be there in person. My name is Kate Webster, and today I'm talking on mental health and the adolescent athlete. This is a large topic, so I'm going to mainly focus on mental health in the context of athletic injury. Adolescence is clearly a time of significant physical, social and psychological development. Over this time of growth, it's estimated that as many as 1 in 4 female and 1 in 8 males report depressive symptoms high enough to meet the criteria for a major depressive episode, and this prevalence is rising. It's well known that undertaking physical activity and participating in sport has positive mental health benefits for adolescents. However, surprisingly, the incidence or development of mental health disorders in adolescent athletes is not well known. Some studies have reported lower rates of depression, high quality of life and lower levels of hopelessness and suicidality in young athletes compared to non-athletes. Importantly, these positive effects are thought to be mediated by the social support and integration that athletes experience in sporting environments rather than the physical activity itself, and this will be relevant to consider in the context of injury. Athletes are not immune to depression. It's estimated that prevalence of depression is between 16 and 21 per cent for college athletes, and one study in young elite swimmers found that a staggering 68 per cent of athletes in the study experienced a major depressive episode over a three-year period. Part of the reason for this may be that for many athletes, psychological well-being is closely related to athletic performance, which can really play a detrimental role to psychological health. Combine this with a preoccupation in physical changes that are occurring, including body image and other psychosocial factors, particularly in later adolescence, such as the use of sport to achieve social status, all gives way to the notion that adolescent athletes may be more vulnerable to the psychological impact of injury than adults. It's really important to note that the psychological response to injury can continue long after the injury has occurred and can therefore have a significant impact on rehabilitation and return to sport outcomes. If we look at the psychological impacts of injury, there are a number of factors that may mediate recovery. Some of these are clearly associated with poor recovery, such as anxiety and fear, and others, shown in the orange box here, may have either a positive or negative impact on recovery, depending on how the athlete's response, for example, whether expectations are realistic or not. Finally, there are a number of factors such as self-efficacy and resilience that have been associated with a favourable recovery progression. We don't have time to discuss each of these, but I'm going to focus on those where there's some information regarding adolescent athletes. The following athletic injury, there may be either an emergence or an exacerbation of depressive symptoms, and these can be associated with a myriad of negative consequences, such as those listed here. An important finding in relation to adolescent athletes is that many are reluctant to disclose their emotional or psychological struggles initially, and therefore monitoring of maladaptive responses throughout recovery is really important. And there are a number of depression screening tools that allow us to do this. In particular, there's a modified version of the nine-item patient health questionnaire for 13 to 17-year-olds, and the PROMIS anxiety and depression subscales can also be used in children as young as eight. There's significant evidence that athletes who don't return to sport after an injury cite fear of re-injury as the reason why. In young athletes, fear of movement or kinesiophobia has been studied following ACL reconstruction. And in this pilot work, it was shown that athletes with high levels of fear were four times more likely to report lower levels of activity, six to seven times more likely to have worse scores on tests of functional performance, and 13 times more likely to suffer graft re-injury within two years after returning to sport. Athletic identity is the degree to which one identifies as an athlete, and it's been shown that adolescents who strongly identify with the athlete role have higher levels of emotional disturbance following injury. And this is likely due to a loss of identity when they are unable to participate in sport, as well as a loss of involvement with their team. The importance of this social element is what I referred to previously, and steps can and therefore should be put in place to help maintain some of these social aspects for the injured athlete to minimise this loss. On the flip side, having a high athletic identity may be beneficial over the course of rehabilitation, because these athletes have been shown to have higher adherence to rehab, possibly due to their strong desire to return to sport. Coping style is also an important psychological mediator, and there is evidence that this differs according to the athlete's age. And in a study published earlier this year, in athletes who had undergone various types of knee surgery, showed that positive reframing, which is when an athlete focuses on the way a stretcher may be beneficial, was not at all well utilised in younger athletes. But when used, it does seem to be an important coping strategy, which leads to higher satisfaction, higher rates of return to sport, and less fear of re-injury. Psychological readiness to return to sport is also an important construct to predict post-operative outcomes. In brief, this is a combination of an athlete's emotions and confidence, and it's been shown to be strongly associated with return to sport after various injuries, and is also related to sport performance and predictive of re-injury. Importantly, younger-aged athletes have been shown to have significantly greater levels of psychological readiness to return to sport, and this may be protective of some of the negative impacts of injury. To summarise, adolescence is a time of dramatic psychological and physiological development. Serious injuries during this time may lead to negative long-term effects on activity levels and development of mental health disorders. In recognition of this, the Medical Society for Sports Medicine released a consensus statement in 2020. In this, it was noted that one essential part of optimal care is the awareness and acknowledgement of the impact of mental health on wellbeing and recovery in athletes, and we need to have a concerted effort to create a culture in which athletes feel comfortable disclosing psychological concerns. Thank you for your time.

mental health

adolescent athletes

athletic injury

social support

psychological impacts