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. 2001 Oct-Dec;36(4):401–407.

Life-Stress Sources and Symptoms of Collegiate Student Athletic Trainers Over the Course of an Academic Year

Vincent G Stilger *,✉, Edward F Etzel *, Christopher D Lantz †
PMCID: PMC155436  PMID: 12937483

Abstract

Objective:

To examine the impact of life-stress sources that student athletic trainers encountered over the course of an academic year, to investigate the existence of sex differences in stress source symptoms, and to provide athletic training staffs with suggestions on ways to assist student athletic trainers.

Design and Setting:

In a classroom setting, the 25-item Quick Stress Questionnaire (QSQ) was administered to all subjects at the beginning of each month during an academic year. The QSQ, which can be completed in approximately 5 minutes, uses a 9-point Likert scale ranging from 1 (little stress) to 9 (extreme stress) to measure sources of stress and stress-related symptoms.

Subjects:

The sample consisted of 11 male and 9 female student athletic trainers enrolled in a Commission on Accreditation of Allied Health Education Programs (CAAHEP)-accredited undergraduate program at a mid-Atlantic university.

Measurements:

We computed descriptive statistics for the stress items and symptoms (ie, cognitive, somatic, and behavioral) and graphed them according to sex. Separate sex × time analyses of variance were performed to investigate changes in cognitive, somatic, and behavioral stress over the course of the study and to determine if these changes were different for male and female student athletic trainers.

Results:

Academic and financial concerns represented the greatest sources of stress for student athletic trainers. Repeated-measures analyses of variance indicated that stress levels fluctuated significantly during the academic year, with peak stress levels experienced during midterm and at the end of the spring semester. Although female student athletic trainers consistently reported higher levels of stress than their male counterparts, these differences were not statistically significant.

Conclusions:

Student athletic trainers exhibited fluctuations in their stress levels throughout an academic calendar. Academic and financial concerns were the most common stressors. Certified athletic trainers should take an interest in their student athletic trainers and be willing to provide assistance in times of need. Additional research is needed regarding student athletic trainers and stress.

Keywords: burnout, college students, coping, stress

Life stress, in particular chronic distress, has an undesirable effect on physical and mental health.1–7 Capel8 investigated burnout among athletic trainers and identified various sources of life stress, such as extensive time commitment, low salary, limited opportunity for career advancement, poor working conditions, job dissatisfaction, and conflicts with coworkers.

Capel8,9 further observed that the rate of burnout among athletic trainers was relatively low when compared with that of other allied health professionals.10–12 Campbell et al13 reported that approximately 40% of all athletic trainers they surveyed were suffering from stress and burnout. Psychological aspects of rehabilitation from sport injury14–21 and the potential influences of stress on injury22–28 have received considerable scholarly attention, as has the topic of stress and certified athletic trainers.8,9,13,29 However, no research has addressed the psychological stresses of student athletic trainers.

Thousands of student athletic trainers provide care to student-athletes on a daily basis in various athletic training curriculum and internship sites across the United States. Recent data indicated that more than 1000 students were enrolled in 121 National Athletic Trainers' Association-approved or Commission on Accreditation of Allied Health Education Programs (CAAHEP)-accredited undergraduate curriculums and hundreds more in nonaccredited programs.30 Under the direct supervision of a certified athletic trainer (ATC), student athletic trainers must often provide coverage for a specific intercollegiate team or to an entire school's sport program (eg, when assigned to a high school). Such commitment requires the regular investment of considerable time and energy, in addition to the demands of the academic program.

Many researchers have investigated the demands and stressors faced by college students.2,31–33 This population regularly reports experiencing numerous stressful academic, health-related, and personal-social challenges, such as the pressures to perform well in the classroom, excessive time demands, relationship issues, family pressures, and financial concerns.2,31–33

Much like the collegiate student-athletes they serve, student athletic trainers are confronted with multiple, often stressful, life demands.34 Typically high-achieving student athletic trainers must balance the roles of student, helping professional in the making, and perhaps most challenging of all, developing young person. First and foremost, student athletic trainers are young people in transition. Like their peers, they must work through the so-called “developmental tasks” of college students, such as establishing one's life purpose, solidifying a set of personal values and standards, establishing meaningful and lasting relationships, developing feelings of competence, and establishing one's independence.35–37 The stress associated with these tasks creates the developmental undercurrents that influence the daily functioning, growth, achievement, and satisfaction of student athletic trainers—factors that deserve attention and study.

A review of the literature revealed limited information regarding student athletic trainers and stress. Therefore, the 3 purposes of our study were to (1) identify the sources of stress that student athletic trainers face regularly and the types of stress symptoms they experience over the course of an academic year, (2) investigate the existence of possible sex differences between stress sources and symptoms, and (3) provide suggestions for athletic training staffs and helping professionals on how to assist this population.

METHODS

Subjects

Forty-three student athletic trainers at a mid-Atlantic National Collegiate Athletic Association Division I institution with an accredited undergraduate CAAHEP athletic training curriculum volunteered to participate in the study. Only 20 of 43 subjects (47%; 11 men, 9 women; age, 22 ± 4.6 years) provided data suitable for analysis due to missing stress questionnaires, missing items, or both. Thus, 23 of the original 43 subjects dropped out of the study for various reasons. The length of the study (8 months) may have contributed to the high attrition rate due to students' dropping the class, or they may have simply lost interest in participating. The University's Institutional Review Board for the Protection of Human Subjects approved this study. All participants provided informed consent.

Instrument

The Quick Stress Questionnaire (QSQ) is a 25-item, self-report inventory designed to measure sources of stress and stress-related symptoms in college students along a 9-point Likert scale (1 = little stress, 9 = extreme stress).38 The QSQ provides a cost-effective, psychometrically sound measure of stress sources and symptoms. Respondents rate the severity of 8 potential areas of stress (academic, social/personal, family, financial, self-image, health, sexual, day-to-day hassles) on their lives and identify the types and degrees to which they experience various stress-related symptoms. Individual stress symptoms can be classified as cognitive (eg, anxiety), somatic (eg, headaches), or behavioral (eg, procrastination). Adding items according to the factor loading reported by Otani,38 one can derive stress symptom factors (Table). Support for the QSQ's construct validity has been established through maximum likelihood factor analysis,38 which revealed that the 9 stress source items loaded (loading reflects the extent of a relationship between each observed variable and each factor)39 on a single stress source factor. Maximum likelihood factor analysis also identified 3 symptom factors that were labeled cognitive, somatic, and behavioral. Omega coefficient estimates of internal reliability for the cognitive, somatic, and behavioral factors were observed to be .89, .83, and .79, respectively.38

Quick Stress Questionnaire (QSQ) Items and Item Loadings for Cognitive, Somatic, and Behavioral Factors

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Survey Administration

Student athletic trainers enrolled in 3 different athletic training theory classes completed the QSQ within the first week of each month during the academic year (ie, September to April), for a total of 8 administrations. Students who missed class were asked to complete the QSQ within 24 hours of the in-class administration of the instrument. The QSQ was administered by a research assistant, who discouraged students from discussing their answers while completing the questionnaire, advised students that their responses would remain confidential, and encouraged them to respond honestly to all items. Only the data provided by the subjects who responded to all QSQ items were retained for data analysis.

Statistical Analysis

We calculated means and standard deviations for each stress source and for the cognitive, somatic, and behavioral symptoms of stress. Separate sex × time analyses of variance (ANOVAs) were performed to investigate changes in the severity of stress from each of the 8 stress sources. Also, separate sex × time repeated-measures ANOVAs were performed to examine if the cognitive, somatic, or behavioral expression of stress changed significantly over the course of the study. Significant main effects were analyzed via post hoc testing. In addition, all statistical analyses were based on an alpha level of .05 and were conducted using the SPSS statistical package (version 7.0, SPSS Inc, Chicago, IL).

RESULTS

Means and standard deviations for the 8 stress-source items and the 15 stress-symptom items, partitioned by sex, were calculated separately for each month. Academics (men, 5.36 ± 1.55; women, 6.39 ± 1.46) and financial concerns (men, 5.51 ± 1.90; women, 6.63 ± 1.87) were the primary sources of stress for both male and female student athletic trainers. The means and standard deviations for all other stress source items were 3.01 ± 1.65 for men and 4.36 ± 2.24 for women.

Fluctuations in the severity of stress associated with each of the 8 stress-source items (ie, items 1–8) over the course of the academic year were assessed using separate sex × time ANOVAs. The stress levels associated with all but one of the stress sources (family concerns) fluctuated significantly over the course of the study (F7,15 = 1.80, P = .093). However, in no case did men and women differ in the amount of stress they reported.

In order to examine changes in the cognitive, somatic, and behavioral expression of stress over the course of the study, responses to individual symptom items (ie, items 10–22) were added according to the factor loadings reported by Otani.38 Separate sex × time repeated-measures ANOVAs revealed no significant interactions relative to changes in the cognitive (F7,126 = 1.90, P = .074), somatic (F7,126 = .65, P = .711), or behavioral (F7,126 = .48, P = .870) symptoms of stress. In addition, there was no main effect for sex with regard to the somatic expression of stress (F1,18 = 2.58, P = .126). However, significant main effects for sex relative to the cognitive (F1,18 = 5.99, P = .001) and somatic expressions of stress (F1,18 = 2.50, P = .019) were noted. In both cases, women reported greater stress symptoms than did men. Significant time main effects were found for behavioral (F7,15 = 2.50, P = .019), cognitive (F7,15 = 5.99, P = .001), and somatic (F7,15 = 4.18, P = .001) symptoms of stress. Changes from month to month with regard to behavioral, cognitive, and somatic symptoms of stress are presented in Figures 1–3.

Figure 1.

Figure 1

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Fluctuations in behavioral stress.

Figure 3.

Figure 3

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Fluctuations in somatic stress.

Figure 2.

Figure 2

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Fluctuations in cognitive stress.

Relative to cognitive stress, both male and female student athletic trainers tended to report apprehension, fear, and worry. Men reported thoughts of anger and hostility as well. Somatic stress was experienced by both men and women through sleep disturbances, insomnia, and troublesome dreams. Men also reported excess muscle tension and headaches. Behavioral manifestations of stress were expressed through forgetfulness, mental inefficiency, and amotivation. Women reported excessive alcohol consumption and avoidance behaviors such as procrastination and escapism.

Finally, in order to assess the overall stress levels experienced by student athletic trainers over the course of an academic year, a repeated-measures ANOVA was conducted on item 23 of the QSQ (overall stress at this time). The results of this analysis revealed no significant interaction (F7,126 = .58, P > .05) but did reveal significant main effects for sex (F1,18 = 14.38, P < .001) and time (F7,126 = 4.20, P < .001). This indicates that women reported greater overall stress during the academic year than men. Additionally, the overall levels of stress fluctuated in a similar fashion for both male and female student athletic trainers (Figure 4).

Figure 4.

Figure 4

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Overall stress.

DISCUSSION

Although gleaned from a small sample of convenience, our findings provide unique preliminary insights into the life stresses and stress symptoms of student athletic trainers at a National Collegiate Athletic Association Division I institution. Not surprisingly, many of the stressors that this sample of student athletic trainers reported are common to college students. For example, many students confront pressures (eg, academic, financial, social, family, and other stressful life events) typical of the collegiate environment.2,31,34,40,41 Most students cope effectively with these pressures; some cope less well. The additional responsibilities associated with the student athletic trainer lifestyle (travel, maintaining high academic standards, dealing with noncompliant athletes, sensitive coach interactions) may place them at risk to experience physical and psychological problems (cognitive and somatic complaints in our sample). Perhaps these lifestyle demands are unavoidable, because student athletic trainers typically engage in clinical experiences that require involvement similar to a part-time job and, at times, much more. Student athletic trainers give many hours in the athletic training room but seldom receive remuneration for their clinical experiences. Thus, student athletic trainers may be at risk for experiencing financial stress because, unlike typical college students, they rarely have the time to devote to a part-time job that might help defray the increasing costs of school and daily living.

How well student athletic trainers cope with the various life stressors associated with their roles and responsibilities is critical to their well being and success. Sex and acquired personal coping skills (eg, stress-management activities) may positively influence a student's ability to cope with these demands. Traditional sex-role conceptions commonly depict women as more emotionally responsive and sensitive, men as more analytic and task oriented.42–44 Thus, men may tend to work through their difficulties on their own and use personal problem-solving strategies to cope with stress, whereas women often reach out to others and rely on emotion-focused coping strategies.43

Heilburn and Chefitz45 reported that general irritability, unstable emotions, inability to concentrate, easy fatigability, emotional tenseness, and loss of appetite are common stress symptoms among college students. Female students are more susceptible to psychosomatic symptoms, physical illness, psychological disorders, and anxiety and report greater depressive mood symptoms than male students.46,47 Sigmon et al48 found that women rated stressful situations as more unpleasant than men, whereas men perceived themselves as having more control and viewed stressful events as more of a challenge than a threat.

Men and women in this study tended to differ on how they managed time and stress. Macan et al49 found that women scored higher than men when dealing with time-management behaviors. Women reported a higher frequency of engaging in time-management practices such as making lists, planning, and scheduling; however, they felt no more in control of time as a result of these behaviors.49 A National Collegiate Athletic Association report on intercollegiate athletes noted that female athletes spent more time preparing for class than male athletes and less time in social activities and relaxing alone.50,51

Our results suggest that academics may be a major source of stress to student athletic trainers. This is particularly evident in the months of October, December, and March due to midterm and final examinations. However, less stress is reported during March than in October, and this may be attributed to spring break, which often serves as a source of stress relief.

Effective time-management and study skills appear to be essential facilitators of academic success in the classroom. In fact, students who are academically challenged are often less able to manage and control their time.49 How male and female student athletic trainers manage their time and studies may have significant positive or negative effects, both in and out of the classroom. With the stringent demands associated with the responsibilities of student athletic trainer programs, faculty and staff should encourage students to participate in time-management and study-skill seminars or to obtain individual assistance from on-campus professionals for these needs.

Students face many stresses associated with college, such as moving away from home and family, adapting to a new environment, establishing new friendships, and managing a challenging academic environment.52,53 Student athletic trainers face additional pressures similar to those of college student-athletes, such as increased travel demands, high performance expectations, team expectations and rules, and financial pressures.52 Thus, student athletic trainers' involvement with athletics at the collegiate level places them in the role of nonathletes participating in an extracurricular activity as they strive to be successful in both the classroom and their athletic training clinical responsibilities. In comparison with their more high-profile athlete peers, they strive to be accepted by their fellow student athletic trainers, to be recognized by staff athletic trainers based on their clinical performance, and to provide quality health care for the athletes and coaches they interact with on a daily basis.

Providing Support and Assistance to Student Athletic Trainers

Our data suggest that student athletic trainers are young people at risk for experiencing stress in various ways. Their many responsibilities make their lifestyles uniquely demanding. They should be viewed much like student-athletes, first as developing young people in an academic community, and second as people who are actively involved in a very challenging extracurricular activity—college athletics.54

Certified athletic trainers who work with student athletic trainers can have a significant effect on the daily functioning and development of these future professionals. Helping student athletic trainers to understand our efforts in the athletic training room with an athlete's treatment and rehabilitation is often given the utmost attention and concern. Nevertheless, attending to a student athletic trainer's health and welfare should also be a very high priority for all faculty and staff athletic trainers in the collegiate setting.

Athletic training professionals should learn to be effective listeners and be sensitive to the concerns of student athletic trainers. According to Bolton,55 we spend more time listening than anything else we do during our waking hours. Clearly our ability to listen directly influences our friendships, relationships, and effectiveness at work. Often, a faculty or staff athletic trainer may not need to intervene formally but can simply provide an empathetic ear to a struggling young person.

The physical and mental health of student athletic trainers may be facilitated by regularly engaging in a few simple professional practices. Always have an open-door policy for student athletic trainers. Student athletic trainers should believe they can approach any staff or faculty athletic trainer with problems (eg, class demands, peer conflicts, family matters) should the need arise. Encourage student athletic trainers to check in with the athletic training faculty or staff on a regular basis, even if the contact is brief. Be willing to spend time with them when they visit. Demonstrate a genuine interest in them and their concerns by giving them undivided attention. Get to know them on an ethically appropriate personal level rather than just through the superficial daily interactions in the clinical or classroom setting. Ask them questions regarding their daily life interactions:

  • How are things at home?

  • How are they and their roommates or classmates getting along?

  • How are their classes going?

  • Are they traveling out of town this week with their respective teams?

  • What's new and exciting in their life?

  • How is their health these days?

These types of questions show genuine interest and concern for student athletic trainers as people and not merely students. Professionals can inquire about these and other issues without losing sight of what needs to be accomplished every day in the classroom and athletic training room. Indeed, providing such social support facilitates the student's coping with stress and promotes overall health.21,56

Because of their involvement in and commitment to the athletic training program, academics, and personal lives, student athletic trainers may be vulnerable to physical and mental breakdown, especially around certain demanding times. Our data suggest that they may be especially vulnerable to stress during midterm examinations (ie, October and March), when academic pressures are common and team-related responsibilities are often heavy. Faculty and staff athletic trainers should be sensitive to these vulnerable times to better recognize when students may encounter problems and to be aware of unusual stress responses. Unusual stress responses might include feelings of depression, apprehension, anger, hostility, sleep disturbances, muscle tension, headaches, forgetfulness, and avoidance behavior. Faculty and staff athletic trainers need to monitor stressful responses among student athletic trainers and show care and concern without being intrusive. Perhaps a day off to deal with their stressful plight (academics, family, or personal) may be all the student athletic trainer needs. If further intervention is needed, athletic training professionals need to be aware of on-campus resources so they can make appropriate and timely referrals to qualified helping professionals, such as counseling-center psychologists and health-service physicians.

The data from this study suggest that student athletic trainers in general, and female student athletic trainers in particular, may benefit from learning and regularly practicing stress-management skills (progressive relaxation, diaphragmatic breathing, meditation) and engaging in other effective stress-reducing behaviors (proper diet, regular physical exercise).57 Although most people express commitment to maintaining peak mental and physical health, like other busy people, student athletic trainers may not engage in health-promoting activities as much as they should, given their lifestyles. Athletic training faculty and staff would do well to enthusiastically promote these activities and even to program them into the weekly schedules of student athletic trainers. It can be quite helpful to make available mechanisms to monitor life stress (eg, brief instruments to self-monitor stress, such as the QSQ). Faculty and staff athletic trainers can help student athletic trainers cope with stress by offering workshops on stress management to enhance the awareness of stress and its potential effects. Students can obtain emotional support through student athletic trainers' support groups or clubs. On-campus mental health professionals are usually available to provide many of these services. Many institutions have adopted the National Collegiate Athletic Association's CHAMPS(Challenging Athletes' Minds for Personal Success)/Life Skills program for student-athletes, which may also be a useful resource for student athletic trainers.58

Limitations of the Study

Several aspects of the investigation should be considered when interpreting the findings of our study. Only 47% of subjects' QSQ responses were usable for data analysis, which adversely affected the ability to generalize our results to other populations and settings. Another shortcoming was that we used a sample of convenience from our institution alone rather than obtaining a random sampling. Also, repeated administrations of the QSQ may have had an undesirable effect on our subjects' QSQ responses (ie, the threat of testing existed). The Hawthorne effect was another potential limitation of the study. Although subjects' responses were guaranteed to be confidential, they knew that they were participating in a study and some may have provided socially desirable responses to the QSQ items. Hence, a reasonable degree of caution should be exercised when interpreting our results.

CONCLUSIONS

Student athletic trainers appear to lead stressful and demanding lives, much like those of college student-athletes. The time demands placed upon student athletic trainers in combination with daily life stressors confronting them as college students (eg, academic pressures, financial concerns) may lead to considerable distress that can affect health and functioning. Certified athletic trainers should promote primary prevention strategies that help student athletic trainers cope effectively with anticipated life stress and should provide a holistic approach to assisting student athletic trainers in times of need. Future studies should involve random selection, using a control group, and include other programs accredited by the Commission on Accreditation of Allied Health Education Programs to better understand the stress experienced by student athletic trainers at the collegiate level.

ACKNOWLEDGMENTS

We thank Tybetha Cook, MSEd, for her assistance in data collection.

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