Families, health care providers, schools, sports organizations and public health organizations continue to face the difficult task of weighing the risks of SARS-CoV-2 infection against the risks of increased restrictions.
Of particular concern are the impacts of COVID-19 on the mental health of children, with the AAP, American Academy of Child and Adolescent Psychiatry and others recently declaring a national emergency in children’s mental health.
Organized sports can have significant mental health benefits for kids. Participation in sports is associated with reduced stress, anxiety, depression and substance misuse as well as increased self-confidence, self-esteem, social skills, social support and academic achievement.
Impact of restrictions early in the pandemic
Following the cancellation of organized sports in March 2020, the impacts on mental health among youth athletes were obvious immediately. In a study published early last year, adolescent athletes throughout the country were asked about their mental health in spring 2020 (McGuine TA, et al. J Athl Train. 2021;56:11-19, https://doi.org/10.4085/1062-6050-0478.20). Thirty-seven percent reported moderate-to-severe anxiety, and 40% reported moderate-to-severe symptoms of depression.
Another study compared the 5,000 Wisconsin athletes from the same data collection with historical data from over 3,000 Wisconsin athletes surveyed prior to the pandemic (McGuine TA, et al. J Athl Train. 2021;56:836-844, https://doi.org/10.4085/1062-6050-0739.20). This study showed that the proportion of athletes who reported moderate-to-severe symptoms of depression had jumped from 10% to 33%.
Benefits of returning to sports
To evaluate the impact of returning to sports, a third study compared depression and anxiety symptoms between athletes who had or had not been able to return to sports in fall 2020 (McGuine TA, et al. J Athl Train. https://doi.org/10.4085/1062-6050-0121.21). After controlling for race, socioeconomic status, gender and attending school virtually vs. in person, athletes who had not returned to sports were more than twice as likely to report moderate-to-severe depression and six times more likely to report moderate-to-severe anxiety. Perhaps most concerning, athletes who had not returned to sports in fall 2020 reported slightly higher levels of anxiety and depression than athletes in spring 2020.
Where do we go from here?
Advocating for youth sports and safe sports participation during the COVID-19 pandemic is one way pediatricians and other health care providers can work to undermine the mental health emergency. Families and providers should monitor for mood changes in young athletes during times of sports disruption and be aware that youths who are unable to participate in milestone events (e.g., final high school sports season or state championship tournament) and those with a history of depression or anxiety may be affected by sports disruptions more than others.
AAP COVID-19 interim guidance on returning to sports and physical activity can help guide safe participation. Youth athletes should always transition back to sports gradually after time off.
As we consider how to prioritize pediatric mental health in the long term, the promotion of broad, equitable access to youth sports can have lifelong beneficial impacts on mental health for children.
Dr. Watson is a member of the AAP Council on Sports Medicine and Fitness. Dr. Reardon is a board-certified psychiatrist specializing in sports psychiatry and is a professor in the Department of Psychiatry at University of Wisconsin School of Medicine and Public Health.
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