Screening for Physical Activity and Mental Health in Pediatric Sports Medicine

Background: Various events may trigger new mental health concerns or exacerbate an existing condition in an adolescent. Injuries may pose significant psychological stress to adolescents. To assess a correlation between injury and risk on mental health, adolescent athletes with acute injuries, overuse injuries, and concussions were screened for anxiety, depression, and amount of weekly physical activity.

Methods: Adolescent patients, ages 12 to 18 years of age, reported to an outpatient sports medicine clinic were eligible to receive the following three screenings: Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionaire-9 (PHQ-9), and physical activity questionnaire, which mimics adult exercise vital sign. A screening score ≥ 5 on GAD-7 and PHQ-9 is categorized as mild anxiety and mild depression respectively. Acute injuries were defined as those resulting from acute mechanisms such as falls, twisting etc. and were diagnosed as sprains, fractures, or dislocations. Overuse injuries were chronic in nature and carried diagnoses such as tendonitis, stress fractures, and apophysitis.  Concussions resulted from a blow to the head or body (with force transmitted to the head) with transient impairment in neurologic function.

Results: At the initial outpatient visit, 119 adolescent patients were included with the demographics: 40% female and average age was 15.47 ± 1.50 years. The participants were classified into three categories: 45 acute injuries, 57 overuse injuries, and 17 concussions. Three separate one-way ANOVAs were completed to examine differences in anxiety, depression, and physical activity scores between groups.  The screenings recorded GAD-7 of 3.89 ± 4.54, PHQ-9 of 4.00 ± 4.39, and physical activity of 427.90 ± 277.20 minutes per week. There were no significant differences between acute, overuse, or concussions in anxiety, depression, or physical activity (p = 0.33, p = 0.64, p = 0.25, respectively). Overall, 24% reported elevated anxiety scores and 28% reported elevated depression scores. Chi-square analysis between the proportions of those with acute, overuse, or concussion injury with elevated anxiety or depression demonstrated no significant difference (p = 0.29, p = 0.95, respectively).

Conclusion: There were no significant differences between injury groups in anxiety, depression, or physical activity screenings. Overall, 24% of the patients screened by GAD-7 and 28% screened by PHQ-9 scored ≥ 5. This cohort’s results mirrored the general adolescent population with a high mental health burden. While injury types did not show a significant difference in screenings, this study highlights the importance of screening for mental health conditions such as depression and anxiety. Identification and effective referral to mental health care is essential to promoting the adolescent’s lifelong health and well-being.