# Exercise as it relates to Disease/The impact of community sport participation on symptoms of mental health in adolescents

This is a critique of the research article:
Graupensperger, S., Sutcliffe, J., & Vella, S. A. (2021). Prospective Associations between Sport Participation and Indices of Mental Health across Adolescence. Journal of youth and adolescence, 50(7), 1450–1463.

## What is the background to this research?

Adolescence is a critical period in the development of positive mental health behaviours and habits that ultimately helps to shape mental wellbeing throughout adulthood. However, more than 50% of mental health disorders that adults experience in their lifetime have started by the age of 14 years old, increasing to 75% by the age of 24. In Australia specifically, 14% of young people aged 12-17 years old experience a mental health disorder each year, with a further 20% experiencing high or very high levels of psychological distress.
While much is already known about the physical health benefits of regular exercise in adolescents, such as reduced risk of cardiovascular disease and diabetes later in life, researchers have sought to examine the impact that organised sport participation may have on mental health outcomes, as this is a readily accessible and cost effective form of physical activity for young people. Although previous research in the industry presents evidence to suggest sport may be beneficial for mental health in adolescents, this paper utilises longitudinal research methods to clarify the prospective association between organised sport and mental health outcomes in adolescents, and to analyse the differing effects between boys and girls.
In particular, the analysis focuses on mental health indices of depression, anxiety, hyperactivity, conduct problems, peer problems and emotional symptoms; and how these outcomes may evolve between individuals and within the same individual over time.

## Where is the research from?

The paper was published in the Journal of Youth and Adolescence, an academic journal subject to double blind peer review, specialising in a wide variety of allied health issues among youth and adolescents. Author Scott Graupensperger is an assistant professor at the University of Washington, with dozens of published articles relating to health and risk behaviours. The other contributing authors Jordan Sutcliffe and Stewart Vella, conduct research out of the University of Wollongong, and have multiple publications in the field of youth sport and health development.

## What kind of research was this?

Participants in the study were randomly selected from Australian postal codes and the national Medicare database to reflect a national representative sample. This included:
| Age Bracket (Years) | Number of Participants |
| 12-13 | 3956 |
| 14-15 | 3537 |
| 16-17 | 3089 |
| | Total: 10582 |
Informed consent was obtained from all participants, with data then collected using self-reported questionnaires from the primary parent for participants aged 12-13, and by the children themselves for all other ages.
To analyse the data, random intercept cross-lagged panel modelling was used to group individuals and separate time-variant associations from stable trait-like difference within individual participants. Partially missing data was accounted for using full-information maximum likelihood estimation to ensure the influence of errors or bias on the results were reduced.

## What did the research involve?

The authors submitted the methodology and questionnaire survey content to be reviewed and approved by the Australian Institute of Family Studies Ethics Committee prior to commencement. During the study, participants completed a variety of questionnaires that specifically related to sport participation frequency, anxiety symptoms (using Spences Children’s Anxiety Scale), depressive symptoms (using the Short Mood and Feelings Questionnaires), and emotional and behavioural difficulties (using the Strength and Difficulties Questionnaire).
Mental health markers were measured using a numbered scale to assess the degree of prevalence within a given time period, or using true or false prompts to determine their occurrence in the participant’s life. Questionnaires regarding sport involvement were limited to an estimation of days and hours per week spent participating in sport, however limited details were collected that examined the competitive level of the sport involved in. As such, the association between elite, sub-elite or recreational levels of sporting participation could not be assessed in its relation to mental health outcomes. Similarly, questionnaires only summarised results over two year intervals, and as such lacked an in-depth analysis of the day-to-day effects that sporting participation may have on mental health.
Despite the self-reporting nature of the questionnaire methodology, evidence suggests that adolescent children can accurately self-report on health measures within their own life.

## What were the basic results?

There were several key findings relating individual and team sport participation to mental health outcomes, as well as the gender differences between boys and girls.
A substantial portion of participants recorded considerable symptoms of depression and anxiety that increased throughout adolescence, despite mean scores falling below thresholds used to identify mental health disorders.
* Boys who typically participated in more team sport reported fewer symptoms of mental health issues, however female participation was only associated with positive outcomes at later timepoints.
* Boys who typically engaged in more individual sport report lower levels of depression, however when this sporting participation exceeded the expected amount, so too did the expected level of depressive symptoms.
* There was no association between individual sport participation and symptoms of depression in adolescent girls, but symptoms of depression inversely predicted sport participation at later time points.
Although the authors made several associations that linked sport participation with mental health outcomes, they were reserved with making definitive statements regarding the implications of their findings.

## What conclusions can we take from this research?

Despite a positive association between team sport participation and fewer negative mental health outcomes in adolescents, those in the study that demonstrated more negative symptoms were less likely to continue with sport. The study also supported previous research that suggests individual sport involvement had a greater predictive association for symptoms of anxiety and depression than team sport.
Similarly aligning with the literature, although male participation in individual sport led to positive mental health outcomes, at timepoints in which participation was elevated, negative depressive symptoms were predicted. Furthermore, females were much more susceptible to mental health problems among individual sports in comparison to males and team sports.
Although the association between sport participation and increased mental health and wellbeing is supported in research, the effect has a significant variance across participants and may in some cases have no association.

## Practical advice

Adolescent participation in organised sport is undoubtedly associated with a more positive mental health status, in particular in recreational and sub-elite levels of competition. The mental benefits of this involvement however may be influenced by several factors such as social interactions, external pressure to participate at a certain frequency, and if the sport matches the expectations of the individual. As such, further consideration and support should be provided to adolescents involved in elite sport, in particular individual sport, to ensure a positive mental health status is maintained.

## Further information/resources

There are several resources available for those seeking further information or support about adolescent mental health and sporting participation.
Mental health resources:
https://www.aihw.gov.au/reports/children-youth/mental-illness
https://www.blackdoginstitute.org.au/resources-support/
https://raisingchildren.net.au/pre-teens/mental-health-physical-health/about-mental-health/teen-mental-health
Sport participation and physical activity:
https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-children-and-young-people-5-to-17-years
https://www.betterhealth.vic.gov.au/health/healthyliving/sport-and-children
Mental health support services for parents and adolescents:
https://headspace.org.au/explore-topics/for-young-people/mental-ill-health/
https://www.beyondblue.org.au/get-support
https://www.lifeline.org.au/about/our-services/

## References

* ↑ Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593–602.
* ↑ Australian Institute of Health and Welfare. (2021). Mental illness. Retrieved from https://www.aihw.gov.au/reports/children-youth/mental-illness
* ↑ Centers for Disease Control and Prevention. (2022). Benefits of Physical Activity. Retrieved from https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm#:~:text=Being%20physically%20active%20can%20improve,activity%20gain%20some%20health%20benefits.
* 1 2 Panza, M. J., Graupensperger, S., Agans, J. P., Doré, I., Vella, S. A., & Evans, M. B. (2020). Adolescent Sport Participation and Symptoms of Anxiety and Depression: A Systematic Review and Meta-Analysis. Journal of sport & exercise psychology, 42(3), 1–18.
* ↑ University of Washington. (2021). Scott Graupensperger. Retrieved from https://sites.uw.edu/cshrb/our-people/faculty/scott-graupensperger/
* ↑ ResearchGate. (2022). Jordan Sutcliffe. Retrieved from https://www.researchgate.net/profile/Jordan-Sutcliffe
* ↑ ResearchGate. (2022). Stewart Vella. Retrieved from https://www.researchgate.net/profile/Stewart-Vella
* ↑ Lüdtke, O., & Robitzsch, A. (2021). A Critique of the Random Intercept Cross-Lagged Panel Model. PsyArXiv, 3.
* ↑ Little, T.D., Jorgensen, T.D., Lang, K.M., & Moore, E.W. (2014). On the joys of missing data. Journal of pediatric psychology, 39(2), 151–162.
* ↑ Spence, S.H., Barrett, P.M., & Turner, C.M. (2003). Psychometric properties of the Spence Children’s Anxiety Scale with young adolescents. Journal of Anxiety Disorders, 17, 605–625.
* 1 2 Angold, A., Costello, E.J., Messer, S., Pickles, A., Winder, F., & Silver, D. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249.
* ↑ Goodman, R., Ford, T., Simmons, H., Gatward, R., & Meltzer, H. (2000). Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. British Journal of Psychiatry, 177, 534–539.
* ↑ Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007). How young can children reliably and validly self-report their health-related quality of life?: an analysis of 8,591 children across age subgroups with the PedsQL 4.0 Generic Core Scales. Health and quality of life outcomes, 5, 1.
* ↑ Eime, R.M., Young, J.A., Harvey, J.T., Charity, M.J., & Payne, W.R. (2013). A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport. The international journal of behavioral nutrition and physical activity, 10, 98.
* ↑ Pluhar, E., McCracken, C., Griffith, K. L., Christino, M. A., Sugimoto, D., & Meehan, W. P., 3rd (2019). Team Sport Athletes May Be Less Likely To Suffer Anxiety or Depression than Individual Sport Athletes. Journal of sports science & medicine, 18(3), 490–496.
* ↑ Haase, A.M. (2011). Physique anxiety and disordered eating correlates in female athletes: Differences in team and individual sports. Eating Behaviors, 12, 64–67