O1018: The Influence of Return to Sport on Mental Health, Physical Activity and Quality of Life Among Adolescent Athletes During COVID-19

Background: COVID-19 has had profound detrimental impacts on the mental health of children and adolescents. Among youth athletes, the loss of sports was associated with dramatic increases in anxiety and depression and significant reductions in quality of life (QOL) and physical activity (PA). Although PA and organized sport participation have historically been associated with improved mental health and well-being among adolescents, the impact of the return to sports on psychosocial outcomes in young athletes during COVID-19 is poorly defined. Therefore, the purpose of this study was to evaluate the changes in mental health, QOL and PA among adolescent athletes during the COVID-19 pandemic as organized sports resumed.

Methods: Adolescent athletes from throughout the United States completed surveys including demographic and sport participation information, the Patient Health Questionnaire-9 Item (PHQ-9), the Generalized Anxiety Disorder-7 item (GAD-7), and the Hospital for Special Surgery Physical Function and Activity Brief Scale (PFABS) in May 2020 following COVID-19 related sport cancelations (Spring20) and after returning to sports in May 2021 (Spring21). The groups were balanced by inverse propensity score weighting using age, geographic region, school enrollment, socioeconomic status, number of sports played, and sport type. Thereafter, continuous variables were compared using ANOVA models, and categorical outcomes were compared using age and sex-adjusted ordinal regression models.

Results: A total of 17,421 participants were included (Spring20=13,002; Spring21=4,419; 16.2 +/- 1.2 years; 53% female). Anxiety was significantly lower (better) in Spring21 than Spring20 with respect to GAD-7 total scores (Spring20 = 7.0 [6.9,7.1], Spring21 = 4.9 [4.8,5.0], p< 0.001) as well as the prevalence of moderate to severe anxiety (Spring20 = 29.4%, Spring21 = 17.1%, p< 0.001; see Figure 1). Similarly, depression was significantly improved in Spring21 with respect to PHQ-9 total scores (Spring20 = 7.6 [7.5,7.7], Spring21 = 4.6 [4.5,4.8], p< 0.001) as well as the prevalence of moderate to severe depression (Spring20 = 32.2%, Spring21 = 15.4%, p< 0.001; see Figure 2). Lastly, athletes in Spring21 reported higher levels of PA (Spring20 = 13.8 [13.6,13.9], Spring21 = 22.7 [22.6,22.9], p< 0.001) and QOL (Spring20 = 79.6 [79.3,79.9], Spring21 = 84.7 [84.4,85.0], p< 0.001).

Conclusion: Adolescent athletes reported significant impairments in mental health, QOL and PA during the early pandemic when sports were canceled. In 2021, after returning to sports, athletes report significant improvements in mental health, PA and QOL. Unfortunately, the reported levels of anxiety, depression and QOL remain worse than previously reported values among adolescents before COVID-19. This suggests that while sport participation may have a significant and beneficial impact on psychosocial outcomes, the impacts of the COVID-19 pandemic on the mental health and well-being of young athletes will remain an important consideration into the future.