Community outpatient services ◦ Fees associated with. ◦ Often difficult to find.  Inpatient services ◦ Only useful when individual is risk to self or others.      Injury ◦ “endemic to sport” ◦ Approx 12,000 collegiate sport injuries (NCAA injury surveillance system) Culture of sport – “machoism” Less likely to seek help in general, even moreso related to mental health Lack of time for “self-care” 10-15% of student-athletes experience psychological distress that requires clinical attention (Stenfeldt et al., 2009; Watson & Kissinger, 2007)   75% of student athletes reported either that there were no sport psych/mental health services available to them or that they were unaware of any available to them (315,000) Over 30% of these student-athletes expressed interest in having access to sport psych/mental health services (126,000)  Mental health professionals ◦ Masters level counselors ◦ Doctoral level psychologists  APA Division 47 (all mental health professionals with special training in sport psychology)  Sport performance consultants ◦ Performance focused with possible ability to screen and refer. ◦ May or may not have training in mental heath skills  AASP (some mental health professionals)      Those embedded in athletics need to know what to look for and who to refer to. Training in identification and communicating with student athletes regarding mental health Aid in the reduction of stigma around mental health help seeking. Identified referral points to professionals with competency in the area. Qualified professional on staff. Lindsey McGuire, PhD, LAT, ATC    Research is limited; almost all using selfreport measures Prevalence of clinical levels of depression in the literature is varied (13.5%-26%) All cross-sectional: one snap-shot in time (Donohue et al., 2004; Yang et al., 2007; Armstrong & Oomen-Early, 2009; Hammond et al., 2013; Ramanathan, Rabinowitz, Barwick, & Arnett, 2012; Proctor & Boan-Lenzo, 2010)    Measure temporal changes in depression symptoms in 644 collegiate student-athletes PHQ-9: Brief self-report depression measure Baseline pre-season & every two weeks until end of fall season    644 athletes ◦ Male (n = 475, 73.8%) ◦ Female (n = 169, 26.2%) 18 years of age or older ◦ Underclassmen (n = 400, 62.1%) ◦ Upperclassmen (n = 244, 37.9%) A member of one of the four institution’s NCAA varsity, fall, 2013 athletic teams ◦ DII: (n = 399, 62%) ◦ DIII: (n = 245, 38%)   Race ◦ Minority race (n = 132, 20.5%) 7 sports ◦ Football (n = 414, 64.3%) ◦ Women’s soccer (n = 85, 13.2%) ◦ Women’s volleyball (n = 48, 7.5%) ◦ Men’s soccer (n = 31, 4.8%) ◦ Men’s cross-country (n = 30, 4.7%) ◦ Field hockey (n = 21, 3.3%) ◦ Women’s cross-country (n = 15, 2.3%) 20 (3.1%) athletes:  previously diagnosed with depression (n = 17, 2.6%)  currently in treatment for depression (n = 12, 1.9%)  currently on depression medication (n = 14, 2.2%) there are at least 4 checks in the blue highlighted section of the PHQ-9, including questions #1 and #2 (indicating those symptoms bothered them more than half the days, or nearly every day), and the impairment question #10 is answered at least “somewhat difficult” OR  total score is ten or higher, question 1 or 2 was checked in the blue highlighted section, and the impairment question #10 is answered at least “somewhat difficult” OR  Question 9 (suicidal ideation) is checked as occurred some of the days, more than half the days, or nearly every day  What is the temporal prevalence of and difference in depression throughout a fall athletic season in collegiate student-athletes?   At any one point in time, 0.2 - 1.6% of studentathletes’ PHQ-9s red-flagged Across the entire athletic season, 3.7% of studentathletes had their PHQ-9s red-flag Repeated Measures ANOVA (n = 323):  Significant differences across time (F (3.69, 1187.08) = 5.71, p < 0.001, partial eta squared = 0.02) ◦ symptoms were significantly higher at Time 1 than Time 6 (p = 0.03) and at Time 2 than Time 6 (p = 0.01) ◦ symptoms at Time 2 significantly higher than Time 3 (p = 0.03) Repeated measures ANOVA (n = 323) ◦ significant difference in PHQ-9 scores between sex (p = 0.05) Independent t-tests between males & females at each Time interval (all athletes) ◦ Significant differences in depression symptoms were found between males and females at Time 3 (p = 0.01), Time 4, (p = 0.00) and Time 6 (p = 0.02) ◦ Time 5 approached significance (p = 0.051) Repeated measures ANOVA (n = 323) ◦ significant difference in PHQ-9 scores between sport (p = 0.00) Post-hoc pairwise comparisons: ◦ Significant differences in PHQ-9 scores between women’s volleyball players and all other sports   37 (5.7%) indicated they went through a negative life event within the past three months (at baseline) Independent t-tests at each time interval: ◦ Differences between life event and non-life event groups were statistically significant at all six time intervals (p = 0.00 – 0.04)  Limitations: ◦ Underreporting of depression symptoms  Positive attributes: ◦ Methodological approach: repeated measures vs. crosssectional examination of depression  Positive for research in investigating mental health issues in athletes ◦ Controlled for pre-study depression   Support and promote the adoption of psychological measures within preparticipation exams, and throughout the season Have someone to refer your patients to… ◦ Sport psychologist on your Sports Medicine Team Yvette Ingram, PhD, LAT, ATC My involvement in this study   Participating in collegiate sports does not make athletes exempt from dealing with depression symptoms – depression does exist in this population! Athletic Trainers are in a unique healthcare position: ◦ Screening for depression symptoms, referral to mental health professional ◦ Not just at pre-season physicals, but throughout the season  Negative life events    CS#1 – FBL 19 y.o, overweight individual, medicated CS#2 – FBL friendly, polite, medicated Process: ◦ Lindsey would call me ◦ I would discuss with athlete ◦ Decision would be made  Athletic Trainers (AT) are beginner sport psychologists  A way to introduce the topic to the athletes, BEFORE something occurs ◦ Preseason & post season ◦ Preseason, regular intervals, post season ◦ When injured, whether it is an A’ sprain, LBP or a concussion ◦ Observation only ◦ Can use:  PHQ-9  Beck’s Depression Inventory  Children’s Depression Inventory 2       Listening Use your connections with the athlete Face the person Maintain an open posture Maintain an appropriate distance b/t you and the athlete Use non-verbal communication ◦ Facial expressions ◦ Heading nodding  From a place of concern ◦ I am worried b/c…. ◦ Send clear, concise message   Hear & correctly understand the message you are being told Avoid: ◦ Attacking, criticizing, judging  Your goals is to get them to confide in you & get them the help they need   Educate athletes about potential risk factors Use – get to know them ◦ On-campus resources – i.e. counseling center or guidance counselor ◦ Community resources – private practice psychologists or psychiatrists     Call ahead of time Offer to go with them Explain confidentiality Stay in touch – different ways to do this   Refer to the: Inter-Association Recommendations in Developing a Plan for Recognition and Referral of Student-Athletes with Psychological Concerns at the Collegiate Level: A Consensus Statement PATS Research Grant NCAA Graduate Research Award