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The Relationship of Stress, Competitive Anxiety, Mood State, and Social

Support to Athletic Injury

Article  in  Journal of Athletic Training · February 1996

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Lisa Lavallee Frances Flint

Sacred Heart University York University
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The Relationship of Stress, Competitive
Anxiety, Mood State, and Social Support to
Athletic Injury
Lynn Lavallee, BA; Frances Flint, PhD, ATC
Study Objective: We examined the role of stress, competi- .001) were related to injury frequency, and that tension/anxiety
tive anxiety, mood state, and social support in athletic injury. (r = .44, p = .008), anger/hostility (r = .30, p = .02), and total
Specifically, we hypothesized that athletes reporting high levels negative mood state (r = .28, p = .038) were related to injury
of stress, high competitive trait anxiety, negative mood state, severity. Individually, the two sports yielded somewhat different
and low social support would exhibit greater incidence of injury results: for football, injury frequency and injury seventy were
and injury severity. related to tension/anxiety (r = .43, p = .004 and r = .47, p =
Design and Setting: Correlational analysis. Major Canadian .002, respectively). Vigor/activity was found to be significantly
university. related to injury rate (p = .02), but since the internal consistency
Subjects: Voluntary sample, 55 male varsity athletes (42 of vigor/activity was less than .70 on the Cronbach alpha scale,
football, 81 % of the football team, and 13 rugby, 74% of the this significant finding was disregarded. In rugby, injury fre-
rugby team), ages 19-28 yr (x = 22). quency was related to tension/anxiety (r = .58, p = .04) and
Measurements: The inventories Sport Competition Anxiety depression/dejection (r = .57, p = .04).
Test (SCAT), Social Support Scale, Social Athletic Readjust- Conclusions: These findings are useful for athletic trainers in
ment Rating Scale (SARRS), and Profile of Mood States identifying athletes who may possess psychological factors
(POMS) were administered. Internal consistency of the self- predisposing them to athletic injury. Subsequently, athletic
report measures was tested using Cronbach's alpha coeffi- trainers can instruct these athletes or refer them for assistance
cient. Injury rate and severity were recorded by the head in psychological preventive interventions.
student therapist throughout the season. Key Words: Sport Competition Anxiety Text, Social Support
Results: Correlational analyses performed using Pearson Scale, Social Athletic Readjustment Rating Scale, Profile of
correlational coefficient revealed that competitive anxiety (r = Mood States.
.29, p = .03) and tension/anxiety mood states (r = .43, p =

T he purpose of this study was to investigate the relation- trainers, in an attempt to prevent injury, to identify the
ship among stress, competitive anxiety, mood state, psychological factors that are related to athletic injury.
social support, and athletic injury. Specifically, it was Based on the history of research in this field Andersen and
hypothesized that football and rugby varsity athletes reporting Williams' proposed a model of stress and athletic injury that
high levels of stress and competitive trait anxiety would exhibit attempts to incorporate all possible intervening factors. This
greater incidence of injury and injury severity. It was also model suggests that when an athlete is faced with a potentially
hypothesized that high competitive trait anxiety and negative stressful athletic situation, there is a resultant stress response.1
mood states would contribute to the increase of injury rate The body's response to the potentially injurious situation is a
and/or severity. Moreover, it was hypothesized that a healthy cognitive appraisal of the demands, resources, and conse-
social support system would aid in dealing with life stress and, quences, followed by physiologic and attentional changes.'
therefore, decrease the rate and severity of injury. These physiologic and attentional changes may include in-
Sport injury can be one of the most traumatic events a creased muscle tension, narrowing of the visual field, and
competitive athlete faces during his or her career. Athletic increased distractibility, which may have a negative impact on
the stress-injury response." '3 The stress-injury response can be
trainers are responsible, not only for rehabilitation of the
influenced by personality, coping resources, and psychological
athlete, but also for prevention of injury. Therefore, athletic interventions, such as cognitive restructuring, distraction, de-
trainers should identify possible causes of athletic injury. Many sensitization, and relaxation skills." 5'8
factors can attribute to athletic injury such as environment,
equipment, and physical condition of the athlete.7 There is a
growing realization that psychological factors, such as stress METHOD
and anxiety, may also play a role in the frequency and extent
of injury.2'7'8"1 For this reason, it is important for athletic
Subjects
Lynn Lavalle and Frances Flint are affiliated with York University A total of 55 male varsity athletes from a major Canadian
School of Physical Education, 4700 Keele Street, Toronto, ON, Canada university participated in the study. The group comprised 42
M3J 1 P3. varsity football players and 13 varsity rugby players, ranging in

296VVolume 31 * Number 4 * December 1996

age from 19 years to 28 years, with a mean age of 22 years. The Life Stress. The Social Athletic Readjustment Rating Scale
relatively small sample size was due to the voluntary nature of (SARRS) was used to measure life stress.3 SARRS lists 57 life
the study. Eighty-one percent of the football team and 74% of events, giving different weighting depending on the severity of
the rugby team participated. the stressor, ranging from 0-100. A total SARRS score is
derived by summing all different stressors experienced during
Procedure the last 12 months. The SARRS score reflects the amount of
readjustment required by the subject to adapt to the life change.
The study was explained to all participants and then in- A higher score indicates a higher level of stress in the life of the
formed consents were signed. The inventories-Sport Compe- subject. The SARRS does not distinguish eustress from dis-
tition Anxiety Test (SCAT),9 Social Support Scale,6 Social tress. Internal consistency is relatively low (r = .42).
Athletic Readjustment Rating Scale (SARRS),3 and Profile of Mood State. Mood state was measured by the Profile of
Mood States (POMS)10-were administered before the end of Mood States (POMS) inventory.'0 POMS measures six mood
the season. Due to the voluntary nature of the study and an or affective states: tension/anxiety, depression/dejection, an-
attempt to obtain a greater sample size, inventories were ger/hostility, vigor/activity, fatigue/inertia, and confusion/
accepted throughout the season. SCAT and POMS are general bewilderment. A total mood score, either negative or positive,
inventories that measure traits and do not fluctuate as im- can be determined by summing all the scores. Sixty-five,
mensely with life events as SARRS or the Social Support five-point Likert-type scales describe the mood states. Internal
Scale.369'0 Therefore, time of administration of the SCAT consistency is very high (r = .90).
and POMS inventory is not as sensitive as the SARRS or
Social Support Scale. Optimally, to allow for changes in life
events, inventories should be administered before the season, at
RESULTS
the time of injury, and at the end of the season. A number of statistical analyses were conducted to address
the research questions of the study. First, the internal consis-
tency of the self-report measures used in the present study was
Injury Recording tested using Cronbach's4 alpha coefficient. Second, all injury
Recording of injuries for both sports was performed by the data for the 1993-94 school year for the involved athletes were
head student therapist of each sport according to Reid's12 tabulated. Third, correlational analyses were performed using a
classification of injuries, specifically, Grade I, Grade II, and Pearson correlational coefficient.
Grade III injuries. Contact with the student therapists for minor
treatments such as blisters and prophylactic taping was not
recorded. All other Grade I, Grade II, and Grade HI injuries
Reliability of Measures
were included in the study. Some of the previous research in The internal consistency reliability of SCAT and POMS
this field5'7 measured injury severity by number of days missed were evaluated using Cronbach's4 alpha coefficient. An alpha
practicing or in games, but these can be influenced by value of .70 or higher is considered to be an acceptable
individual differences in physical and emotional responses to indication of scale reliability.4 Therefore, only those scales
injury. Reid's classification of injury takes the actual injury with alpha values of .70 or higher were retained for further
severity into account rather than simply days of practice analysis. Both SCAT and POMS total negative mood states
missed. The classification system used in this study is repre- were found to have acceptable internal consistency. SARRS
sentative of each specific injury and attempts to rule out other and the individual measures of vigor/activity and confusion/
possible factors that may influence days missed. bewilderment of POMS were found to have unacceptable
internal consistency; therefore, these results were disregarded.
Self-Report Measures
Injury Data Analysis
Competitive Trait Anxiety. Competitive trait anxiety was
measured by Martens'9 Sport Competition Anxiety Test Throughout the season, a total of 67 injuries were recorded
(SCAT). The SCAT is a 15-item inventory with scores ranging for the football and rugby athletes who participated in the
from 10 (low) to 30 (high). A higher score represents a higher study. A total of 54 injuries were reported for football. Ten
level of trait anxiety. The SCAT has been found to have a high athletes (24%) were injury free, 16 athletes (38%) sustained
internal consistency (r = .95). Concurrent validity for SCAT is only one injury, 10 athletes (24%) sustained two injuries, and
difficult to measure due to the inability to relate to other sport six athletes (14%) sustained three or more injuries. Seventeen
anxiety measures versus general anxiety (r = .28 to .46). injuries were classified as Grade I, 11 injuries were classified
Social Support. Social support was measured by the Social as Grade II, and only four injuries were classified as Grade III.
Support Scale.6 The seven items of the questionnaire include Most of the injuries were a result of direct contact (contusions,
parents, other family members, friends, coaches, sport injury brachial plexus stretches, knee ligament sprains) followed by
staff, instructors/professors, and teammates. Subjects deter- overuse-type injuries (shin splints, tendonitis, and muscular
mine satisfaction of perceived social support ranging from 1-5 strains).
on a Likert-type scale. A higher score represents a greater A total of 13 injuries were reported for rugby. Five athletes
degree of satisfaction with social support. (38%) did not sustain any injuries, four athletes (31%) sus-

Journal of Athletic Training 297

tained only one injury, three athletes (23%) sustained two Individually, the sports of rugby and football were found to
injuries, and one athlete (8%) sustained three or more injuries. have similar results. For football, consistent with the findings
Four injuries were classified as Grade I, three injuries were of both sports combined, tension/anxiety was significantly
classified as Grade II, and only one injury was classified as related to injury rate and severity of injury (r = .43, p = .004
Grade III. As with football, most of the injuries were a result and r = .47, p = .002, respectively). These correlations were
of direct contact followed by overuse-type injuries. The fre- considered moderate. Vigor/activity was also found to be
quency and grade of injury between the two sports of rugby significantly related to injury rate (p = .02), but since the
and football were relatively comparable. internal consistency of vigor/activity was less than .70 on the
Cronbach alpha scale, this significant finding was disregarded.
A higher rate and severity of injury was significantly related to
Correlational Analysis a reportedly higher degree of tension/anxiety. Those football

Correlation analysis was performed using a Pearson corre- players who were under greater tension/anxiety experienced a
lation coefficient. Significant findings were obtained for foot- greater frequency and severity of injury.
For rugby, the rate of injury was significantly related to
ball and rugby combined and individually.
Injury rate was significantly correlated to SCAT (r = .29, tension/anxiety (r = .58, p = .04), but severity of injury was
not significantly related to tension/anxiety as was found with
p = .03). This correlation is considered weak at r = .29. In this
study, a higher score on SCAT was related to a higher rate of football and both sports combined. Rather, depressed/dejected
injury. Those athletes exhibiting high competitive trait anxiety mood state was significantly related to rate of injury (r = .57,
p = .04), which was not found in football or both sports
had a higher rate of injury. combined. These correlations were considered moderate. A
Injury rate was also significantly related to tension/anxiety higher rate of injury was significantly related to a higher degree
on the POMS scale (r = .43, p = .001). This correlation was
of tension/anxiety and depressed/dejected mood state. Those
moderate at r = .43. A reported higher degree of tension/ rugby players under greater tension/anxiety and a depressed/
anxiety was significantly related to a higher rate of injury. dejected mood state experienced a higher frequency of injury.
Those athletes reporting high tension/anxiety had a higher rate
of injury.
Severity of injury was significantly related to tension/ DISCUSSION
anxiety (r = .44, p = .008) and anger/hostility (r = .30, p = In support of Andersen and Williams'l model, high compet-
.02) and total negative mood state (r = .28, p = .038) on the itive trait anxiety and tension/anxiety were found to be signif-
POMS. Tension/anxiety was moderately correlated at r = .44 icantly related to rate of injury, while tension/anxiety, anger/
and the correlation of anger/hostility and total negative mood hostility, and total negative mood state were significantly
state was weak at r = .30 and r = .28, respectively. A higher related to severity of injury. High competitive trait anxiety
degree of tension/anxiety, anger/hostility, and total negative (SCAT) also played a significant role in the degree of tension/
mood state was significantly related to higher severity of anxiety, anger/hostility, and total negative mood state recorded
injury. Thus, those athletes reporting greater tension/anxiety, by POMS.
greater anger/hostility, and negative mood state experienced The fact that no relationship was found between life stress
greater severity of injury. and athletic injury may be due to SARRS, the inventory used
Social support was significantly negatively related to ten- to assess life stress. The Spearman rank-order correlation
sion/anxiety (r = -.32, p = .027) on the POMS. This coefficient of SARRS reported by Bramwell et al3 is quite low
correlation was moderate at r = -.32. The greater the satisfac- (r = .42). SARRS was altered from SRRS in 1975 to better fit
tion the athlete felt with social support, the lower the degree of the athletic population. Even in 1975 there were shown to be
tension/anxiety. This finding is quite significant due to the significant differences in the individual's perception of adjust-
correlation found between tension/anxiety and injury. A ment for certain life events, particularly between ethnic popu-
greater satisfaction with social support may have an indirect lations.3 SARRS was designed over 20 years ago, and since
effect on injury rate, due to influence on tension/anxiety mood that time views toward many life events such as marriage,
state. Confusion was also found to be significantly related to divorce, and discrimination have changed dramatically. It is
social support at p = .03, but due to the unacceptable internal suggested that SARRS may not be the ideal inventory to assess
consistency as measured by Cronbach alpha, these findings life stress. Rather, due to multicultural and societal differences,
were disregarded. an inventory should allow the individual to assess how much
SCAT was significantly related to tension/anxiety (r = .30, adaptation he or she feels is required for specific events that
p = .027), anger/hostility (r = .37, p = .004), and total mood have been encountered.
state score (r = .31, p = .02). These correlations were The differences between the sports of football and rugby
moderate at r = .30 for tension/anxiety and r = .37 for were not dramatic. Football players under greater tension/
anger/hostility. A high SCAT score was significantly related to anxiety as measured by POMS experienced a greater frequency
a high tension/anxiety, anger/hostility, and total negative mood and severity of injury. Rugby players under greater tension/
state score. Thus, those athletes exhibiting high competitive anxiety and a depressed/dejected mood state experienced a
trait anxiety also had a greater degree of tension/anxiety, higher frequency of injury, but not a greater severity of injury.
anger/hostility, and total negative mood state. It is suggested that the lack of significance found with severity

298 Volume 31 * Number 4 * December 1996

of injury can be explained by the typical "downplaying" of Athletic trainers, medical personnel, coaches, and athletes
injury by rugby players in order to stay in the game. should recognize possible psychological predisposing factors
Social support alone did not significantly alter frequency and of injury and aim to instruct or refer the athlete for assistance
severity of injury, but expression of greater satisfaction with in methods outlined in the Andersen and Williams' model.
social support correlated with a lower degree of depression/ Psychological interventions such as cognitive restructuring,
dejection as measured by POMS. This finding is quite signif- thought stoppage, and relaxation skills may be instrumental in
icant given the fact that depression/dejection was found to be reducing the incidence of injury in sport.5'7
positively related to injury rate in rugby players. With a sound
base of social support there is a reported lower degree of
depression, which may have had a protective effect. ACKNOWLEDGMENTS
The effect of tension/anxiety, depressed/dejected mood
state, anger/hostility, total negative mood state, and competi- I thank Dr. Frances Flint for her guidance in advising me on my
tive anxiety on increased frequency and severity of injury can undergraduate thesis, the coach of Varsity Football and Varsity Rugby
be interpreted in light of Andersen and Williams' model.' for allowing me to administer my inventories to the athletes, and the
Andersen and Williams suggest that physiologic responses to athletes at York University who participated in the study.
stress and anxiety, such as increases in muscle tension and
physical fatigue, may heighten the relationship between psy-
chological stress and physical injury. This may also be ex- REFERENCES
panded to include tension/anxiety, anger/hostility, depressed/
dejected mood state, and total negative mood state. A higher 1. Andersen MB, Williams JM. Psychological risk factors and injury
prevention. In: Heil J, ed. Psychology of Sport Injury. Champaign, IL:
total negative mood state may also contribute to increased Human Kinetics; 1993:49-55.
muscle tension and physical and mental fatigue, which may 2. Blackwell B, McCullagh P. The relationship of athletic injury to life stress,
promote the relationship between psychological stress and competitive anxiety and coping resources. J Athi Train. 1990;25:23-27.
physical injury.' 3. Bramwell ST, Masuda M, Wagner NN, Holmes TH. Psychological factors
in athletic injuries: development and application of the Social and Athletic
Readjustment Rating Scale (SARRS). J Hum Stress. 1975;1:6-20.
PRACTICAL IMPLICATIONS 4. Cronbach LJ. Coefficient alpha and the internal structure of tests.
Psychometrika. 195 1;16:297.
These findings add information to a growing body of 5. Davis JO. Sports injuries and stress management: an opportunity for
literature that points to the contribution of psychological research. Sports Psychol. 1991;5: 175-182.
factors in the incidence of athletic injuries sustained in univer- 6. Flint F. Psychological reaction to athletic injury and return to competition
sity sport. Thus, a new dimension can be added to the Andersen considerations. Presented at the annual meeting of the Association for the
Advancement of Applied Sport Psychology; October, 1992; Montreal,
and Williams' model. Andersen and Williams' emphasize that CAN.
information gained from research into the stress-injury re- 7. Heil J. Psychology of Sport Injury. Champaign, IL: Human Kinetics;
sponse should not be used to label athletes as "injury-prone." 1993:49-55.
Rather, as found by Davis,5 the findings should serve to allow 8. Kerr G, Fowler B. The relationship between psychological factors and
identification of high-risk athletes who may be aided by sport injuries. Sports Med. 1988;6:127-134.
9. Martens R. Sport Competition Anxiety Test. Champaign, IL: Human
psychological intervention such as mental imagery and relax- Kinetics; 1977:53.
ation techniques. 10. McNair DM, Lorr M, Droppleman LF. Profile of Mood States. San Diego,
It is very difficult to conduct a study including all possible CA: Educational and Industrial Testing Service; 1971.
variables that may influence rate and severity of injury. All 11. Petrie TA. Psychosocial antecedents of athletic injury: the effects of life
research performed in the realm of the stress-injury response stress and social support on women collegiate gymnasts. Behav Med.
contributes to the Andersen and Williams' model. Although 1993;18: 127-138.
12. Reid DC. Sport Injury Assessment and Rehabilitation. New York, NY:
many causal factors have been suggested, further research in
Churchill-Livingston Inc.; 1992.
the stress-injury relationship is needed to support past findings, 13. Williams JM, Tonymon P, Andersen MB. The effects of stressors and
identify new determinants, and identify psychological inter- coping resources on anxiety and peripheral narrowing. J Appl Sport
vention techniques. Psychol. 1991;3:126-141.

Journal of Athletic Training 299

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