Team Sport Athletes May Be Less Likely to Suffer Anxiety Or Depression Than Individual Sport Athletes

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©Journal of Sports Science and Medicine (2019) 18, 490-496 http://www.jssm.org

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Team Sport Athletes May Be Less Likely To Suffer Anxiety or Depression than Individual Sport Athletes

Emily Pluhar 1, Caitlin McCracken 2, Kelsey L. Griffith 3, Melissa A. Christino 3, Dai Sugimoto 3 and William P. Meehan III 1,3 1 Division of Adolescent Medicine and Young Adult Medicine and Division of Sports Medicine, Department of Orthope- dics at Boston Children’s Hospital and Harvard Medical School; 2 Oregon Health Science University College of Phar- macy, Oregon State University; 3 The Micheli Center for Sports Injury Prevention and Division of Sports Medicine, De- partment of Orthopedics at Boston Children’s Hospital, USA

dence, physical activity has been associated with decreased risk of these illnesses (Adachi and Willoughby, 2014; Abstract Boone and Leadbeater, 2006; Findlay and Bowker, 2009; The objective of the study was to determine whether 1) the proportion of athletes with mental health diagnoses and 2) athlete Lubans et al., 2016; McMahon et al., 2017; Toseeb et al., motivations for playing differ between team sports and individual 2014). Several studies suggest that physical activity is ben- sports. We conducted a cross-sectional study of child and adoles- eficial to the mental health of young people, 30-40% of cent athletes assessed at a sports injury prevention center. We whom will show moderate or severe depressive symptoms compared self-reported anxiety, depression, and reasons for par- between ages 12 and 19 (Boone and Leadbeater, 2006; ticipating in sports between athletes in individual sports (e.g. Sabiston et al., 2016). Strong et al. (2005) recommend gymnastics, running, diving) and team sports (e.g. soccer, foot- school-age youth should engage in 60 minutes of exercise ball, hockey). In addition, we categorized motivation for partici- per day to increase muscle strength, reduce body fat, main- pating in sports as 1) for fun, with associated benefits of partici- tain healthy body weight, promote bone density, improve pation including, motives such as making friends and being part of a team or 2) for goal-oriented reasons with associated benefits mood, and decrease symptoms of depression and anxiety. of participation including motives such as obtaining scholarship Therefore, individual and team sports seem to help mediate or controlling weight. At the time of this analysis, 756 athletes the presentation of psychological disorders and serve as ef- between the ages of 6 and 18 years had undergone a sports injury fective treatment measures. prevention evaluation. Most athletes were White (85%) and there Furthermore, organized sports participation is asso- was a slight female predominance (56%). Of the total population, ciated with a decreased risk of anxiety, depression, feelings 8% reported suffering from anxiety or depression. A higher pro- of hopelessness, suicidal ideation and suicide attempts, il- portion of individual sport athletes reported anxiety or depression licit drug use, and the smoking of tobacco products, above than team sport athletes (13% vs. 7%, p < 0.01). Individual sport exercise alone (Miller et al., 2002; Miller and Hoffman, athletes were more likely than athletes in team sports to play their sports for goal-oriented reasons, as opposed to for fun (30% vs. 2009; Pedersen et al., 2017). Organized sports correlate 21%, p < 0.05). Individual sport athletes are more likely to report more positively with adolescent mental health than other anxiety and depression than team sport athletes. The mental forms of physical activity (Eime et al., 2013). Organized health benefits of participation in organized sports may vary be- sports have been associated with decreased depressive tween individual sport athletes and those playing team sports. symptoms, increased self-esteem, and improved social abilities (Sabiston et al., 2016; Vella et al., 2017). The so- Key words: Mental health, athlete, organized sport, competi- cial benefits of participating in sports have been linked to tion, depression, anxiety, adolescents. reduced stress and better self-reported overall mental health in young adults (Sabiston et al., 2016; Vella et al., 2017). A study from 2015 revealed that those who do not Introduction participate in or drop out of organized sports have greater social and emotional difficulties than those who continue As the prevalence of mental health issues continues to in- to play (Vella et al., 2015). Non-athletes are also 10-20% crease globally, more studies have focused on physical ac- more likely to suffer from mental health issues (Vella et al., tivity as a potential protective mediator for mental health 2017). The benefits of sport and physical activity on met- disorders including anxiety and depression (Boone and rics of mental health have been well-established. Leadbeater, 2006; Schaal et al., 2011). Having extensively Not all sports, however, impact mental health in the examined how exercise improves physical health, re- same way. Kajbafnezhad et al. (2011) discovered “signifi- searchers are now focusing on the psychological impacts cant difference between [team sports and individual sports] of physical activity (Eime et al., 2013; Nixdorf et al., in terms of psychological skills and motivation of athletic 2016). Between 2-9% of children are diagnosed with major success” (p. 1904). Playing on a team both encourages fit- depressive disorder, while 5-10% of children and up to ness and allows young people to develop important mental 25% of teenagers suffer from anxiety (Glover and Fritsch, and social skills (Boone and Leadbeater, 2006; Vella et al., 2018; Sabiston et al., 2016). Presenting adolescents with an 2017). Team sports provide an opportunity for children to opportunity to socialize, relieve stress, and build confi- learn to work well with others and effectively contribute to

Received: 24 December 2018 / Accepted: 03 June 2019 / Published (online): 01 August 2019

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a group (Sabiston et al., 2016). The resulting sense of sup- atric medical center between April 2013 and February port and acceptance likely plays an integral role in reducing 2018. The focus of the center is to reduce the risk of depressive symptoms and leads to healthy relationships sport-related injuries and conduct research on injury pre- with adults and peers (Eime et al., 2013; Boone and Lead- vention in sport. Specifically, each athlete completes an beater, 2006). Boone and Leadbeater (2006) found that extensive questionnaire detailing sports participation, positive experiences on teams with coaching, skill devel- previous injury history, training regimen, dietary intake, opment, and peer support contribute to feelings of social and sleeping habits followed by anatomic measurements, acceptance and decreased body dissatisfaction and ulti- performance measures, biomechanical evaluations, func- mately fewer depressive symptoms among adolescents. tional movement assessments, and physical fitness Individual sports help cultivate other important psy- screening. At the end of the evaluation a list of injuries chological skills. When athletes practice alone, they can for which the athletes are at highest risk is generated and improve their ability to concentrate and improve mental a prescription for decreasing the risk of those injuries is strength. While individual sports often provide less social given to the athlete. Athletes are either self-referred, re- opportunity, they encourage responsibility and self-reli- ferred by other athletes who have gone through an IPE, ance. Individual sport athletes may engage in a “higher referred in by coaches, or are referred in by physicians level of preparation” because their success depends com- who have treated them for past injuries. All stages of ath- pletely on their own skills and training (Kajbafnezhad et letes from early amateur through professional are evalu- al., 2011). Yet, this increased sense of accountability can ated. Only participants aged 18 years and younger were lead to intense feelings of shame or guilt after losing (Nix- included in these analyses. The institutional review board dorf et al., 2016). Team sports are sometimes stressful as a of Boston Children’s Hospital approved this study. result of competition, team dynamics or coaching issues, Participants were provided with a list of the most but individual sports may cause greater internal attribution common sports and asked to select the three organized such as shame after failure, which is linked to depressive sports they prioritize participating in yearly; participants symptoms (Boone and Leadbeater, 2006; Hanrahan and were allowed to write in sports not listed. Individual sport Cerin, 2009; Nixdorf et al., 2016). Nixdorf et al. (2016) re- was defined as a sport not requiring another person to ports that elite junior athletes who play individual sports compete with you (not including the opponent or events suffer more from depression than those who play team such as relays). Individual sports included swimming, sports. Sabiston et al. (2016) reveals that youth who en- cross country, gymnastics, tennis, fencing, track and gaged in team sports throughout high school reported fewer field, boxing, equestrian, dance, figure skating, long dis- depressive symptoms later in life, but the same did not ap- tance running, martial arts, diving, wrestling, and sailing. ply to individual sports. Both team and individual sports For the purposes of this analysis, participants were ana- have been shown to support mental and physical health, lyzed as individual sport athletes only when they partici- but, as noted by Vella et al. (2017), “the weight of evidence pated exclusively in individual sports year-round; any suggests that participation in team sports may be more athlete who participated in a team sport during any season strongly linked to positive social and psychological out- was categorized as a team sport athlete. Single sport ath- comes when compared to individual sports” (p.688) letes were defined as those who only listed participation Individual sport athletes can exhibit increased anx- in one sport during the year and measured as a binary iety not only because of the way they internalize failure, yes/no variable. but also their tendency to set intense personal goals for Reason for playing was coded into thematic cate- themselves (Nixdorf et al., 2013). Individual sports for gories. Fun reasons for playing included: to have fun, to which judges determine success, including gymnastics, make friends, to be part of a team, or enjoyment/love of figure skating, and dance, correlate with the highest rates the sport. Goal-oriented reasons for playing included: to of anxiety in elite athletes; these athletes feel immense obtain a school scholarship, to control weight, to be pressure to differentiate themselves from the competition strong, to be popular, to make parents happy, or to win a in the pursuit of perfection and a judge’s approval (Schaal championship. Strenuous and moderate exercise was et al., 2011). Team sport athletes also engage in perfection- measured using the Marx Activity Rating Scale and ana- ist behaviors, but perhaps not to the extent of individual lyzed categorically by how often a participant engaged in sport athletes (Nixdorf et al., 2013). The current study tests either level of exercise outside of their usual practice reg- the hypothesis that team and individual sports have distinct imens over the course of a week (0 x/week, 1-2x/week, associations with the diagnoses of anxiety and depression. ≥3x/week). In addition, we hypothesized that young team sport athletes BMI was adjusted by age and gender using ranges are motivated to play for different reasons than individual recommended by the Center for Disease Control (CDC, sport athletes. 2017). Anxiety and or depression was defined as clinician diagnosed, but was self-reported by the participant. Alco- Methods hol consumption was defined as a binary measure where “no” was defined as an athlete who reported never drink- Study design ing alcohol and “yes” was defined as an athlete that se- We conducted a cross-sectional study of athletes who un- lected a response option ranging from less than 1x per derwent an injury prevention evaluation (IPE) at a sports month to daily. injury prevention center affiliated with an academic pedi-

492 Anxiety and depression in team sports compared to individual sports

Statistical analyses athletes (Table 2). Individual sport athletes also had a All analyses were performed using Stata® software higher proportion of athletes that played only one sport version 14 (©StataCorp, 2015). We screened for potential all year (Table 2). There was no significant difference covariables by first conducting univariable analyses. A overall between athletes who played mostly for fun com- Pearson’s Chi-square or Fisher’s exact test was used to pared to those who played for goal-oriented reasons in the compare categorical variables. Any variable that differed proportion with anxiety and depression (8.1% vs. 7.8%, p between individual sport and team sport athletes on univar- = 0.87). iable comparisons with a statistical significance of p <0.2 was entered into a logistic regression model in order to de- Table 1. Athletes that underwent an injury prevention evalu- termine the independent effect of each variable on our main ation (n = 756). outcomes. A p-value of <0.05 or a 95% confidence interval n/Na (%) 6 - 12 233/756 (31) that did not cross 1 were used to define statistical signifi- Age (yrs.) cance. 13 -18 523/756 (69) Female 426/756 (56) Gender Male 330/756 (44) Results White 644/756 (85) Black 16/756 (2) Race There were 756 athletes that underwent an injury preven- Asian 26/756(3) tion evaluation during the study period. The mean age of Other 70/756 (10) Team 608/749 (81) participants was 13.5 ± 2.5 years. The mean age was sim- Sport Type ilar between male and female athletes (13.5 ± 2.6 years, Individual 141/749 (19) Yes 60/756 (8) and 13.6 ± 2.6, p = 0.11). Just over half of the study cohort Depression/Anxiety was comprised of female athletes (Table 1). Nearly three No 696/756 (92) Normal 526/672 (78) quarters of participants had a normal BMI and most par- BMI (kg/m2) Over/Obese 146/672 (22) ticipants identified as White (Table 1). Yes 45/515 (9) Drink Alcohol There were no significant differences in type of No 470/515 (91) sport (individual vs. team) between age groups but a Fun 577/750 (77) Reasons For Playing higher proportion of female athletes only participated in Goal Oriented 173/750 (23) individual sports (Table 2). Self-reported diagnoses of de- *Not all respondents answered every question pression and or anxiety were also higher among individual sport athletes (13% vs. 7%, p < 0.01) and among fe- Because single sport athletes included dancers, male athletes (10.3% vs. 4.9%, p < 0.01). While overall figure skaters, and gymnasts—sports for which athletes participants were largely within a normal BMI range for typically train year round—we thought they might have a their age and gender, the proportion of overweight/obese disproportionate effect on whether athletes who trained participants was lower among individual sport athletes year round were also those who only participated in one (Table 2). Few (n = 8) athletes were underweight. Indi- sport. Thus, in order to ensure that the effect of these ath- vidual sport athletes had a higher proportion of athletes letes was not solely responsible for our findings, we re- playing for goal-oriented reasons compared to team sport peated the analyses after removing these athletes.

Table 2. Univariable comparisons between individual and team sport athletes † Individual Sport Team Sport n/N (%) n/N (%) P-value † Age (yrs.) 6 - 12 42/141 (30) 190/608 (31) p=0.76 13 -18 99/141(70) 418/608 (69) Gender Female 104/141 (74) 319/608(52) p<0.01 Male 37/141 (26) 289/608 (48) Depression/Anxiety Yes 19/141 (13) 40/608 (7) p<0.01 No 122/141 (87) 568/608 (93) BMI (kg/m2) Normal 109/124 (88) 415/544 (76) p<0.01 Over/Obese 15/124 (12) 129/544 (24) Drink Alcohol Yes 7/97 (7) 38/413 (9) p=0.69 No 90/97 (93) 375/413 (91) Reasons For Playing Fun 98/140 (70) 477/603 (79) p<0.05 Goal Oriented 42/140 (30) 126/603 (21) Single Sport Athlete Yes 78/141 (55) 83/608 (14) p<0.01 No 63/141 (45) 525/608 (86) Train Year Round Yes 125/141 (89) 448/608 (74) p<0.01 No 16/141 (11) 160/608 (26) Strenuous Exercise (Times a week) 0 53/138 (38) 119/603 (20) p<0.01 1 -2 37/138 (27) 193/603 (32) 3 or more 48/138 (35) 291/603 (48) Moderate Exercise (Times a week) 0 38/141 (27) 99/605 (16) p<0.05 1 -2 44/141 (31) 203/605 (34) 3 or more 59/141 (42) 303/605 (50) † Pearson’s χ2 or Fisher's Exact. Underweight not included (n = 8).

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Table 3. Independent associations after adjusting for gender, age, and BMI ‡ OR - Individual Sport 95% Confidence Interval Reasons For Playing Fun 0.51 (0.3-0.8) Single Sport Athlete Yes 8.76 (5.6 – 13.8) Train Year Round Yes 2.39 (1.3 – 4.3) Depression/Anxiety Yes 1.72 (0.9-3.2) ‡ Models adjusted for gender and age and gender adjusted BMI.

After removing dancers, figure skaters, and gymnasts, in- resssion. As most of our study individual athletes were fe- dividual sport athletes were still more likely to play one male, it raises the question of whether this points to a spe- sport exclusively (31% vs. 13%, p < 0.01); however, in- cific patient population who may be at increased risk for dividual sport athletes were no longer significantly more mental health issues. For example, research has shown that likely to train year round compared to team sport athletes sex differences in brain structure and function, such as (82% vs. 73%, p = 0.15). Team sport athletes were more those that promote reproductive success, are also likely to likely to engage in moderate to strenuous exercise outside put women at greater risk of mood and anxiety disorders of practice. (Altemus et al., 2014). Therefore, it is important to con- After adjusting for potential covariates, individual sider how the coupling of gender and sport type may affect sport athletes were significantly less likely to play for fun, risk for mental health issues. more likely to train year round, and more likely to only Sports can provide relief for symptoms of mental participate in a single sport. In addition, individual sport health issues, allowing adolescents to alleviate and manage athletes were more likely to carry a diagnosis of anxiety their problems (Toseeb et al., 2014). This mechanism of or depression, but the significance of this finding de- amelioration may be most effective through team sports be- creased as we adjusted for the other variable (Table 3). cause of their added social component (Boone and Lead- beater, 2006; Sabiston et al., 2016). The sense of commu- Discussion nity and the relationships that youth build on teams with peers and adults promote feelings of comfort and ac- We hypothesized that type of sport, team vs. individual, ceptance and may reduce emotional problems and insecu- would be associated with athletes’ motivations for playing rities (Boone and Leadbeater, 2006; Eime et al., 2013; and/or mental health diagnoses. Concerning the relation- Sabiston et al., 2016). Although the benefits of individual ship between sports and mental health, current research sports are evident, they may be grounded in the general ef- suggests that youth who engage in sports have lower levels fects of physical activity rather than the culture of team- of self-reported diagnoses of anxiety and depression than work in which group athletes train and compete. those reported by the general population (Jewett et al., A higher proportion of adolescent individual sport 2014). In our study, 8% of athletes reported suffering from athletes also reported training year round in a sport and physician-diagnosed anxiety or depression, a statistic be- playing only one sport year round. This type of consistent low the national average. Data from the National Surveys attention to one sport may suggest a challenging invest- on Drug Use and Health found prevalence rates of major ment in a single activity and make single-sport athletes depressive episodes in adolescents and young adults to be more vulnerable to anxiety and depression (Schaal et al., 11.3% in 2014, up from 8.7% in 2005 (Mojtabai et al., 2011). We also found that team sport athletes are more 2016). Therefore, while depression and anxiety rates seem likely to work out strenuously three or more times per to be increasing over time in the general adolescent popu- week, outside of regular practices; having a potentially lation, individual and team sports seem to help mediate the more balanced schedule and equal distribution of energy presentation of psychological disorders in adolescents and among multiple activities could contribute to lower rates of serve as effective treatment measures (Vella et al., 2017). anxiety and depression. Individual athletes could be more The physical benefits of exercise as well as the sense of likely to suffer from mental health problems, in part, be- accomplishment and self-esteem youth gain by playing cause they may feel increased pressure to perform. Dedi- sports may contribute to fewer mental health issues (Eime cating all of their energy to succeeding in a single athletic et al., 2013; Toseeb et al., 2014; Vella et al., 2017). In our pursuit, they may be overly focused on the outcomes and study, a significantly higher proportion of individual sport experience greater internal attribution after failure (Nix- athletes suffered from anxiety or depression. While both dorf et al., 2016). Whereas team sport athletes can depend team and individual sports may be protective factors for on the support of their teammates, individual sport athletes these disorders, a greater proportion of individual sport ath- rely on only their own preparation and skill level to achieve letes (13%) reported anxiety or depression compared to success (Kajbafnezhad et al., 2011; Nixdorf et al., 2016). team sport athletes (7%). After adjusting for other covari- Competing alone, individual sport athletes can not only ex- ates, sport type (individual vs. team) remained associated perience loneliness, but also, if they do not succeed in ac- with a diagnosis of anxiety or depression, but the findings complishing their goals, may experience the weight of fail- were no longer statistically significant (OR 1.72; 95%CI ure alone (Nixdorf et al., 2016). While we did not collect 0.9-3.2). data on the pattern of motivation over the course of the ath- In regression analysis however, playing an individ- lete’s career, it can be hypothesized that this increased ual sport alone was not a risk factor for anxiety and dep- pressure on individual athletes may also result in a change

494 Anxiety and depression in team sports compared to individual sports

of their intrinsic motivation from pleasure or enjoyment to Prospective studies examining the effect of team goal-oriented reasons such as outperforming others. and individual sports on adolescent mental health in a lon- This study further identifies a major difference be- gitudinal manner might further reveal both the immediate tween team and individual sports related to what factors and long-term impacts of sport participation on mental motivate adolescents to play each type of sport (Deci and health. In addition, to reflect a realistic sample of the ado- Ryan, 2000). Given the critical role of motivation in deter- lescent population, studies should include participants who mining behavior and effort, a closer look at what drives represent a diversity of races and ages. athletes to pursue success in their sport has the potential to be quite informative. The achievement goal theory and Conclusion self-determination theory are the most common in deter- mining what motivates athletes, and common links are Among young athletes, anxiety and depression are more found between the two (Ntoumanis, 2001). Achievement common in those who play individual sports than those goal theory consists of two goal orientations: task, which who play team sports. In addition, adolescent individual- is the need to perform well, and ego, which is driven by the sport athletes are more likely to play their sport for goal- desire to outperform others. Self-determination theory, on oriented reasons, instead of for fun when compared to their the other hand, “is based on the gratification of the three counterparts participating in team sports. Researchers basic psychological needs for competence, autonomy and should continue to investigate how children’s motivation relatedness” (Georgiadis et al., 2001, p. 2). Theories pro- for participating in sports may relate to or explain why vide interesting context when examining athletes in per- team sports mediate psychological problems more effec- forming “for fun” or for goal-oriented reasons.” tively than individual sports. It is possible that the social A greater percentage of individual-sport athletes re- opportunities associated with team sports promote fun and ported playing sports for goal-oriented reasons, as opposed stress relief, while training for individual sports is lonelier to for fun. The social component of team sports may play and can lead to less healthy goal setting and internal attrib- a part in this outcome, as team engagement presents more ution after failure. opportunities for fun than the solo training that many individual sports require. While team sports involve a commu- Acknowledgements nity and network of players, individual sports focus more Dr. William Meehan III research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the directly on one player’s singular track to success. In addi- Corey C. Griffin Pro-Am Tournament. The remaining authors do not have tion, the possible relationship between individual sports any funding sources to disclose.Financial disclosures: Dr. Meehan re- and internal attribution could explain the tendency for in- ceives royalties from 1) ABC-Clio publishing for the sale of his books, dividual sport athletes to be goal-oriented. Players who in- Kids, Sports, and Concussion: A guide for coaches and parents, and Con- cussions; 2) Springer International for the book Head and Neck Injuries ternalize and dread failure would be more likely to hyper- in Young Athlete and 3) Wolters Kluwer for working as an author for Up- focus on results, enduring the sport in order to attain suc- ToDate. Dr. Meehan’s research is funded, in part, by philanthropic sup- cess, instead of enjoying it (Stenling et al., 2014). The na- port from the National Hockey League Alumni Association through the ture of scoring for individual sports could also contribute Corey C. Griffin Pro-Am Tournament and the National Football League. No other authors have any financial disclosures or conflicts of interest. to why athletes are goal-oriented. In sports including run- This study complied with the laws of the country of the authors’ affilia- ning, swimming, and gymnastics, success is usually quan- tion. tified by a time or number of points (Schaal et al., 2011). As a result, individual sport athletes can easily track their References success and set concrete, numerical goals in attempt to Adachi, P.J.C. and Willoughby, T. (2014) It’s not how much you play, achieve it (Schaal et al., 2011). While goal-oriented moti- but how much you enjoy the game: the longitudinal associations vation is still intrinsically driven, such intense focus on out- between adolescents’ self-esteem and the frequency versus en- come has the potential to strip the athlete of enjoyment in joyment of involvement in sports. Journal of Youth and Adoles- training and competition. cence 43(1), 137-145. Altemus, M., Sarvaiya, N., and Epperson C.N. (2014) Sex differences in The reach of this study is potentially restricted by a anxiety and depression clinical perspectives. Frontiers in neuro- few factors, and underscores the need for further study. The endocrinology, 35(3), 320-330. participants involved were not randomly selected, as they Boone, E. M., and Leadbeater, B. J. (2006) Game on: diminishing risks are all patients at a sports injury prevention center. The for depressive symptoms in early adolescence through positive involvement in team sports. Journal of Research on Adolescence sample is also predominantly White athletes < 18 years old. 16(1), 79-90. The narrow representation of this group suggests that the Centers for Disease Control and Prevention. (2017) Clinical Growth results may be limited in their generalizability. Moreover, Charts. Available from URL while we asked participants if they were diagnosed with https://www.cdc.gov/growthcharts/clinical_charts.htm Deci, E. L. and Ryan, R. M. 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Key points McMahon, E.M., Corcoran, P., O’Regan, G., Keeley, H., Cannon, M., Carli, V., Wasserman, C., Hadlaczky, G., Sarchiapone, M.,  Individual sport athletes are more likely to report anx- Apter, A., Balazs, J., Balint, M., Bobes, J., Brunner, R., Cozman, D., Haring, C., Iosue, M., Kaess, M., Kahn, J.P., Nemes, B., Pod- iety and depression than team sport athletes. logar, T., Poštuvan, V., Sáiz, P., Sisask, M., Tubiana, A., Värnik,  Reasons for playing sports vary between individual P., Hoven, C.W., Wasserman, D. (2017) Physical activity in Eu- sport athletes and team sport athletes, wherein indi- ropean adolescents and associations with anxiety, depression and vidual sport athletes play for goal-oriented reasons well-being. European Child & Adolescent Psychiatry 26(1), 111-122. and team sport athletes play for fun. Miller, K. E., Barnes, G. M., Melnick, M. J., Sabo, D. F., and Farrell, M.  The mental health benefits of participation in orga- P. (2002) Gender and racial/ethnic differences in predicting ado- nized sports may vary between individual sport ath- lescent sexual risk: athletic participation versus exercise. Journal letes and those playing team sports. of Health and Social Behavior 43(4), 436. Miller, K. E. and Hoffman, J. H. (2009) Mental well-being and sport-related identities in college students. Sociology of Sport Jour- nal 26(2), 335-356. AUTHOR BIOGRAPHY Mojtabai, R., Olfson, M., and Han, B. (2016) National trends in the prev- Emily PLUHAR alence and treatment of depression in adolescents and young adults. Pediatrics 138(6). Employment Nixdorf, I., Frank, R., Hautzinger, M., Beckmann, J. (2013) Prevalence Psychologist in the Division of Sports Medicine at Boston of depressive symptoms and correlating variables among Ger- Children’s Hospital man elite athletes. Journal of Clinical Sport Psychology 7(4), Degree 313-326. PhD Nixdorf, I., Frank, R., and Beckmann, J. (2016) Comparison of athletes' Research interests proneness to depressive symptoms in individual and team sports: Adolescent mental health. research on psychological mediators in junior elite ath- E-mail: [email protected] letes. Frontiers in Psychology 7. Ntoumanis, N. (2001) Empirical links between achievement goal theory Caitlin MCCRACKEN and self-determination theory in sport. Journal of Sports Sci- Employment ences 19, 397-409. A research analyst at Oregon State University School of Phar- Pedersen, M.T., Vorup, J., Nistrup, A., Wikman, J.M., Alstrøm, J.M., macy. Melcher, P.S., Pfister, G.U., and Bangsbo, J. (2017) Effect of Degree team sports and resistance training on physical function, quality MSc of life, and motivation in older adults. Scandinavian Journal of Research interests Medicine & Science in Sports 27(8), 852-864. Sports medicine. Promoting Physical Activity. (2017) In: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents 4th edi- E-mail: [email protected] tion. Elk Grove Village: American Academy of Pediatrics. 193- Kelsey GRIFFITH 203. Employment Sabiston, C. M., Jewett, R., Ashdown-Franks, G., Belanger, M., Brunet, Performance Enhancement & Rehabilitation Specialist at The J., O’Loughlin, E. and O’Loughlin, J. (2016) Number of years of Micheli Center for Sports Injury Prevention. team and individual sport participation during adolescence and Degree depressive symptoms in early adulthood. Journal of Sport and MSc Exercise Psychology 38(1), 105-110. Schaal, K., Tafflet, M., Nassif, H., Thibault, V., Pichard, C., Alcotte, M., Research interests Guillet, T., El Helou, N., Berthelot, G., Simon, S., Toussaint, J.F. The mental challenges associated with sport and sport injury (2011) Psychological balance in high level athletes: gender- to better reach self-determined goals and optimal performance. based differences and sport-specific patterns. PLoS ONE 6(5). E-mail: [email protected] StataCorp. (2015) Stata Statistical Software: Release 14. College Station

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Melissa CHRISTINO Employment Orthopaedic Surgeon at Boston Children’s Hospital Degree MD Research interests The psychological aspects of injury and recovery. E-mail: [email protected] Dai SUGIMOTO Employment Associate Director of Clinical Research at the Micheli Center for Sports Injury Prevention and Instructor at Harvard Medical School. Degree PhD Research interests Sports injuries. E-mail: [email protected] William P. MEEHAN III Employment Director of the Micheli Center for Sports Injury Prevention, Director of Research for the Brain Injury Center at Boston Children’s Hospital. Degree MD Research interests Sports injuries, spine injuries, and concussive brain injury. E-mail: [email protected]

 Emily Pluhar, PhD Division of Adolescent Medicine, Boston Children’s Hospital, 333 Longwood Avenue, Boston, MA 02115; USA