Changes in Quality of Life Among Collegiate Athletes During COVID-19

Abstract

Background:

The COVID-19 pandemic has had a significant effect on the mental health of athletes. How this has affected quality of life (QoL), specifically in the college population, is poorly defined.

Hypothesis:

During the COVID-19 pandemic, the mental and physical QoL will have decreased in collegiate athletes as compared with before the pandemic.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 3.

Methods:

Division I athletes from a total of 23 varsity teams at a single institution completed surveys between 2018 and 2022. QoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12). VR-12 scores were separated into mental component scores (MCS) and physical component scores (PCS). Separate linear mixed effects models evaluated changes in MCS and PCS from pre-COVID to during COVID overall, as well as differences in changes by sex and sport type (individual, team).

Results:

For all athletes, the PCS increased (54.6 [95% CI 54.4-54.7] vs 55.1 [54.9-55.3]; P < 0.01) and the MCS decreased (55.2 [54.9-55.5] vs 53.5 [53.1-53.8]; P < 0.01) from pre-COVID to during COVID. When evaluating for sex, women demonstrated a greater increase in PCS (0.57 ± 0.22; P = 0.01) and greater decrease in MCS (1.06 ± 0.38; P < 0.01). With respect to sport type, individual sports demonstrated a greater decrease in MCS (1.46 ± 0.39; P < 0.01), but no interaction was identified for PCS (0.42 ± 0.23; P = 0.07).

Conclusion:

Collegiate athletes demonstrated a decrease in their self-reported mental QoL during the COVID-19 pandemic, as compared with before the pandemic. This effect was most evident in women and in individual sports. Athletes also reported an increase in physical QoL during COVID that was also larger in women, but not related to sport.

Clinical Relevance:

This study demonstrates the impact of the COVID-19 pandemic on collegiate athletes’ QoL, including negative effects on mental health. It also identifies cohorts of athletes (women, individual) who may be more significantly affected.

The COVID-19 pandemic has had a significant effect on the lives of many people, including college students and young adults. The pandemic led to the closure of college and high school campuses and the subsequent cancellation and alteration of multiple seasons of sports. These cancellations and closures are thought to have, in part, contributed to the significant increase in mental health symptoms, including anxiety and depression, seen in adolescents and young adults.^1,7,16

The role of sport participation and the benefits it provides in relation to the COVID-19 pandemic has been examined throughout the course of the pandemic.^12,13,15 Nationwide, adolescent athletes reported higher levels of anxiety and depression symptoms during the early pandemic, with women, older adolescent athletes, those who participate in team sports, and those who come from counties with higher poverty levels identified among the groups of athletes at higher risk for these symptoms.^11,13 A follow-up study of Wisconsin high school athletes demonstrated that those allowed to return to play sports in the fall of 2020 exhibited significantly lower levels of anxiety and depression, providing evidence for the potential benefit of sports participation during the pandemic. ¹⁴

While previous research has demonstrated the effect of the COVID-19 pandemic on the quality of life (QoL) and mental health of adolescent athletes,^12,13,15 less is known about its effects on collegiate athletes. Reports investigating the initial effect of COVID-19 on collegiate athletes suggested that mental health was negatively affected early on due to disrupted sport participation.^2-4,9 However, it is unclear what effect variables such as sex and sport type (individual vs team sports) have on the physical and mental health of collegiate athletes. Our study sought to evaluate changes in the physical and mental QoL in collegiate athletes around the COVID-19 pandemic. We also sought to determine whether there were populations within this group that were more susceptible to the negative consequences of the disruption to sport than others.

We hypothesized that there would be a decrease in self-assessed QoL among collegiate athletes during the COVID-19 pandemic as compared with before the pandemic. This decrease would include both physical and mental QoL. We further hypothesized that the COVID-19 pandemic would have a greater effect on select populations, including women and those participating in team sports. Determining the effect of the COVID-19 pandemic on physical and mental health and identifying at-risk populations will be important in the long-term care of collegiate athletes, especially those affected by the COVID-19 pandemic.

Methods

Student athletes at a single Division I institution were provided surveys to assess their QoL twice per year between January 2018 and September 2022. Athletes were asked to provide information regarding age, year in school, sex, and sport. Sport type was classified as team (football, basketball, hockey, soccer, softball, volleyball) or individual (track, cross country, tennis, golf, wrestling, spirit squad, swimming). All procedures performed in this study were approved by the University of Wisconsin-Madison institutional review board

Quality of Life

QoL was assessed using the Veterans RAND 12-Item Health Survey (VR-12). The VR-12 is a brief, validated health survey made up of 12 items to measure an individual’s perspective on their QoL. The 12 items are ultimately formulated into 2 separate constructs, the physical component score (PCS) and mental component score (MCS). Higher values indicate a more positive perception of a respondent’s QoL. The VR-12 has been used across a wide variety of populations, including current and former college athletes. ¹⁸

Statistical Analysis

Responses were grouped by sex, sport type (individual, team), time of year (winter, summer), and COVID (before, during), and evaluated over time descriptively. PCS and MCS were compared before and during COVID using least squares means and 95% confidence intervals (CIs) from linear mixed effects (LME) models with sex, sport type, time of year (winter, summer), and COVID (before, during) as fixed effects, and individual as a random effect. Similarly adjusted LME models were used to evaluate the interaction of (1) COVID and sex and (2) COVID and sport type. Significance was determined a priori at P < 0.05, and all analyses were conducted in R.

Results

A total of 2593 athletes (1282 men and 1311 women) completed 6969 surveys. A total of 23 teams were represented and 2501 surveys (36%) were completed by participants in team sports. A total of 56% (n = 3895) of surveys were completed before the beginning of the COVID-19 pandemic in March 2020.

For all athletes, the PCS increased from pre-COVID-19 to during COVID (54.6 [95% CI = 54.4-54.7] vs 55.1 [54.9-55.3]; P < 0.01). The MCS decreased from before the COVID-19 pandemic to during the pandemic (55.2 [54.9-55.5] vs 53.5 [53.1-53.8]; P < 0.01) (Figure 1). Both women and men demonstrated an increase in PCS scores and decrease in MCS scores during COVID-19 compared with prepandemic values (Figure 2). When evaluating the interaction of time and sex, women demonstrated a greater increase in PCS (β = 0.57 ± 0.22; P = 0.01) and greater decrease in MCS (β = 1.06 ± 0.38; P < 0.01) from pre-COVID to during COVID relative to men.

Figure 1.

Physical component score (PCS) and mental component score (MCS) for all athletes from winter 2017 to summer 2022.

Figure 2.

Changes in PCS and MCS by sex for pre-COVID and during COVID time periods. MCS, mental component score; PCS, physical component score.

Participants in team sports and individual sports both demonstrated higher PCS scores and lower MCS scores during the COVID-19 pandemic as compared with before the pandemic (Figure 3). When assessing the interaction of sport type and time, athletes in individual sports showed a larger decrease in MCS as compared with those in team sports (β = 1.46 ± 0.39; P < 0.01). There was no association between PCS scores and the interaction between time and sport type (β = 0.42 ± 0.23; P = 0.07) (Figure 3).

Figure 3.

Changes in PCS and MCS for sport type (individual, team) for pre-COVID and during COVID time periods. MCS, mental component score; PCS, physical component score.

Discussion

Our study found that collegiate athletes self-reported worse assessments of their mental QoL and improved assessments of their physical QoL during the COVID-19 pandemic as compared with before the onset of the pandemic in March 2020. Women were found to be more significantly affected, with a larger decrease in MCS and larger increase in PCS as compared with men. Those who participated in individual sports also demonstrated a greater decrease in MCS during the pandemic compared with those who played team sports. To the best of the authors’ knowledge, this is the first study to demonstrate improvements in physical QoL during the early stages of the pandemic, when there were still significant disruptions to sport participation. In addition, this study is unique in that it evaluates markers of physical and mental QoL separately, rather than QoL on a whole.

MCS values were significantly decreased from prepandemic to during the pandemic across the entire study population. This decrease was larger in women and individual athletes when compared with men and team sport participants. These findings likely relate, in part, to the increase in mental health symptoms seen in youth and athletes during the COVID pandemic. In a study of over 13,000 high school athletes, McGuine et al ¹³ identified women as having a higher prevalence of anxiety and depression symptoms during the pandemic as compared with men, a finding consistent with the changes in mental QoL seen in our study. In contrast, the same study also found team sport athletes to exhibit a higher prevalence of anxiety and depression features compared with individual sport athletes. While our study was not designed to determine the cause of these differences between collegiate and high school athletes, the differences in mental QoL between team and individual sport athletes suggests there may be meaningful differences in how collegiate teams managed disruptions to sport participation.

In contrast to the decreases in MCS, PCS values were increased during the COVID pandemic as compared with prior, indicating that athletes perceived their physical health to be better during the pandemic. Reasons for this increase in physical health are likely multifactorial, but potential causes include fewer injuries occurring as a result of canceled games and competitions as well as decreases in training loads overall that may have typically led to increased soreness or even overuse injury. While it remains to be seen how exactly injury rates during the pandemic will compare to prepandemic levels, early studies have demonstrated fewer sports-related injuries being evaluated in emergency departments during the pandemic. ¹⁷ In addition, research on elite athletes demonstrated a 50% decrease in time spent training during pandemic confinement. ¹⁰ This reduction in training time may have affected the rate of injuries that athletes may have otherwise experienced with their usual training volume.

There are several limitations to this study. First, the data were collected through self-reported surveys as opposed to clinical examination by a healthcare provider. However, our results are consistent with prior research that has demonstrated the effect of the COVID-19 pandemic on the health of athletes. Second, our data were collected during the initial years of the COVID-19 pandemic when disruptions to sport participation were the greatest, and thus it is uncertain whether the effects demonstrated in our results would remain significant through the course of the entire pandemic or following the pandemic. Third, while the differences in changes in MCS were significant for sex and sport type and PCS for sex, few studies have investigated the minimal clinically important difference (MCID) for the VR-12. Studies that have sought to determine a MCID for the VR-12 have typically been focused on specific populations, such as postoperative patients, not related to athletes or adolescents.^5,6,8,19 Fourth, our study gathered data only from a cohort of student athletes and not the general population; therefore, it is uncertain how these results compare with college students and young adults not participating in sports. Furthermore, the role that sport participation may play in affecting QoL, while previously found to improve QoL in high school students during the COVID-19 pandemic,^14,15 is unknown in this population due to the absence of general population data. Fifth, survey data collected did not include variables such as socioeconomic status which could potentially have an effect on mental and physical QoL. Finally, this study was conducted at a single institution and additional variables, such as how different academic institutions approached the pandemic including closing campuses, may have also had an effect on mental or physical QoL.

Conclusion

Collegiate student athletes demonstrated worse mental QoL but improved physical QoL scores during the COVID-19 pandemic as compared with before the pandemic. These changes in mental QoL were most pronounced in women athletes and those that participate in individual sports. Improvements in physical QoL were significant for women when compared with men but were not significant for a specific sport type (individual vs team sport). These findings correspond to increases in mental health symptoms including anxiety and depression within athletes and youth as a result of the COVID-19 pandemic, as well as suggest that cancellation and alteration of collegiate seasons may have led to an improvement in the physical QoL within athletes. These results will help identify groups of athletes who may be more at risk of experiencing the negative mental health effects related to the COVID-19 pandemic.