Abstract
Background:
The purpose of this study was to compare the benefits of sport participation with no sport participation during the COVID-19 pandemic and determine the moderating effects of race and ethnicity, socioeconomic status (SES), and physical activity (PA) on mental health in adolescent athletes.
Hypothesis:
Sport participation would be associated with greater improvements in mental health for athletes from racial and ethnic minority and lower SES groups compared with White and high SES groups. PA would mediate <30% of the mental health benefits of sport participation.
Study Design:
Cross-sectional study.
Level of Evidence:
Level 4.
Methods:
In May 2021, adolescent athletes completed an online survey (demographics, sport participation, measures of anxiety and depression, PA). Participants were classified as those who played sports (PLY) and those who did not (DNP). Mental health symptoms for the PLY and DNP groups were compared via analysis of variance models that controlled for demographic variables. Moderating analyses assessed the interaction of sport participation status by (1) race and ethnicity (White/non-White) and (2) SES (high/low) with mental health. Mediation analyses assessed the degree that PA scores explained the differences in anxiety and depression between the 2 groups.
Results:
Participants included 4874 adolescent athletes (52% female; age, 16.1 ± 1.3 years; PLY, 91%). Athletes who returned to sport from racial minority groups and low SES had greater decreases in anxiety (race and ethnicity: interaction estimate (b) = -1.18 ± 0.6, P = 0.04; SES, b = -1.23 ± 0.5, P = 0.02), and depression (race and ethnicity: b = -1.19 ± 0.6, P = 0.05; SES, b = -1.21 ± 0.6, P = 0.03) compared with White and high SES athletes, respectively. PA explained 24% of anxiety (P < 0.01) and 20% of depression scores (P < 0.01).
Conclusion:
Athletes who identify as a racial or ethnic minority and from areas of lower household income experienced disproportionately greater negative mental health impacts from sport restrictions during COVID-19.
Clinical Relevance:
Improving access to sports in traditionally underserved areas may have significant mental health impact for adolescents.
Keywords: anxiety, COVID-19, depression, mental health, minorities, public health, youth
An estimated 8.4 million United States (US) high school students participate in interscholastic athletics each year. 25 Adolescent sport participation is recognized to have profound positive influences on the health and well-being of adolescent athletes in the short and long term.2,7,8,17 During the spring of 2020, COVID-19, the disease caused by the novel SARS-CoV-2 virus, reached pandemic levels in the US. Virtually all high school and club sport opportunities were cancelled in an effort to slow the spread of the disease. Experts have reported that COVID-19 mitigation strategies may nonetheless have had profound negative health consequences for youth and adolescents.4,24,26,27
In particular, several studies have identified the mental health consequences of the pandemic on adolescents, where studies have found an increase in anxiety,20,29 depression,20,29 and suicidal ideation and suicide rate in this population.15,26,34 Unfortunately, the mental health crisis for adolescents in the US was already a growing issue before the pandemic, which only exacerbated the issue. 40 However, several studies have recognized the important role organized sport and physical activity (PA) can play in improving mental health.3,6,12,23 Therefore, the sharp increases in anxiety and depression in high school athletes during the pandemic compared with prepandemic levels was not a surprising finding.1,20 Interestingly, among athletes who returned to sport during the pandemic, increase in PA from sport participation explained only 22% of the decrease in depression symptoms that has been seen. 38 This suggests that the social dynamics of organized sport participation may play a larger role in mental health than previously thought. 38 However, this sample was from a single state and found no relationship with PA and anxiety. 38
As sport participation has returned after the pandemic, mental health in adolescent athletes has improved, but is still significantly worse than prepandemic levels. 1 Importantly, the return to sport has not been equal among people of different races and socioeconomic status (SES). According to the Aspen Institute sport participation report, from 2012 to 2021, participation in sport by White adolescents (13-17 years old) dropped <1%, whereas the participation rate among Black and Hispanic adolescents dropped 8% and 4%, respectively. 41 Fleming et al 11 identified that parents from racial minority groups were more concerned about their child’s health when returning to sport after the pandemic. Furthermore, sport participation during the pandemic was much higher in White adolescent athletes than non-White athletes, and children from a family with a full-time job were more likely to participate in sport during the pandemic than children from families without a full-time job. 11 This aligns with the Aspen Institute’s report that found adolescent sport participation decreased by 10% in families with a household income under $25,000 compared with 2% in families with household incomes over $100,000. 41 However, there is a gap in our knowledge on how adolescent sport participation may affect mental health in persons from racial and ethnic minority groups and from a low SES background.
Therefore, the purpose of this study was to use a nationally representative sample of US adolescent athletes to (1) report the effect sport participation had on adolescent athletes’ mental health and PA during the pandemic, (2) report how racial and ethnic minority status and SES moderated the benefits of returning to sport during the pandemic, and (3) determine how much increased PA levels accounted for the mental health improvements for those who returned to sport during the pandemic. The hypotheses of this study were that adolescent athletes who participated in sport during the pandemic would have better mental health and PA outcomes than those who did not participate in sport during the pandemic. In addition, we hypothesized that adolescents from racial and ethnic minority groups and low SES would experience a greater improvement in mental health when returning to sport compared with White adolescent athletes. Lastly, we hypothesized that PA would explain a significant portion of the mental health benefits observed from returning to sport, but that it would explain <30% of those improvements.
Methods
This study was approved by the University of Wisconsin-Madison Institutional Review Board. Portions of these data have been published previously. 37 US adolescent athletes (male and female; grade, 9-12; age, 13-19 years) were recruited to participate in the study by completing an anonymous online survey in May to June 2021. Emails with social media links to the study were sent to state high school association directors, medical providers, and club coaches across the US to solicit their athletes to participate in the study. Consent and assent to take part in the study were obtained by asking potential participants to read the information regarding the study’s purpose and design and get permission from their parent and/or guardian to complete the survey.
The survey included 69 items, with a section regarding demographics and sport participation, followed by 2 validated instruments used to measure PA and mental health. Demographics included the participant’s age, sex, race and ethnicity, grade, school name, the type of school attendance (in person, online, or hybrid) in which they took part in the weeks before the survey, as well as all the school or club sports in which they participated the year before the COVID-19 pandemic (2019) and all the sports they participated in during the COVID-19 pandemic (2021). The remainder of the survey consisted of an assessment of mental health and PA.
Mental Health Measures
The General Anxiety Disorder-7 Item (GAD-7) and Patient Health Questionnaire-9 Item (PHQ-9) surveys were used to evaluate anxiety and depression symptoms, respectively. 20 Both the GAD-7 and PHQ-9 are valid, reliable, and sensitive measures of anxiety symptoms and depression symptoms, respectively.22,28 For the GAD-7, scores range from 0 to 21 with a higher score indicating increased anxiety. In addition to the total score, GAD-7 categorical scores of 0 to 4, 5 to 9, 10 to 14, and 15 to 21 correspond to no, mild, moderate, and severe anxiety symptoms, respectively. 22 The PHQ-9 is a 9-item screening questionnaire for depression symptoms with scores ranging from 0 to 27, with a higher score indicating a greater level of depression. In addition to the total score, PHQ-9 categorical scores of 0 to 4, 5 to 9, 10 to 14, 15 to 19, and >20 correspond to minimal or none, mild, moderate, moderately severe, and severe depression symptoms, respectively. 18
PA Measures
PA level was assessed with the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (PFABS). This instrument contains 8 items designed to measure the activity of children between 10 and 18 years old for the past month. Scores range from 0 to 30 with a higher score indicating greater PA, and the PFABS has demonstrated validity in adolescent populations.9,10
Statistical Analyses
Statistical analyses were performed for participants who provided a valid, complete survey. Participants were excluded if they (1) did not complete the entire survey or (2) were not in grades 9 to 12. Participants’ demographic variables were summarized (means and standard deviations or N [%]) overall and were summarized by sex and spring sport participation. Participants who did play a club or school sport during the COVID-19 pandemic were categorized as part of the played sports (PLY) group, whereas those who did not play a sport during the COVID-19 pandemic were categorized as being in the did not play (DNP) group.
The study team collected data for each participant that included (1) the percentage of students eligible for free or reduced lunch for the school attended, (2) the percentage of residents in the participant’s county aged <18 years living in poverty, and (3) the county setting (categorized as completely rural, mostly rural, or mostly urban). The free or reduced lunch at each participants’ school was gathered from publicly available data for each state’s department of instruction website. The characteristics for the schools attended by the participants included the percentage of county residents aged <18 years living in poverty and the county setting and were collected from publicly reported US Census Data.29,30 Median household income was determined for the zip code of each respondent, and SES (high, low) was determined by a median split of median household income.
Demographic variables were compared between groups using t tests, Wilcoxon rank sum tests, or chi-square tests. Estimated means (95% CI) for continuous variables were reported and compared between sport participation groups by analysis of variance (ANOVA) models that controlled for age, sex, race and ethnicity, type of school attendance, percentage of students who were eligible for free or reduced lunch, and concern over COVID-19. A moderation analysis of mental health (GAD-7 and PHQ-9 scores) was used to see the interaction between persons from racial minority groups (yes/no) and sport participation status in the Spring of 2021 (yes/no). A similar analysis was used for SES (low/high) using median household income. Last, to evaluate the extent to which reported PA accounts for the improved anxiety and depression symptoms among athletes able to return to sport in 2021, 2 separate mediation analyses were conducted to assess the proportion of the difference in anxiety scores and depression scores between PLY and DNP that was explained by differences in PA. This calculation requires the average causal mediation effect (the effect of sport status on PA multiplied by the effect of PA on the mental health outcome variable) to be divided by the total effect (average causal mediation effect plus the direction effect of sports status on the mental health outcome variable while controlling for the mediator [PA]). Therefore, for each mental health outcome variable, 2 models were created: (1) a linear model to predict the mental health outcome variable with age, sex, school instruction type, and sport status as covariates; and (2) a linear model to predict the variable with PA, age, sex, school instruction type, and sport status as covariates. 38 By using the “mediate()” function in R statistical software, the outputs from the 2 models were used to generate 500 quasi-Bayesian Monte Carlo simulations that yield parameter estimates and 95% CIs. All tests were 2-tailed, and the analyses were conducted in R for statistical computing Version 3.5 with statistical significance set at P < 0.05.
Results
A total of 4874 current and former adolescent athletes (age, 16.1 ± 1.3 years; female, 52.1%, male, 47.4%; other, 0.5%) provided complete survey data. Due to the convenience sampling design, the total number of athletes who received the survey is unknown, and a response rate is unavailable. In the sample, 2400 (49%) participants were in the low SES group and 2397 (49%) were in the high SES group; 77 athletes did not have median household income county data (1%). Of the low SES group, 77% were Caucasian and 33% were non-Caucasian or selected “preferred to not say.” In addition, of the high SES group, 83% were Caucasian and 17% were non-Caucasian or selected “preferred to not say.” A total of 4419 (90.7%) participants reported that they had participated in an interscholastic or club sport since May 2020 (PLY), while 455 (9.3%) reported they did not play an interscholastic or club sport during that time (DNP).
The DNP group had a higher percentage of non-White or non-Caucasian respondents (DNP, 34.8%; PLY, 14.2%; P < 0.01), attended schools with a higher median percentage of students eligible for free or reduced lunch (DNP, 29.0% vs PLY, 27.0%; P < 0.01) and resided in counties with a higher mean percentage of their residents aged <18 years in poverty (DNP, 16.1% vs PLY, 14.9%; P = 0.01) than athletes in the PLY group. The PLY group was more likely to attend school in person (PLY, 72.2% vs DNP, 55.8%; P < 0.01), and was more likely to reside in a completely rural or mostly rural county (PLY, 27.2% vs DNP, 21.5%; P = 0.03) than the DNP athletes. A summary of the demographic characteristics for the athletes in the study participants is found in Table 1. The types of sports played by the participants before the COVID-19 pandemic are found in Appendix Table A1 (available in the online version of this article). The sport participation data for the study participants since May 2020 are found in Appendix Table A2 (available online).
Table 1.
Participant demographics and characteristics for adolescent athletes in PLY and DNP groups during the COVID-19 pandemic
| Variable | All Participants (n = 4874) | DNP During the COVID-19 Pandemic (n = 455) | PLY During the COVID-19 Pandemic (n = 4419) | P value |
|---|---|---|---|---|
| Age | 16.1 (1.3) | 16.1 (1.3) | 16.1 (1.3) | 0.81 |
| Sex | 0.86 | |||
| Female | 2529 (51.9%) | 238 (52.3%) | 2291 (51.8%) | |
| Male | 2320 (47.5%) | 214 (47.0%) | 2106 (47.7%) | |
| Other/Prefer to not say | 25 (0.5%) | 3 (0.6%) | 22 (0.4%) | |
| Race | <0.01 | |||
| Asian | 107 (2.2%) | 11 (2.4%) | 96 (2.2%) | |
| Black or African American | 233 (4.8%) | 47 (10.3%) | 186 (4.2%) | |
| Hispanic or Latino | 410 (8.4%) | 58 (12.7%) | 352 (8.0%) | |
| Native American or Native Alaskan | 141 (2.9%) | 40 (8.8%) | 101 (2.3%) | |
| White or Caucasian | 3878 (79.6%) | 293 (64.4%) | 3585 (81.1%) | |
| Other | 48 (1.0%) | 3 (0.7%) | 45 (1.0%) | |
| Prefer to not say | 57 (1.2%) | 3 (0.7%) | 54 (1.2%) | |
| Grade | <0.01 | |||
| 9th | 1300 (26.7%) | 91 (20.0%) | 1209 (27.4%) | |
| 10th | 1239 (25.4%) | 136 (29.9%) | 1103 (25.0%) | |
| 11th | 1293 (26.5%) | 132 (29.0%) | 1161 (26.3%) | |
| 12th | 1042 (21.4%) | 96 (21.1%) | 946 (21.4%) | |
| Very | 92 (1.9%) | 11 (2.4%) | 81 (1.8%) | |
| School attendance | < 0.01 | |||
| Online | 526 (10.8%) | 52 (11.4%) | 474 (10.7%) | |
| Hybrid | 904 (18.5%) | 149 (32.7%) | 755 (17.1%) | |
| In-person | 3444 (70.7%) | 254 (55.8%) | 3190 (72.2%) | |
| School funding | 0.31 | |||
| Private | 569 (11.7%) | 46 (10.1%) | 523 (11.8%) | |
| Public | 4305 (88.3%) | 409 (89.9%) | 3896 (88.2%) | |
| Percentage eligible for free or reduced lunch | 27.0 (13.0 - 42.0) | 29.0 (17.0 - 47.0) | 27.0 (13.0 - 42.0) | <0.01 |
| County setting - participant residence | 0.03 | |||
| Completely rural | 237 (4.9%) | 15 (3.3%) | 222 (5.0%) | |
| Mostly rural | 1063 (21.8%) | 83 (18.2%) | 980 (22.2%) | |
| Mostly urban | 3574 (73.3%) | 357 (78.5%) | 3217 (72.8%) | |
| Percentage in county aged <18 years in poverty | 15.0 (7.8) | 16.1 (9.2) | 14.9 (7.6) | 0.01 |
DNP, did not play sports; PLY, played sports.
Participants in the DNP group reported higher (worse) anxiety and depression symptoms than the PLY group (Table 2). In addition, 40% of the DNP group was classified as having moderate-to-severe anxiety compared with 23% of the PLY group (Figure 1). Similarly, 41% of the DNP group reported having moderate-to-severe depression symptoms compared with only 22% of the PLY group (Figure 2). PA, as measured by PFABS scores for the PLY group were higher (better) than the DNP group. The PFABS scores for both groups are found in Table 2.
Table 2.
Comparison of anxiety, depression, and physical activity for adolescent athletes in PLY and DNP groups during the COVID-19 pandemic a
| Variable | All Participants (n = 4874) | DNP (n = 455) | PLY (n = 4419) | P value |
|---|---|---|---|---|
| GAD-7 total score | 6.5 (6.1, 7.0) | 7.7 (7.1, 8.3) | 5.4 (5.0, 5.8) | <0.01 |
| PHQ-9 total score | 6.7 (6.2, 7.2) | 8.1 (7.5, 8.7) | 5.2 (4.8, 5.7) | <0.01 |
| PFABS total score | 17.4 (16.8, 18.0) | 13.6 (12.8, 14.4) | 21.1 (20.5, 21.7) | <0.01 |
DNP, did not play sports; GAD-7, General Anxiety Disorder-7 Item survey; PA, physical activity; PFABS, Pediatric Functional Activity Brief Scale; PHQ-9, Patient Health Questionnaire-9 item survey; PLY, played sports.
Reported as mean (SD), N (%), or estimated mean (95% CI) when controlling for Age, Sex, Teaching delivery (in person, online or hybrid) method, school, percentage eligible for free or reduced lunch percentage, and concern over COVID-19.
Figure 1.
Prevalence of anxiety symptoms for adolescent athletes who did or did not participate in sports during the COVID-19 pandemic. GAD-7 category percentages were estimated when controlling for age, sex, teaching delivery method, school, percentage of students eligible for free and reduced lunch, and concern over COVID-19. GAD-7, General Anxiety Disorder-7 Item survey.
Figure 2.
Prevalence of depression symptoms for adolescent athletes who did or did not participate in sports during the COVID-19 pandemic. PHQ-9 category percentages were estimated when controlling for age, sex, teaching delivery method, school, percentage of students eligible for free and reduced lunch, and concern over COVID-19. PHQ-9, Patient Health Questionnaire-9 item survey.
Adolescent athletes from racial and ethnic minority groups in the PLY group had relatively greater improvements in symptoms of anxiety (interaction estimate [b] = -1.18 ± 0.6, P = 0.04) and depression (b = -1.19 ± 0.6, P = 0.05) with sport participation compared with White athletes (Figure 3). In addition, athletes from low SES counties in the PLY group had a greater decrease in anxiety (b = -1.23 ± 0.5, P = 0.02) and depression (b = -1.21 ± 0.6, P = 0.03) symptoms with sport participation compared with athletes from counties with higher SES (Figure 4).
Figure 3.
Interaction between racial minority status (yes/no) and sport status (PLY/DNP) on GAD-7 and PHQ-9 scores. DNP, did not play sports; GAD-7, General Anxiety Disorder-7 Item survey; PHQ-9, Patient Health Questionnaire-9 item survey; PLY, played sports.
Figure 4.
Interaction between socioeconomic status (high/low) and sport status (PLY/DNP) on GAD-7 and PHQ-9 scores. DNP, did not play sports; GAD-7, General Anxiety Disorder-7 Item survey; PHQ-9, Patient Health Questionnaire-9 item survey; PLY, played sports.
PA significantly explained 24.2% (95% CI = 15.5%-36.4%, P < 0.01) of the difference in anxiety scores between the PLY and DNP groups. Similarly, PA significantly explained 20.0% (95% CI = 13.6%-28.6%, P < 0.01) of the difference in depression scores between the PLY and DNP groups.
Discussion
The most important findings of this study were that (1) athletes who participated in sports since the onset of the COVID-19 pandemic reported significantly lower anxiety and depression levels and higher PA levels than athletes who had been unable to return to participation; (2) athletes from racial and ethnic minority and low SES groups reported greater mental health and PA benefits from sport participation during the COVID-19 pandemic, and (3) PA explained less than a quarter of the mental health improvements associated with sport participation observed in this cohort. This study builds on previous research demonstrating the dramatic changes in physical and mental health after the cancellation of high school sports in the spring of 2020.19,21 This suggests that the reinitiation of sport participation may result in significant improvements in health for adolescents during the COVID-19 pandemic, especially adolescents from racial and ethnic minority groups and areas with lower SES.
Mental Health
Athletes who continued playing sports during the COVID-19 pandemic demonstrated significantly lower symptoms of anxiety and depression than those athletes who had not played a sport since spring 2020. Participants in the DNP group were nearly twice as likely to report moderate-to-severe symptoms of anxiety and moderate-to-severe symptoms of depression. While PLY athletes were less likely to report moderate-to-severe depression than DNP athletes, PLY athletes demonstrated higher (worse) PHQ-9 scores (5.2[4.8, 5.7]) compared with a sample of athletes before the COVID-19 pandemic (3.3[3.1,3.5]), and nearly twice as many participants reported moderate-or-severe depression (9.7%) compared with what athletes reported before the pandemic (5.3%). 20 This is in agreement with previous studies, which found that adolescent athletes who returned to sport toward the end of the pandemic still had a higher rate of mental health issues compared with prepandemic levels.1,16 Although the PLY group did not quite return to prepandemic mental health levels, this study supports previous research that has demonstrated that sport participation improves the mental health of youth and adolescents.7,12 This supports the premise that sport participation may represent an important mechanism to improve the mental health of adolescents as society continues to attempt to mitigate the impact of COVID-19 in the months and years to come.
Influence of Race and SES
Mental health improvements were greater in athletes from a racial and ethnic minority compared with White adolescent athletes. Conversely, this suggests that the negative health impacts of restriction from sports may disproportionately impact adolescent athletes from racial and ethnic minority and low SES groups. To the best of our knowledge, this is the first study to demonstrate that the degree of mental health improvement by participating in sport varies by race and ethnicity. Interestingly, previous research found that parents in Black and Hispanic families had more health-related concerns about their child returning to sport during the pandemic. 11 Fleming et al 11 suggested that there is a connection between the disparities in mortality rate of White compared with non-White subjects and the fear of children returning to sport. Another possible consequence of this fear may have been that children from Black and Hispanic groups participated in fewer sporting opportunities during the pandemic than children from White families. 11 The results of the current study suggest that persons from traditionally underserved communities may be disproportionately negatively impacted by restriction from sports. Consequently, clinicians working with parents and children from racial and ethnic minority groups should consider and discuss their concerns about their child becoming sick when returning to organized sport and balance that with the mental health benefits the current study highlights.
Similarly, the current study found that adolescent athletes from low SES families saw greater mental health improvements from participating in sport as compared with adolescent athletes from high SES families. Again, we are aware of no previous work that illustrates that mental health improvements were greater in adolescent athletes from low SES families compared with adolescent athletes from high SES families overall. Previous studies have found that adolescents from low SES families are less likely to participate in sport than adolescents from high SES families.11,35 A systematic review revealed that “cost” and “time” were key barriers to adolescent sport participation, 33 and, in conjunction with previous work, the pandemic may have increased these barriers, especially for low SES families. However, our results suggest that policies and communities can greatly improve mental health in adolescents from low SES backgrounds by improving access to sporting opportunities.
Physical Activity’s Relationship With Mental Health
This study demonstrates that, during the COVID-19 pandemic, adolescent athletes who played sports had a significantly higher level of PA than athletes who did not play a sport. The total PFABS score for the PLY group was similar to scores (mean, [95% CI]) for healthy high school aged athletes before COVID-19 (24.7 [24.5, 24.9]). 20 Similarly, the PFABS scores for the PLY group were similar to scores for adolescents reported by Donovan et al 5 (23.8 ± 5.3) as well as to normative data reported by Fabricant et al 10 (20.2 ± 7.2). This may indicate that sport participation restored prepandemic levels of PA and may be an important means of countering the low level of PA reported during the onset of the COVID-19 pandemic that is leading to weight gain in adolescents. 39
PA is known to have a beneficial effect on a wide range of health outcomes in adolescents, including sleep, academic success, well-being, and mental health.2,7,8,17,36 The results of this study demonstrated that PA accounted for 24% of the improvement in anxiety measures and 20% of the improvement in depression measures. These results are in line with a previous study in a state-wide sample that found that PA significantly explained 22% of depression scores. 38 However, our results are contradictory to state-wide sample of Watson et al, 38 which found that PA did not significantly explain anxiety scores. These differences may be due to the difference in sample size or the difference in location as the current study represents a larger, national sample.
Although PA activity significantly explains a percentage of the mental health outcomes, it still accounts for only 20% to 24% of those outcomes. There may be a few reasons why PA accounts for such a small percentage. First, our findings may support the idea that sport participation offers more than PA benefits. Easterling et al 7 demonstrated that adolescents who participated in team sports after enduring adverse childhood experiences had better anxiety and depression outcomes compared with those who did not participate in team sports. Similarly, Eime et al 8 proposed a conceptual model of Health through Sport that highlights the individual and overlapping positive effects sports can have on physical, psychological, and social well-being. Following this model, previous studies have identified the loss of athletic identity, loss of potential future sporting career, and increased time in negative environments at home or in other peer circles as having a negative effect on an adolescent athletes’ well-being.13,30 Future studies will need to continue to expand upon our knowledge of how sport supports mental health through other modes than PA. Second, our findings may support the reality that mental health during the COVID-19 pandemic is extremely multifaceted. Experts have pointed out that the COVID-19 pandemic has negatively impacted the mental health of youth and may be related to decreased socialization, increased family strain, and reduced access to support services.14,27,31 As such, we recognize that factors beyond sport participation may contribute to adolescent mental health.
Limitations
This study has several major limitations. First, mental health is complex and is potentially affected by other factors for which we were not able to account in our study and which would confound the results. Nonetheless, we were able to control for sex, age, school attendance method, and the percentage of students eligible for free or reduced lunch to help better define the impact sport participation may have during COVID-19. Second, the data provided were self-reported from online surveys and not the result of a clinical examination. However, our findings are consistent with reports from experts and the US Centers for Disease Control, which stated that the COVID-19 pandemic will impact adolescent health overall.15,17,32 Finally, due to the survey delivery method, our sample is likely biased toward athletes from higher SES groups with easy access to internet services.
Conclusion
Adolescent athletes who participated in sport during COVID-19 had markedly improved mental health and PA compared with adolescent athletes who did not participate in sport since the onset of the pandemic. In addition, race, ethnicity, and SES appeared to significantly influence the negative effects of prolonged restriction from sports, such that athletes from racial and ethnic minority and lower SES groups were much more negatively impacted by restrictions than White adolescent athletes and those from high SES groups. This study reaffirms that sport participation is a public health priority for children and that efforts to improve access for traditionally underserved groups may have significant physical and mental health benefits.
Supplemental Material
Supplemental material, sj-docx-1-sph-10.1177_19417381231223494 for The Influence of Race, Socioeconomic Status, and Physical Activity on the Mental Health Benefits of Sport Participation During COVID-19 by Kevin M. Biese, Timothy A. McGuine, Kristin Haraldsdottir, Claudia Reardon and Andrew M. Watson in Sports Health
Acknowledgments
The authors would like to acknowledge the staff and athletes who helped facilitate this research. This study was partially funded by the National Federation of State High School Associations.
Footnotes
The authors report no potential conflict of interest in the development and publication of this article.
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: a grant from the National Federation of State High School Associations.
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Supplementary Materials
Supplemental material, sj-docx-1-sph-10.1177_19417381231223494 for The Influence of Race, Socioeconomic Status, and Physical Activity on the Mental Health Benefits of Sport Participation During COVID-19 by Kevin M. Biese, Timothy A. McGuine, Kristin Haraldsdottir, Claudia Reardon and Andrew M. Watson in Sports Health