Oakland A's pitcher Justin Duchsherer announced that he will sit out the rest of the season in order to focus on getting treatment for depression. It is not clear if Duchsherer has dealt with clinical depression in the past but the fact that the former all-star has missed a large portion of the last 3 seasons due to injury probably hasn't helped matters at all. The risk for mood change in an athlete after an injury can be significant.
How common is it? One study of 343 male college athletes found that 51 percent had some symptoms of depression after being injured, and 12 percent became moderately to severely depressed. I find that college underclassmen are particularly vulnerable. Their self-esteem is already under attack as they adjust from being the high school star to just another player on the team fighting for playing time - all while dealing with new academic and social pressures not to mention living away from home for the first time. Not a good time to have a health problem put one's very identity - the role of athlete - at risk.
A New York Times article about skier Picabo Street's mental struggles after blowing out her knee provides a glimpse into the mind of an athlete during the post-injury period:
What sent her hurtling into a depression was the realization of how long and difficult her recovery would be. In the end, it took 20 months.
''I think it was a combination of the atrophying of my legs, the new scars, and feeling like a caged animal,'' Ms. Street said. ''I went from being a very physical person, a very powerful athlete, to barely having any strength to get from my room to the kitchen. You're stuck and you can't do what you normally do and it makes you crazy.''
Because suicide is the third leading cause of death in teens (and college aged persons too) the USPSTF recommended this year that all teens should be screened for depression. Athletes are no different. As mentioned in a previous post, the sports pre-participation exam presents an opportunity to ask about mood problems. We also need to stay particularly vigilant while athletes recover from injury. 1994 article in the Journal of Athletic Training described 5 common factors among 5 athletes who had attempted suicide:
1) considerable success before sustaining injury; 2) a serious injury requiring surgery; 3) a long, arduous rehabilitation with restriction from their preferred sport; 4) a lack of pre-injury competence on return to sport; and 5) being replaced in their positions by teammates. Also, all were in the high-risk age group (15-24) for suicide.
This is why athletic trainers and those practicing sports medicine should be well-versed in the psychology of athletic injury. It can be quite challenging to get young people to share their feelings with someone who is outside of their peer group. This task can be even more difficult in athletes who as a group have been trained to hide anything that could be perceived as a weakness. Athletic trainers are best positioned to monitor for post-injury depression as they usually have a pre-existing relationship with the athlete and are with them regularly through the recovery process allowing them to pick up on subtle changes in mood and behavior.
Here at Wake Forest we have had success with an injured athlete support group that allows these students to share their frustrations and fears with and learn coping skills from others who are going through the same challenges. Another strategy is to make sure to focus on achievable short term goals during the rehabilitation process - e.g. regain full motion in the knee after an ACL reconstruction - because, as mentioned in the Picabo Street article above, it can be quite daunting to consider the long road to full recovery. Finally, medical staff, coaches, and peers can work to make sure that the sidelined athlete still feels included as a part of the team.
These steps can help insure that the mental rehabilitation goes as well as the physical side.
I like the 140%.
The Cockroach Catcher
Posted by: Am Ang Zhang | September 01, 2009 at 09:57 AM