Purpose: To study mental health, sleep duration, and daytime sleepiness in young athletes. Methods: A cross-sectional questionnaire study was conducted. The main outcome measures included sleep duration and daytime sleepiness. Results: Study participants included 756 athletes with a mean age of 13.5 years. A total of 39% (n = 296/756) reported not meeting current sleep recommendations for age. Athletes >12 years and with a self-reported anxiety and/or depression history were less likely to meet sleep recommendations and showed higher daytime sleepiness (adjusted odds ratio [aOR] = 1.29, 95% confidence interval [CI] [1.2, 1.4], β [SE] = 3.06 [0.74], respectively). Athletes with goal-oriented reasons for playing versus enjoyment (52% vs. 35%, aOR = 1.70, 95% CI [1.12, 2.58]) were less likely to meet sleep recommendations. Night time internet access and weeknight homework hours were negatively associated with sleep recommendations (aOR = 1.68, 95% CI [1.68, 2.47] and aOR = 3.11, 95% CI [1.82, 5.3]) and positively associated with daytime sleepiness (β [SE] = 1.44 [0.45] and 2.28 [0.59]). Conclusions: Many young athletes are not meeting sleep recommendations. Associated factors include mental health, reasons for play, internet access, and homework demand.
Andrea Stracciolini, Caitlin M. McCracken, William P. Meehan III, and Matthew D. Milewski
David R. Howell, Thomas A. Buckley, Brant Berkstresser, Francis Wang, and William P. Meehan III
The purpose of this study was to identify the rate of abnormal single-task and dual-task gait performance following concussion compared to uninjured controls using previously established normative reference values. The authors examined athletes with a concussion (n = 54; mean age = 20.3 [1.1] y, 46% female, tested 2.9 [1.5] d postinjury), and healthy controls were tested during their preseason baseline examination (n = 60; mean age = 18.9 [0.7] y, 37% female). Participants completed an instrumented single-/dual-task gait evaluation. Outcome variables included average walking speed, cadence, and step length. A significantly greater number of those with concussion walked with abnormal dual-task gait speed compared with the control group (56% vs 30%, P = .01). After adjusting for potential confounding variables (age, concussion history, symptom severity, and sleep), concussion was associated with lower dual-task gait speed (β = −0.150; 95% confidence interval [CI] = −0.252 to −0.047), cadence (β = −8.179; 95% CI = −14.49 to −1.871), and stride length (β = −0.109; 95% CI = −0.204 to −0.014). Although group analyses indicated that those with a concussion performed worse on single-task and dual-task gait compared with controls, a higher rate of abnormal gait was detected for the concussion group compared with the control group for dual-task gait speed only. Dual-task gait speed, therefore, may be considered as a measure to compare against normative values to detect postconcussion impairments.
Michael W. Kirkwood, David R. Howell, Brian L. Brooks, Julie C. Wilson, and William P. Meehan III
While placebo effects are well recognized within clinical medicine, “nocebo effects” have received much less attention. Nocebo effects are problems caused by negative expectations derived from information or treatment provided during a clinical interaction. In this review, we examine how nocebo effects may arise following pediatric concussion and how they may worsen symptoms or prolong recovery. We offer several suggestions to prevent, lessen, or eliminate such effects. We provide recommendations for clinicians in the following areas: terminology selection, explicit and implicit messaging to patients, evidence-based recommendations, and awareness of potential biases during clinical interactions. Clinicians should consider the empirically grounded suggestions when approaching the care of pediatric patients with concussion.
David R. Howell, Jessie R. Oldham, Melissa DiFabio, Srikant Vallabhajosula, Eric E. Hall, Caroline J. Ketcham, William P. Meehan III, and Thomas A. Buckley
Gait impairments have been documented following sport-related concussion. Whether preexisting gait pattern differences exist among athletes who participate in different sport classifications, however, remains unclear. Dual-task gait examinations probe the simultaneous performance of everyday tasks (ie, walking and thinking), and can quantify gait performance using inertial sensors. The purpose of this study was to compare the single-task and dual-task gait performance of collision/contact and noncontact athletes. A group of collegiate athletes (n = 265) were tested before their season at 3 institutions (mean age= 19.1 ± 1.1 years). All participants stood still (single-task standing) and walked while simultaneously completing a cognitive test (dual-task gait), and completed walking trials without the cognitive test (single-task gait). Spatial-temporal gait parameters were compared between collision/contact and noncontact athletes using MANCOVAs; cognitive task performance was compared using ANCOVAs. No significant single-task or dual-task gait differences were found between collision/contact and noncontact athletes. Noncontact athletes demonstrated higher cognitive task accuracy during single-task standing (P = .001) and dual-task gait conditions (P = .02) than collision/contact athletes. These data demonstrate the utility of a dual-task gait assessment outside of a laboratory and suggest that preinjury cognitive task performance during dual-tasks may differ between athletes of different sport classifications.
J.D. DeFreese, Samuel R. Walton, Zachary Yukio Kerr, Benjamin L. Brett, Avinash Chandran, Rebekah Mannix, Hope Campbell, Ruben J. Echemendia, Michael A. McCrea, William P. Meehan III, and Kevin M. Guskiewicz
Transition from professional sport to nonsport endeavors has implications for postcareer health and well-being of athletes. The purpose of the current study was to examine associations among transition-related psychosocial factors and current mental health outcomes in former National Football League (NFL) players. Participants were former NFL players (n = 1,784; mean age = 52.3 ± 16.3 years) who responded to a questionnaire assessing the nature of their discontinuation from professional football (i.e., any degree of voluntary choice vs. forced discontinuation), prediscontinuation transition planning (yes vs. no), and current symptoms of depression and anxiety. After adjusting for relevant covariates, having an involuntary discontinuation and no transition plan prior to discontinuation were associated with greater depressive and anxiety symptom severity. Autonomy in discontinuation and pretransition planning are important to former NFL football players’ mental health. Increasing autonomy in the discontinuation decision and pretransition planning represent psychoeducational intervention targets for this population.