Effect of Depression and Anxiety on Rehabilitation Adherence and Injury Recovery in Collegiate Athletes

Introduction: The noted prevalence of depressive and anxious symptomology both pre-injury and post-injury in collegiate athletes raises concern regarding their ability to maintain appropriate rehabilitation adherence in their recovery from sports injury. The purpose of this study was to further explore the effect of depressive and anxious collegiate athlete symptoms on athletic trainers’ perceptions of rehabilitation adherence and return-to-play. Methods: NCAA Division II and Division III injured collegiate athletes (N = 19, M age = 20.58 ± 1.31) were observed throughout their rehabilitation programs by 5 separate collegiate athletic trainers. Collegiate athlete depressive and anxious symptoms were assessed during preseason retroactively, at the beginning of rehabilitation, and at clearance for full sports participation. Individual athletic trainers most responsible for the rehabilitation programming of their respective collegiate athletes were asked to provide their perceptions of rehabilitation adherence at the end of the programs. Depressive and anxious symptoms were measured with the use of the Hospital Anxiety and Depression Scale, and athletic trainer perceptions were measured using the Rehabilitation Adherence Measure for Athletic Training. Results: Significant differences were found between the mean symptom scores of HADS 1 and HADS 2 (P = .001) and the mean symptom scores of HADS 1 and HADS 3 (P = .004), thus indicating that depressive and anxious symptoms increased post-injury, but they did not return to preseason levels upon clearance for full sports participation. Collegiate athletes with less depressive and anxious symptoms took on average 70.33 ± 19.87 less days than their more depressed and anxious counterparts to recover from sports injury (P = .010). Depressive and anxious symptoms did not influence the perceptions that the athletic trainers shared relevant to rehabilitation adherence. Discussion: Injured collegiate athletes may be physiologically ready to return to sport far sooner than they are psychologically ready. Collegiate athletic trainers should make a conscious effort to improve the effectiveness of their currently utilized psychosocial interventions to better address the patient depressive and anxious symptoms that they may not be as cognizant of in the rehabilitation process, given the importance of appropriate rehabilitation adherence in producing positive outcomes.