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Introduction
Whether participation in sport is protective or harmful to mental health remains unclear. Though exercise and participation in sport is generally favourable, improving mood and self-esteem, at the extremes of exercise we see increased stress and burnout and the potential for adverse effects. 1-5 Growing research is dedicated to understanding the relationship between exercise and mental health disorders 1 as well as to chronic stress and mental health. 6 Mental health concerns such as eating disorders, depression and suicide, anxiety, gambling and substance use are among the most important in college-aged students, both athletes and non-athletes. 7-12 Some data exist that certain concerns, such as performance anxiety, eating disorders and binge drinking may be more common in athletes than their non-athletic peers. 13-15 Symptoms of depression are not uncommon in athletes 16 17 and in one study symptoms were reported in 21% of collegiate athletes with women, freshman and those that self-reported pain had a significantly increased risk for reporting depressive symptoms. 16 Depression in some athletes may also be related with performance failure, and elite athletes may be at a greater risk for depression than less elite athletes. 18
Injuries: antecedents and the emotional response
Injuries are common in athletes and the psychological response to injury can include normal as well as problematic responses,. 19-22 Preinjury factors, including biological, physical, psychological sociocultural, and most importantly stress, can increase an athlete's risk of injury and poor recovery. 19-23 After injury, several factors such as cognition, affect and behaviour are all inter-related and can also affect each other in the short and long term. 21
Stress can cause attentional changes, distraction and increased self-consciousness that all can interfere with performance and predispose an athlete to injury. 20 21 24 25 Chronic stress increases hair cortisol levels in a wide range of contexts/situations such as endurance athletes and pain as well as in patients with major depression. 6 Stress increases muscle tension and coordination that can increase the risk for injury; decreasing stress can actually decrease injury and illness rates. 20 24 26 27
Adolescents who have 'high mental toughness' were more resilient to stress and reported a lower number of depressive symptoms. 28 Adolescents with higher 'resilience' scores predicted lower scores on levels of depression,...