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Consensus statement on concussion in sport: the 6th international conference on concussion in sport–amsterdam, october 2022.

For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27–30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components.

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Sports Medicine focuses on definitive and comprehensive review articles that interpret and evaluate the current literature to provide the rationale for and application of research findings in the sports medicine and exercise field. Major topics covered by reviews published in the journal include:

• Sports medicine and sports science, including performance research.
• The medical syndromes associated with sport and exercise.
• The practical role that clinical medicine plays in sport, through injury prevention and treatment.
• The medical use of exercise for rehabilitation and health.
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• Published: 28 November 2019

Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs

• Rosemary Purcell 1 , 2 ,
• Kate Gwyther 1 , 2 &
• Simon M. Rice   ORCID: orcid.org/0000-0003-4045-8553 1 , 2  

Sports Medicine - Open volume  5 , Article number:  46 ( 2019 ) Cite this article

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The current ‘state of play’ in supporting elite athlete mental health and wellbeing has centred mostly on building mental health literacy or awareness of the signs of mental ill-health amongst athletes. Such awareness is necessary, but not sufficient to address the varied mental health needs of elite athletes. We call for a new model of intervention and outline the backbone of a comprehensive mental health framework to promote athlete mental health and wellbeing, and respond to the needs of athletes who are at-risk of developing, or already experiencing mental health symptoms or disorders. Early detection of, and intervention for, mental health symptoms is essential in the elite sporting context. Such approaches help build cultures that acknowledge that an athlete’s mental health needs are as important as their physical health needs, and that both are likely to contribute to optimising the athlete’s overall wellbeing in conjunction with performance excellence. The proposed framework aims at (i) helping athletes develop a range of self-management skills that they can utilise to manage psychological distress, (ii) equipping key stakeholders in the elite sporting environment (such as coaches, sports medicine and high-performance support staff) to better recognise and respond to concerns regarding an athlete’s mental health and (iii) highlighting the need for specialist multi-disciplinary teams or skilled mental health professionals to manage athletes with severe or complex mental disorders. Combined, these components ensure that elite athletes receive the intervention and support that they need at the right time, in the right place, with the right person.

Currently, there is no comprehensive framework or model of care to support and respond to the mental health needs of elite athletes.

We propose a framework that recognises the impact of general and athlete-specific risk factors, and engages key individuals that may identify and promote athlete mental health.

The framework is adaptable and responsive to varied career stages and mental health states.

There has been a rapid increase in research examining the mental health of elite athletes culminating with the International Olympic Committee’s (IOC’s) recent Expert Consensus Statement on mental health in elite athletes [ 1 ]. This statement provides a comprehensive analysis of, and recommendations for, the treatment of both high prevalence (e.g. anxiety and mood symptoms) and more complex mental health disorders (e.g. eating and bipolar disorders) in the elite sporting context. This is a timely resource which will help guide and ultimately improve the clinical management of athletes by sports medicine, mental health, and allied health professionals. The primary focus of the consensus statement, along with much of the extant literature, is on managing the individual athlete affected by mental ill-health. There has been little scholarly and service-level attention to more comprehensive frameworks that (a) recognise the role of the broader elite sports ecology as both a contributor to athlete mental health difficulties and a facilitator of their remediation, and (b) approaches that emphasise the prevention of mental health symptoms, along with early detection and intervention to restore athlete wellbeing (and ideally optimise performance).

Risk Factors for Mental Ill-health in Elite Athletes

Meta-analytic reviews indicate that elite athletes experience broadly comparable rates of mental ill-health relative to the general population in relation to anxiety, depression, post-traumatic stress and sleep disorders [ 2 , 3 ]. This should not be unexpected given the considerable overlap in the years of active elite competition and the primary ages of onset for most mental disorders [ 4 , 5 , 6 ].

Increasing evidence points to a range of both athlete-specific and general risk factors associated with mental ill-health in elite athletes. Athlete-specific risk indicators include sports-related injury and concussion [ 3 , 7 , 8 , 9 ], performance failure [ 10 ], overtraining (and overtraining syndrome) [ 11 ] and sport type (e.g. individual sports conferring a higher risk that team sports) [ 12 ]. General risk indicators include major negative life events [ 13 , 14 ], low social support [ 15 , 16 ] and impaired sleep [ 17 , 18 ]. These risk factors may impact the severity and onset of particular mental health symptoms, but can also guide appropriate response strategies.

The salience of particular risk factors may vary across career phases. For example, in junior development years, supportive relationships with parents and coaches are imperative to athlete wellbeing [ 19 , 20 ]. During the high performance and elite phase, in addition to the coaching relationship, environmental and training demands become more relevant to mental health and wellbeing [ 21 ], including extended travel away from home and exposure to unfamiliar (training) environments [ 22 ]. Environmental conditions and travel may be especially salient for the mental health of para-athletes, who often encounter disruptive logistical issues associated with travel, such as a lack of adaptive sport facilities and sleeping conditions [ 23 ]. Prominent risk factors during the transition out of sport include involuntary or unplanned retirement and lack of a non-athletic identity, both of which are associated with a range of psychological challenges [ 24 ]. For para-athletes, involuntary retirement due to declassification (i.e. no longer meeting the required criteria to be classified as a para-athlete) is a unique burden [ 25 ].

Optimising the Mental Health and Wellbeing of Elite Athletes: Barriers and Facilitators

A comprehensive framework for mental health in elite athletes needs to consider the range of relevant risk factors across key career phases, as well as factors that inhibit or facilitate the ability to effectively respond to athletes’ needs. Key barriers include more negative attitudes towards help-seeking amongst athletes than the general population [ 26 ], as well as greater stigma and poorer mental health literacy. Fear of the consequences of seeking help (e.g. loss of selection) and lack of time are also influential [ 26 , 27 , 28 ]. Facilitative factors include support and acknowledgment from coaches [ 27 ] who can help to create a non-stigmatised environment where help-seeking can be normalised [ 28 ]. Approaches that seek to optimise athletic performance while simultaneously providing intervention for mental health symptoms may also facilitate engagement [ 29 , 30 ]. Brief anti-stigma interventions and mental health literacy programs that seek to increase knowledge of mental health symptoms have been shown to improve help-seeking intentions in elite athletes [ 31 , 32 , 33 ], although the impact of such programs on help-seeking behaviours is not known.

Are there Existing Frameworks or Models of Care for Mental Health in Elite Sport?

To date there are no published frameworks regarding how best to support the mental health needs of elite athletes. In addition to the IOC Consensus Statement, recent position statements have emphasised the need to build awareness of mental health problems and increase help-seeking behaviours [ 34 , 35 , 36 ]. These initiatives are unquestionably warranted; however, improving awareness and help-seeking behaviours are at best pointless, and at worst unsafe, if systems of care to respond to athlete’s need are not available. A whole of system approach needs to be developed simultaneously.

Beyond the peer-reviewed literature, useful guidelines exist within selected sporting associations regarding supporting athlete wellbeing [ 37 , 38 , 39 ]. These resources highlight a number of critical factors in managing athlete mental health in the sporting context including (i) the sports’ responsibility for managing the athlete’s care and support (e.g. duty of care issues); (ii) the need for regular screening or monitoring of athletes to detect changes in mental state or behaviour; (iii) privacy and confidentiality regarding mental health as key ethical issues and challenges; (iv) athlete preferences for help-seeking (how and from whom); (v) the need to refer out to or engage external mental health professionals where expertise does not exist within the sporting environment; and (vi) the value of trained peer workers (former athletes/players) to provide support and guidance to athletes and to coordinate activities related to professional development needs (such as public speaking or financial planning) and individual goal-setting (e.g. around educational or post-sport vocational interests). However, no single framework incorporates all of these factors nor is there a framework that focuses on the spectrum of athlete/player mental health needs, from symptom prevention to specialist mental health care. There has been some progress in developing mental health guidelines in collegiate-level athletes [ 40 , 41 , 42 ], which highlight the need to provide specific and targeted support, while noting that few comprehensive or targeted models of care for mental health have been developed for this population.

Developing a Comprehensive Mental Health Framework to Support Elite Athletes

Many of the general and athlete-specific risk factors for mental ill-health are potentially modifiable (e.g. coping strategies, coaching style, training demands) and require intervention at the individual athlete, the sporting or environmental and/or organisational levels. A comprehensive framework for athlete mental health that is conceptualised within the broader ‘ecology’ of elite sporting environments will be best able to respond to the range of risk indicators in this context (see Fig. 1 ). Ecological systems help to explain the relationship between the aspects or experiences of an individual (termed ‘ontogenetic’ factors, such as coping or substance use) and the broader social and cultural contexts in which they exist [ 43 ]. In the case of elite athletes, this includes the ‘microsystem’ of coach(es), teammates (where appropriate) and family/loved ones. The wider sporting environment (e.g. the athlete’s sport, its rules and governing body) forms the exosystem, while the role of national and international sporting bodies and the media and broader society form the macrosystem.

An ecological systems model for elite athlete mental health

Any mental health framework that ignores wider ecological factors runs the risk of focusing exclusively on, and potentially pathologising the individual athlete, when other factors may be more influential in contributing to, or perpetuating poor mental health. Such factors may include maladaptive relationships with coaches or parents, social media abuse and/or financial pressures.

In addition to ecological factors, a comprehensive framework for mental health should encompass both prevention and early intervention, consistent with established models that are influential in public health and social policy (e.g. Haggerty and Mrazek’s mental health promotion spectrum [ 44 ]; see Fig. 2 ). An early intervention framework can optimise athlete mental wellbeing and respond rapidly to mental health symptoms and disorders as they emerge to best maintain the athlete’s overall function.

The mental health promotion spectrum

Within this framework, the prevention stages aim to reduce the risk of mental health symptoms developing or to minimise their potential impact and severity; the treatment and early intervention stages seek to identify and halt the progression of emerging mental health difficulties; and the continuing care stages help an individual to recover and prevent relapse, typically through ongoing clinical care with a mental health professional [ 44 ].

Based on the extant literature regarding risk factors for mental ill-health in elite athletes, along with existing sporting guidelines or statements regarding athlete wellbeing, and our experience developing and implementing early intervention services and system reform for young people’s mental health [ 45 , 46 , 47 ], we propose the following framework to respond to the mental health of elite athletes (see Fig. 3 ).

Elite athlete mental health and wellbeing framework

Preventative or ‘Foundational’ Components

Core foundational components should include (i) mental health literacy to improve understanding, reduce stigma and promote early help-seeking; (ii) a focus on athlete development (both career and personal development goals) and skill acquisition to help attain these goals; and (iii) mental health screening of, and feedback to, athletes. The purpose of these foundational components is to enhance awareness of the importance of athlete wellbeing across the elite sport ‘ecology’. This in turn addresses workplace duty of care and occupational health and safety responsibilities towards athletes’ overall wellbeing in the context of sport-related stressors.

Mental Health Literacy

Mental health literacy programs should be provided to athletes, coaches and high-performance support staff to help to create a culture that values enhancing the mental health and wellbeing of all stakeholders. Programs should also be offered to the athlete’s family or friends to build their capacity to identify symptoms and encourage help-seeking, particularly as these are the individuals from whom athletes will initially seek help and support [ 48 , 49 ]. Engaging an array of individuals, including organisational staff, in these programs broadens the reach of mental health literacy within an athlete’s (or sport’s) ecology (see Fig. 1 ). Gulliver and colleagues effectively trialled the delivery of a mental health literacy program to elite athletes via team-based workshops facilitated by mental health professionals [ 26 ]. This delivery method is preferred given the opportunity for qualified facilitators to discuss and explore athlete questions or concerns (especially regarding confidentiality and the implications of help-seeking for selection) and to potentially problem-solve together. The content of such training should be customised to address the specific aspects of the sport (e.g. team-based versus individual sport) and developmental stages (e.g. junior versus retiring athletes). Basic program content should cover (i) athlete-specific and general risk factors that can increase susceptibility to mental ill-health; (ii) key signs or symptoms of impaired wellbeing; (iii) how and from whom to seek help, both within and outside the sport; and (iv) basic techniques for athletes to self-manage transient mood states or psychological distress, such as relaxation techniques, adaptive coping strategies, self-compassion and mindfulness.

Individually Focused Development Programs

Individually focused development programs can assist athletes to identify personal/vocational goals and acquire the skills necessary to achieve them. This is necessary to help develop a parallel non-athletic identity, the skills to manage life-sport balance and to prepare for the eventual end of competitive sport. The latter may be challenging in younger athletes who often lack the longer-term perspective or life experience to perceive the need for such planning. However, a focus on developing a non-athletic identity must occur at all phases of the sporting career and not be confined to the transition out of sport phase, since building such skills takes time (and athletes are prone to unplanned retirement due to injury). These activities are ideally facilitated by a skilled, well-trained ‘peer workforce’. These are individuals who have a lived experience of mental ill-health and sufficient training to share their knowledge to help support others in similar situations [ 50 ]. In the sporting context, a peer workforce could include former athletes or coaches who work with current athletes to discuss and normalise experiences of mental health symptoms or their risk factors. Former athletes can assist with athlete development programs and mobilise athletes to the importance of actively participating with such programs, based on their own experiences [ 39 ].

Mental Health Screening

Mental health screening should be included alongside routine physical health checks by medical staff as part of a comprehensive framework. Screening items should be sensitive to the elite context [ 50 , 51 ] and should be designed to provide feedback to athletes to help promote improved self-awareness, such as their mental state and triggers for symptoms. Critical times to screen are following severe injury (including concussion) and during the transition into, and out of sport [ 1 ], and the lead-up to and post major competitions may also be periods of higher risk. It is important to note that there is currently a lack of widely validated athlete-specific screening tools, though one elite athlete sensitised screening measure—the Athlete Psychological Strain Questionnaire—has been validated in a large sample of male elite athletes reporting strong psychometric properties [ 52 ], and is under further validation with female and junior athletes. Research potential exists to not only develop further athlete-specific measures, but to determine who is best suited to conduct screening, and what credentials or training may be required to ensure safety and integrity in this process (e.g. that appropriate help or referral is provided to athletes who screen positive).

Indicated (‘at-risk’) Prevention Programs

The second phase is indicated prevention programs for those considered or assessed as being ‘at-risk’ of impaired mental health and wellbeing. This phase aims to mitigate the likelihood of deterioration in mental health by detecting symptoms as early as possible and facilitating referral to appropriate health professionals. Key staff within the sports system can be assisted to develop skills in early symptom identification and to promote professional help-seeking. This includes coaches, athletic trainers and teammates (where appropriate) who are in a position to notice ‘micro’ changes in an athlete over days or weeks, and sports medicine staff, such as physiotherapists who may detect other non-observable signs, such as changes in energy or body tension. We term these individuals ‘navigators’ in the mental health framework, as they have a crucial role in observing the athlete’s behaviour or mental state and being able to link them to professional care. These navigators can be provided with additional training (adjunctive to mental health literacy) to better recognise and interpret the athlete’s behaviour in relation to their overall wellbeing, understand athlete privacy concerns that inhibit the disclosure of mental health symptoms and build self-efficacy to be able to raise their concerns safely with the affected athlete or medical/mental health staff.

Sport administrators should also consider developing guides on ‘what to do if concerned about an athlete’s mental wellbeing’ and make these available to all relevant staff. These should include information regarding appropriate referral sources, responses (e.g. prevention program vs. early intervention) and facilitators to engage athletes, such as support and encouragement [ 27 , 28 ] and/or linking mental wellbeing with athletic performance [ 29 , 30 ]. Protocols or guides for responding to mental health concerns become less stigmatised when wellbeing needs are already routinely promoted via foundational programs.

Early Intervention

Early intervention is necessary in instances where the performance and life demands placed on an athlete exceed their ability to cope (i.e. major career-threatening injury or significant life stress). Structured clinical interventions for mild to moderate mental ill-health are typically indicated at this phase and should ideally be provided ‘in-house’ by mental health clinicians, such as sports or clinical psychologists or psychiatrists, or medical staff where appropriate (e.g. pharmacotherapy). The use of in-house professionals helps to counter the low levels of service use associated with referring athletes out to external service providers and the stigma that is associated with the athlete needing expert ‘outside help’ [ 53 ]. Where requisite in-house expertise does not exist, this can be managed by the use of qualified consultants, but ideally these professionals should be ‘embedded’ to some extent within the sporting environment to ensure that athletes and other staff understand ‘who they are and what their role is’, even if their presence is infrequent [ 54 ]. When referral out is necessary, or preferred by the athlete, ideally this should be to a mental health professional with appropriate sport sensitised training, knowledge and experience assisting elite athletes.

Early interventions need not always be face-to-face, but can be augmented by telephone or web-enabled consultations, the latter particularly relevant given the frequency with which elite athletes travel unaccompanied by the sporting entourage. All interventions, regardless of the mode of delivery, should use an individualised care approach that is based on assessment and conceptualisation of the individual athlete’s presenting problem(s). The intervention should target the psychological processes of the athlete that are impeding mental health [ 55 ] and take account of the specific familial, sporting and organisational issues that may be impacting on the athlete’s wellbeing.

An example of an early intervention model of care is the Australian Institute of Sport (AIS) mental health referral network [ 56 ]. Athletes are assessed by an AIS mental health advisor, who can make a referral, if necessary, to a qualified mental health practitioner who has been credentialed to work within the network. This practitioner then works individually with the athlete to address their needs and ideally restore their mental health and functioning [ 57 ].

Specialist Mental Health Care

Despite best efforts to prevent or intervene early, some athletes will nonetheless experience severe or complex psychopathology requiring specialist mental health care, particularly where there is a risk of harm to self or others. In some cases, this may include hospitalisation or specialist inpatient or day programs. The IOC Expert Consensus Statement provides a summary of recommended clinical interventions for a range of mental disorders, including bipolar, psychotic, eating and depressive disorders, and suicidality [ 1 ]. Developing and implementing a mental health emergency plan may also be required, particularly in cases where an athlete presents with an acute disturbance in their mental state, for instance agitation/paranoia, or suicidal ideation [ 58 ]. The IOC Expert Consensus Statement recommends that structured plans should acknowledge and define what constitutes a mental health emergency, identify which personnel (or local emergency services) are contacted and when, and consider relevant mental health legislation [ 1 ].

There is also arguably a need for ‘return to sport or training’ guidance for athletes who have been unable to compete or train for their sport due to mental illness, akin to guidelines for managing concussion [ 59 ]. Such guidance could potentially provide a graduated, step-by-step protocol that prepares not only the athlete for a successful return to sport, but also the microsystem that supports them.

Conclusions

We have proposed a comprehensive framework for elite athlete mental health. More research is needed to bolster the efficacy of the approaches discussed here in the elite sports context, as well as other factors that are under-researched in the literature, such as gender-specific considerations in mental health [ 60 ] and considerations for para-athletes [ 23 ]. We are mindful that coaches and other high-performance staff are vulnerable to mental health problems [ 61 ] and the needs of these individuals need to be incorporated into a more inclusive model of care. Further, we recognise the scope of this framework does not cover the needs of non-elite athletes. Elements of this framework may be tailored in the future to be applicable and contextualised for non-elite environments where there may be limited resources, less professional staffing and greater limitations in athlete schedules.

Despite the exponential increase in research interest related to athlete mental wellbeing, major service delivery and treatment gaps remain. Evaluating the efficacy of mental health prevention and intervention programs via controlled trials or other high-quality designs is urgently needed. Program evaluation should ideally adopt an ecological systems approach to account for competition-related, individual-vulnerability and organisational factors on mental health outcomes, for example by seeking to measure system-level variables (e.g. the degree of perceived psychological safety within the sporting organisation [ 62 , 63 ]) and individual athlete-level variables (e.g. coping skills, relationship with coach, injury history). As initiatives are evaluated and enhanced or adapted, developers should consult with elite sport organisations and individuals to ensure the relevance and sport sensitivity of their programs. Increased resources and research funding to support the evaluation and implementation of athlete mental health programs is needed, such as currently exists for managing athletes’ physical health (e.g. musculoskeletal injuries, concussion).

Finally, we are acutely aware that a framework such as that articulated here requires substantial investment and that such funding is scant even in high income settings. The foundational and at-risk components lend themselves, we believe, to be adaptable to low resource settings, given the emphasis on athlete self-management and a trained peer workforce. Adaptations to providing early intervention in low resource settings will be needed, and innovations in general mental health can act as a blueprint [ 64 ]. Regardless of settings or resources, investment in a comprehensive response to athlete mental health needs attention if it is to ever gain parity with physical health.

Availability of Data and Materials

Not applicable.

Abbreviations

International Olympic Committee

Australian Institute of Sport

Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). British Journal of Sports Medicine. 2019;53(11):667–99. https://doi.org/10.1136/bjsports-2019-100715 .

Article   PubMed   Google Scholar  

Gouttebarge V, Castaldelli-Maia JM, Gorczynski P, Hainline B, Hitchcock ME, Kerkhoffs GM, et al. Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. British Journal of Sports Medicine. 2019;53(11):700–6.

Rice SM, Gwyther K, Santesteban-Echarri O, Baron D, Gorczynski P, Gouttebarge V, et al. Determinants of anxiety in elite athletes: a systematic review and meta-analysis. British Journal of Sports Medicine. 2019;53(11):722–30.

Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG. The mental health of elite athletes: a narrative systematic review. Sports Med. 2016;46(9):1333–53. https://doi.org/10.1007/s40279-016-0492-2 .

Article   PubMed   PubMed Central   Google Scholar  

Allen SV, Hopkins WG. Age of peak competitive performance of elite athletes: a systematic review. Sports Medicine. 2015;45(10):1431–41.

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry. 2005;62(6):593–602.

Gulliver A, Griffiths KM, Mackinnon A, Batterham PJ, Stanimirovic R. The mental health of Australian elite athletes. Journal of science and medicine in sport. 2015;18(3):255–61.

Peluso MAM, Andrade LHSGd. Physical activity and mental health: the association between exercise and mood. Clinics. 2005;60(1):61-70.

Rice SM, Parker AG, Rosenbaum S, Bailey A, Mawren D, Purcell R. Sport-related concussion and mental health outcomes in elite athletes: a systematic review. Sports medicine. 2018;48(2):447–65.

Hammond T, Gialloreto C, Kubas H, Davis HH IV. The prevalence of failure-based depression among elite athletes. Clinical Journal of Sport Medicine. 2013;23(4):273–7.

Frank R, Nixdorf I, Beckmann J. Depression among elite athletes: prevalence and psychological factors. Deut Z Sportmed. 2013;64:320–6.

Google Scholar  

Schaal K, Tafflet M, Nassif H, Thibault V, Pichard C, Alcotte M, et al. Psychological balance in high level athletes: gender-based differences and sport-specific patterns. PLoS One. 2011;6(5):e19007. https://doi.org/10.1371/journal.pone.0019007 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Nixdorf I, Frank R, Hautzinger M, Beckmann J. Prevalence of depressive symptoms and correlating variables among German elite athletes. Journal of Clinical Sport Psychology. 2013;7(4):313–26.

Article   Google Scholar  

Gouttebarge V, Aoki H, Verhagen EA, Kerkhoffs GM. A 12-month prospective cohort study of symptoms of common mental disorders among European professional footballers. Clinical Journal of Sport Medicine. 2017;27(5):487–92.

Gutmann MC, Pollock ML, Foster C, Schmidt D. Training stress in Olympic speed skaters: a psychological perspective. The Physician and Sportsmedicine. 1984;12(12):45–57.

Kotnik B, Tušak M, Topič MD, Leskošek B. Some psychological traits of Slovenian Olympians (Beijing 2008)—a gender comparison. Kinesiologia Slovenica. 2012;18(2).

Gupta L, Morgan K, Gilchrist S. Does elite sport degrade sleep quality? A systematic review. Sports Medicine. 2017;47(7):1317–33.

Kölling S, Steinacker JM, Endler S, Ferrauti A, Meyer T, Kellmann M. The longer the better: sleep–wake patterns during preparation of the world rowing junior championships. Chronobiology international. 2016;33(1):73–84.

Berntsen H, Kristiansen E. Guidelines for Need-Supportive Coach Development: The Motivation Activation Program in Sports (MAPS). International Sport Coaching Journal. 2019;6(1):88–97.

Sabato TM, Walch TJ, Caine DJ. The elite young athlete: strategies to ensure physical and emotional health. Open access journal of sports medicine. 2016;7:99.

Saw AE, Main LC, Gastin PB. Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review. British Journal of Sports Medicine. 2016;50(5):281–91. https://doi.org/10.1136/bjsports-2015-094758 .

Donnelly AA, MacIntyre TE, O’Sullivan N, Warrington G, Harrison AJ, Igou ER, et al. Environmental influences on elite sport athletes well being: from gold, silver, and bronze to blue green and gold. Frontiers in psychology. 2016;7:1167.

Swartz L, Hunt X, Bantjes J, Hainline B, Reardon CL. Mental health symptoms and disorders in Paralympic athletes: a narrative review. British Journal of Sports Medicine. 2019:bjsports-2019-100731.

Knights S, Sherry E, Ruddock-Hudson M. Investigating elite end-of-athletic-career transition: a systematic review. Journal of Applied Sport Psychology. 2016;28(3):291–308.

Bundon A, Ashfield A, Smith B, Goosey-Tolfrey VL. Struggling to stay and struggling to leave: The experiences of elite para-athletes at the end of their sport careers. Psychology of Sport and Exercise. 2018;37:296–305.

Gulliver A, Griffiths KM, Christensen H. Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC psychiatry. 2012;12(1):157.

Castaldelli-Maia JM. Gallinaro JGdMe, Falcão RS, Gouttebarge V, Hitchcock ME, Hainline B et al. Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment. British Journal of Sports Medicine. 2019;53(11):707–21. https://doi.org/10.1136/bjsports-2019-100710 .

Reardon CL, Factor RM. Sport psychiatry: A systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Medicine. 2010;40(11):961–80.

Donohue B, Gavrilova Y, Galante M, Gavrilova E, Loughran T, Scott J, et al. Controlled evaluation of an optimization approach to mental health and sport performance. Journal of Clinical Sport Psychology. 2018;12(2):234–67.

Gavrilova Y, Donohue B, Galante M. Mental health and sport performance programming in athletes who present without pathology: A case examination supporting optimization. Clinical Case Studies. 2017;16(3):234–53.

Bapat S, Jorm A, Lawrence K. Evaluation of a mental health literacy training program for junior sporting clubs. Australasian psychiatry. 2009;17(6):475–9.

Beauchemin J. College student-athlete wellness: An integrative outreach model. College Student Journal. 2014;48(2):268–80.

Kern A, Heininger W, Klueh E, Salazar S, Hansen B, Meyer T, et al. Athletes connected: results from a pilot project to address knowledge and attitudes about mental health among college student-athletes. Journal of Clinical Sport Psychology. 2017;11(4):324–36.

Henriksen K, Schinke R, Moesch K, McCann S, Parham William D, Larsen CH, et al. Consensus statement on improving the mental health of high performance athletes. International Journal of Sport and Exercise Psychology. 2019:1–8. https://doi.org/10.1080/1612197X.2019.1570473 .

Moesch K, Kenttä G, Kleinert J, Quignon-Fleuret C, Cecil S, Bertollo M. FEPSAC position statement: mental health disorders in elite athletes and models of service provision. Psychology of Sport and Exercise. 2018.

Schinke RJ, Stambulova NB, Si G, Moore Z. International society of sport psychology position stand: Athletes’ mental health, performance, and development. International journal of sport and exercise psychology. 2018;16(6):622–39.

Queensland Academy of Sport. Athlete wellbeing framework. Queensland Academy of Sport, https://www.qasport.qld.gov.au/about/documents/qas-athlete-wellbeing-framework.pdf . 2014. Accessed 20 May 2019.

Lomax L. System recognises importance of support to help athletes with mental health issues. English Institute of Sport, https://www.eis2win.co.uk/2014/08/21/system-recognises-importance-support-help-athletes-mental-health-issues/ . 2014. .

Australian Football League Players' Association. Development and wellbeing report 2014. Australian football league players' association, http://www.aflplayers.com.au/wp-content/uploads/2015/03/Dev-Wellbeing-2015.pdf . 2014. Accessed 20 May 2019.

Brown GT, Hainline B, Kroshus E, Wilfert M. Mind, body and sport: understanding and supporting student-athlete mental wellness. IN: NCAA: Indianapolis; 2014.

Neal TL, Diamond AB, Goldman S, Klossner D, Morse ED, Pajak DE, et al. Inter-association recommendations for developing a plan to recognize and refer student-athletes with psychological concerns at the collegiate level: an executive summary of a consensus statement. Journal of Athletic Training. 2013;48(5):716–20.

Thompson R, Sherman R. Managing student-athletes’ mental health issues. National Collegiate Athletic Association: Indianapolis; 2007.

Bronfenbrenner U. Ecological systems theory: Jessica Kingsley Publishers; 1992.

Haggerty RJ, Mrazek PJ. Reducing risks for mental disorders: Frontiers for preventive intervention research: National Academies Press; 1994.

Purcell R, Goldstone S, Moran J, Albiston D, Edwards J, Pennell K, et al. Toward a Twenty-First Century Approach to Youth Mental Health Care. International Journal of Mental Health. 2011;40(2):72–87. https://doi.org/10.2753/IMH0020-7411400204 .

McGorry PD, Purcell R, Goldstone S, Amminger GP. Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care. Current opinion in psychiatry. 2011;24(4):301–6.

Rice SM, Purcell R, McGorry PD. Adolescent and young adult male mental health: transforming system failures into proactive models of engagement. Journal of Adolescent Health. 2018;62(3):S9–S17.

Pierce D, Liaw S-T, Dobell J, Anderson R. Australian rural football club leaders as mental health advocates: an investigation of the impact of the Coach the Coach project. International journal of mental health systems. 2010;4(1):10.

Naoi A, Watson J, Deaner H, Sato M. Multicultural issues in sport psychology and consultation. International Journal of Sport and Exercise Psychology. 2011;9(2):110–25.

Vandewalle J, Debyser B, Beeckman D, Vandecasteele T, Van Hecke A, Verhaeghe S. Peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services: A literature review. International Journal of Nursing Studies. 2016;60:234–50.

Donohue B, Galante M, Hussey J, Lee B, Paul N, Perry JE, et al. Empirical Development of a Screening Method to Assist Mental Health Referrals in Collegiate Athletes. Journal of Clinical Sport Psychology. 2019:1–28. https://doi.org/10.1123/jcsp.2018-0070 .

Rice SM, Parker AG, Mawren D, Clifton P, Harcourt P, Lloyd M, et al. Preliminary psychometric validation of a brief screening tool for athlete mental health among male elite athletes: the Athlete Psychological Strain Questionnaire. International Journal of Sport and Exercise Psychology. 2019:1–16.

McDuff DR. Sports psychiatry: strategies for life balance and peak performance. American Psychiatric Pub; 2012.

Morse ED. Sports Psychiatrists Working in College Athletic Departments. Clinical Sports Psychiatry. 1988;203.

Moore ZE, Bonagura K. Current opinion in clinical sport psychology: from athletic performance to psychological well-being. Current opinion in psychology. 2017;16:176–9.

Australian Institute of Sport. Mental health referral network: Support for elite AIS-funded athletes with mental health concerns. SportAus, https://www.sportaus.gov.au/ais/MHRN . 2018. Accessed 20 May 2019.

Rice S, Butterworth M, Clements M, Josifovski D, Arnold S, Schwab C, et al. Development and implementation of the national mental health referral network for elite athletes: A case study of the Australian Institute of Sport. Case Studies in Sport and Exercise Psychology. Under review. .

Currie A, McDuff D, Johnston A, Hopley P, Hitchcock ME, Reardon CL et al. Management of mental health emergencies in elite athletes: a narrative review. British Journal of Sports Medicine. 2019:bjsports-2019-100691. doi:10.1136/bjsports-2019-100691.

McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–47.

PubMed   Google Scholar  

Rice SM, Fallon BJ, Aucote HM, Möller-Leimkühler AM. Development and preliminary validation of the male depression risk scale: Furthering the assessment of depression in men. Journal of affective disorders. 2013;151(3):950–8.

Carson F, Walsh J, Main LC, Kremer P. High performance coaches' mental health and wellbeing: Applying the areas of work life model. International Sport Coaching Journal. 2018;5(3):293–300.

Spink KS, Wilson KS, Brawley LR, Odnokon P. The perception of team envrionment: The relationship between the psychological climate and members’ perceived effort in high-performance groups. Group Dynamics: Theory, Research, and Practice. 2013;17(3):150–61.

Stachan L, Côté J, Deakin J. A new view: Exploring positive youth development in elite sport contexts. Qualitative Research in Sport, Exercise and Health. 2011;3(1):9–32.

Chibanda D, Weiss HA, Verhey R, Simms V, Munjoma R, Rusakaniko S, et al. Effect of a primary care–based psychological intervention on symptoms of common mental disorders in Zimbabwe: a randomized clinical trial. Jama. 2016;316(24):2618–26.

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Purcell, R., Gwyther, K. & Rice, S.M. Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs. Sports Med - Open 5 , 46 (2019). https://doi.org/10.1186/s40798-019-0220-1

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The 100 Most-Cited and Influential Articles in Collegiate Athletics

Anna s. jenkins.

* Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona, USA.

Jordan R. Pollock

M. lane moore, justin l. makovicka.

† Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, USA.

Joseph C. Brinkman

Anikar chhabra, background:.

Bibliometric citation analyses have been widely used in medicine to help researchers gain foundational knowledge about a topic and identify subtopics of popular interest for further investigations. There is a lack of similar research in collegiate athletics.

To identify the 100 most-cited research publications related to collegiate athletics.

Study Design:

Cross-sectional study.

The Clarivate Analytics Web of Knowledge database was used to generate a list of articles relating to collegiate athletics on January 24, 2022. Articles were filtered by the total number of citations, and the 100 most-cited articles were selected. For each article, we identified and analyzed the following: author name, publication year, country of origin, journal name, article type, main research topic area, competitive level, sex of study population, and level of evidence.

Of the top 100 most-cited articles, 63 were related to medicine. In total, 96% of articles were published in the United States, and 80% were published in the year 2000 or later. Of the top 100 articles, 85 were observational; only 5 were experimental. The sport most represented was soccer, followed by football, baseball, and basketball. Of the top 100 articles, 21 were published in a single journal, the American Journal of Sports Medicine. Ten authors published ≥5 of the top 100 most-cited studies.

Conclusion:

The majority of top 100 articles were published in the United States after 1999 and primarily focused on medicine-related topics. Soccer was studied by more articles than football, baseball, and basketball. An author’s prestige may have influenced the likelihood of citation. The top 100 most-cited studies provide researchers, medical students, residents, and fellows with a foundational list of the most important and influential academic contributions to the literature on collegiate athletics.

Since their organization in the 19th century, collegiate sports have been a source of national attention. 102 The predominate governing body of collegiate athletics, the National Collegiate Athletic Association (NCAA), was founded in 1906 in response to escalating concern over injuries and deaths in collegiate sports. 132 Today, >503,000 students compete in the NCAA and attract a fandom of >180 million people. 98 , 133 In 2019, the NCAA generated >$18.9 billion in revenue. 131 In addition to the NCAA, 2 smaller divisions of collegiate athletics—the National Association of Intercollegiate Athletics and National Junior College Athletic Association—include >77,000 and >59,000 athletes, respectively. 130 , 134 Furthermore, many college students participate in nonvarsity sports, with >20% reporting club or intermural sport involvement. 8

With such widespread participation and following, it is no surprise that collegiate athletics have long been a focus of research in the scientific and medical communities. It can be difficult to identify the most significant and influential findings related to collegiate athletics, as topics of interest are ever growing and include students' academic success, 28 , 123 , 160 discrimination, 57 , 61 , 141 sponsorship, 151 , 154 , 163 player mental health, 80 , 150 injury epidemiology, 2 , 60 and mechanics of injury. 122 , 139

Bibliometric analyses provide a helpful way to condense this rapidly evolving research and focus on the most influential scientific articles. Articles with more citations are often considered more influential; as such, bibliometric citation analyses provide quantitative representation of the impact of a specific article. 1 , 38 , 75 , 76 , 142 Bibliometric citation analyses have been widely used in medicine, § medical education, 14 biomechanics, 92 ecology, 167 biotechnology, 25 and various other fields. 10 , 58 , 109 These analyses help researchers gain foundational knowledge about a topic and identify subtopics of popular interest for further investigations. 1 , 142

Accordingly, the purpose of this study was to identify the 100 most highly cited research publications related to collegiate athletics. Because safety has been a focus of conversation since collegiate athletics’ advent and because injuries remain prevalent today, we hypothesized that medicine-related research would compose the greatest proportion of highly cited publications within the 100 most highly cited publications related to collegiate athletics.

This study was exempt from institutional review board approval. The methods of our study were conceived from similar bibliometric analyses. 121 , 124 , 125 The Clarivate Analytics Web of Knowledge database was used to gather data and article information on January 24, 2022. 42 As the focus of our study relates to the collegiate athlete, our final Boolean search terms were as follows: Topic Sentence [(college athlete OR collegiate athlete OR athlete college)] OR [(college OR collegiate OR university) AND (athlete OR athletic OR athletics OR sport OR sports)]. All years dating back to 1950 and all specialty databases within the Web of Knowledge were selected. Using these search terms, we found 9362 articles, including all languages, journals, dates, and countries of origin.

These results were sorted by citation count. Two authors (J.R.P. and M.L.M.) independently reviewed the title and abstract of each article for final inclusion in this bibliometric analysis. Only studies with direct study of college-enrolled athletes as research participants were included for analysis. There were no restrictions on age of participants, sport, sex, or country. Studies with participants not in college (ie, high school, recreational, semiprofessional, and professional) were included only if collegiate participants were a part of the study. If it remained unclear whether an article met inclusion criteria, the full article was obtained and reviewed by the senior author(A.C.). We excluded studies where collegiate athletes were not the focus or participant group of the study. The final 100 studies that met our inclusion criteria for collegiate sports were found after 2 authors (J.R.P. and M.L.M.) reviewed the first 189 most-cited studies. See Appendix Table A1 for a list of the 100 most-cited articles relating to collegiate sports.

The resulting 100 studies were reviewed by the same 2 authors to obtain relevant article information pertaining to our analysis. The variables were as follows: publication year, times cited, number of citations per year, title, category of research (original research, review article, descriptive/epidemiology, case study, short communication, letter to the editor, editorial, and thesis), main research topic area (sports medicine, physiology, biomechanics, nutrition, training and testing, performance analysis, sport psychology, coaching, and social sciences), level of evidence, type of study (observational, experimental, or review), sex (male, female, male and female, unspecified), competitive level (NCAA Division I, II, III), additional population studied (high school, professional, etc), sports studied, country of origin, authors, and journal title.

The levels of evidence were determined according to the standards set by the Journal of Bone and Joint Surgery and determined by 2 authors (J.R.P. and M.L.M.). 112 If consensus was not reached, the senior author was consulted on the classification of each article. An article simply reviewing a subject was classified as an “expert opinion,” while the classification of “review article” was reserved for those studies involving a systematic assessment of the literature, such as a meta-analysis. The citation density of each article was calculated by dividing the total number of citations by the number of years since the publication. All data collection and analysis were completed using Microsoft Excel (Microsoft Corp).

The 100 most-cited publications related to collegiate athletics are listed in Appendix Table A1 , with their rank, number of citations, and citation density. The top 4 articles were cited >1000 times, and the range within the top 100 was 161 to 1265 total citations. The mean number of citations per article was 292.35, while the median was 233.5. Citation densities ranged from 7.3 to 84.3. The average citation density was 17.8, and the median was 13.4. Among the 20 publications with the greatest citation densities, the average citation density was 37.0. Within the top 20 articles, 19 focused on sports medicine, and 8 were published in 2005 or later.

The top 100 articles were published in 42 journals, and the 3 journals with the majority of articles were the American Journal of Sports Medicine (n = 21), Journal of Athletic Training (n = 13), and Medicine and Science in Sports and Exercise (n = 7) ( Table 1 ). Seventeen journals published ≥2 articles. In terms of author impact, 10 authors published ≥5 of the top 100 most-citied articles ( Table 2 ). The 3 authors with the majority of articles from the top 100 were R. Dick (n = 9), S.W. Marshal (n = 8), J. Agel (n = 7), M.W. Collins (n=7), and M.R. Lovell (n=7).

Journal of Publication for the 100 Most-Cited Articles in Collegiate Athletics a

a Only journals with ≥2 articles were included in this table.

Authors With ≥3 Publications in the Top 100 Most-Cited Articles Relating to Collegiate Athletics

Characteristics of the top 100 articles are analyzed in Figures 1 to ​ to4. 4 . Publication dates ranged from 1981 to 2015 ( Figure 1 ). Of the top 100 articles, 80 were published in the year 2000 or later. The top 5 cited articles were published in 2007, 2003, 1995, 2003, and 2007. The year 2007 had the largest number of articles in the top 100 (n = 14). The number of citations that each of the top 100 articles received per year ranged from 11 (in 1982) to 1599 (in 2019) ( Figure 2 ). The United States was the country of origin for 96 of the 100 articles ( Figure 3 ). Other countries were Australia, Belgium, the Netherlands, and Taiwan (each with 1 publication). The majority of articles were evidence levels 3 (n = 41) and 4 (n = 52) ( Figure 4 ).

Number of articles by year of publication of the 100 most-cited articles relating to collegiate athletics.

Number of citations generated by the 100 most-cited articles relating to collegiate athletics each year.

The 100 most-cited articles relating to collegiate athletics by country of origin.

The 100 most-cited articles relating to collegiate athletics by level of evidence.

Of the 100 most-cited publications related to collegiate athletics, 74 were classified as original research; 17, as descriptive/epidemiology research; and 9, as review ( Table 3 ). The research design for the majority of the top 100 articles was observational (n = 85), followed by review (n = 10). Just 5 articles in the top 100 were experimental.

Descriptive Data of Top 100 Most-Cited Articles Relating to Collegiate Athletics a

a NCAA, National Collegiate Athletic Association.

The majority of top 100 articles related to collegiate athletics fell under the topic of sports medicine (n = 63). The second-most common topic of research was training and testing (n = 12), followed by biomechanics (n = 7). Other topics were physiology (n = 6), sports psychology (n = 5), social science (n = 4), performance analysis (n = 2), and nutrition (n = 1).

The majority of articles in the top 100 focused on male and female athletes (n = 56). There were 23 articles focusing on male athletes only, and 14 articles focusing on women only. Seven articles did not explicitly specify whether the study participants were male or female. Of the 100 most-cited publications relating to collegiate sports, 75 focused solely on the collegiate athlete population. Of the articles that included an athlete population in addition to collegiate athletes, 21 included high school athletes, and 8 included professional athletes. The top 100 articles related to collegiate athletics researched a variety of sports ( Table 4 ). The most highly represented sport was soccer (n = 47), followed by football (n = 45) and baseball/softball (n = 40).

Sports Studied in the Top 100 Most-Cited Articles Relating to Collegiate Athletics

The purpose of this study was to identify the top 100 most-cited articles and examine which factors predicted an article’s impact within the field of collegiate athletics. As hypothesized, the majority of highly cited publications were medicine related. This trend remained true when analyzing citation density, with 19 of the top 20 articles relating to sports medicine specifically. The dominance of medically related articles may reflect the importance of research related to injury treatment and prevention. With so many of the top 100 articles focusing on medicine, physicians who treat collegiate athletes will benefit from a review of the articles in our analysis: physical therapists, athletic trainers, collegiate coaches, family care physicians, internal medicine physicians, and orthopaedic surgeons who serve student-athletes.

This study was the first to conduct a bibliometric analysis broadly inclusive of all collegiate athletics–related publications, as prior bibliometric analyses related to collegiate athletics included only articles with a medical or scientific focus. 90 The finding that the majority of top articles broadly related to collegiate athletics were medically focused underscores the importance of medicine in the field of collegiate sports. An estimated 210,674 injuries occur in the NCAA per year, 89 and these can have lasting effects on students’ mental and physical well-being. 30 , 50 , 80 , 150 Injury treatment and prevention appear to be at the forefront of discussion. Although other topics of discrimination are a source of frequent discussion in the media today, 57 , 61 , 141 such as mental health 80 , 150 and compensation 151 , 154 , 163 of collegiate athletes, no related publications were in the top 100 most-cited articles.

The top-cited article in our list had 1265 citations and was related to the epidemiology of 15 collegiate sports (Appendix Table A1 ). Comparatively, a bibliometric analysis focused on overhead throwing athletes found that the top-cited article had 471 citations, 111 an analysis on sports and medicine in football found that the top-cited article had 869 citations, 31 and an analysis on the broader field of sports and exercise medicine found that the top-cited article had 7228 citations. 90 As with other citation analyses related to sports medicine, the majority of our top-cited articles were published within the past 2 decades, reflecting rapid growth in research within the field. 31 , 90 , 121

In our study, 96 of the top 100 articles were published within the United States. This is somewhat expected, as collegiate sports are very popular in North America, along with the rapidly growing field of sports medicine. However, >20,000 NCAA athletes are international, with the majority from Canada followed by the United Kingdom. The absence of any top publications from these 2 countries may reflect the uniquely American interest in collegiate athletics.

Prior bibliometric analyses found that soccer is the most frequently researched sport across top articles relating to sports and athletics. 77 , 90 In alignment with these prior works, we found that soccer was the most highly represented sport in the top 100 articles related to collegiate athletics. However, our study focused on collegiate athletics, and unlike other studies, the majority of the top 100 articles in this study were based in the United States. As football, baseball, and basketball predominate in popularity in the United States, it was unexpected that soccer would be the most represented sport in the top articles. 74 Notwithstanding, football, baseball, and basketball were the next-most represented sports in our findings. This may reflect that popularity of a sport is not as influential a factor as ease of research or injury patterns.

Of the top 100 most-cited articles related to collegiate athletics, the American Journal of Sports Medicine published 21, followed by the Journal of Athletic Training with 13 ( Table 1 ). As citation analysis has been used to evaluate journal impact, individuals hoping to stay up-to-date on the most influential publications in collegiate athletics might consider following these journals. 75 , 76 A recent bibliometric analysis on sports and exercise medicine found that the majority of top-cited sports medicine articles were similarly published in the American Journal of Sports Medicine . 90 Our findings corroborate these results. Interestingly, when compared with broader studies not focused on collegiate athletics, the international participation is much greater in publishing top-cited articles. 10 , 77 , 90 , 96 This difference between our collegiate-focused study and their broader study again demonstrates the American-centric focus of research specific to collegiate athletics.

Ten authors published ≥5 of the top 100 articles, reflecting the dominance of certain researchers in the field of collegiate athletes. This finding may illustrate the prolificity of these authors; it may also suggest that author prestige plays a role in the likelihood that an article is cited. Publications including authors already well established in the field of collegiate athletics may have an easier time gaining recognition and accruing citations.

As seen in Figure 3 , the majority of publications were level 3 and 4 evidence, reflecting the predominance of observational studies. Only 7 articles were levels 1 and 2. This finding is similar to that of the most-cited articles in sports and exercise medicine. 90

Limitations

The publications in this study were based on citation numbers alone. This metric, although useful in identifying highly influential articles, is influenced by a variety of factors, such as time since publication. As such, it should not be used as the sole determinate of impact. Citation density, as included in our study, may be useful to researchers as they seek to explore the most current influential research. A related limitation of our findings is the exclusion of newer publications. This is a limitation of bibliometric analyses in general, as newer publications have not had time to accrue citations and prior work has demonstrated that it takes several years for prominent articles to peak in recognition and citation. 6 , 75 , 83 An additional limitation is our use of only 1 database, the Web of Knowledge. This database is commonly used in bibliometric analyses, but use of other databases may result in slightly different findings. ∥

Our search found that most publications related to collegiate athletics were medicine related. The majority of articles were level 4 evidence, published after 2005, and from the United States. Soccer was the most studied sport. An author’s prestige may have influenced likelihood of citation, with 10 authors publishing ≥5 of the top 100 most-cited studies in collegiate sports.

Top 100 Most-Cited Articles Relating to Collegiate Athletics

§ References 7 , 15 , 16 , 25 , 63 , 69 , 94 , 97 , 103 , 104 , 121 , 124 , 125 .

∥ References 5 , 19 , 20 , 35 , 87 , 99 , 129 , 156 .

Final revision submitted February 8, 2022; accepted April 11, 2022.

One or more of the authors has declared the following potential conflict of interest or source of funding: A.C. has received consulting fees from Arthrex, Trice Medical, and Zimmer Biomet and speaking fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Ethical approval was not sought for the present study.

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Fatal Traffic Risks With a Total Solar Eclipse in the US

• 1 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
• 2 Evaluative Clinical Science Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
• 3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
• 4 Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
• 5 Center for Leading Injury Prevention Practice Education & Research, Toronto, Ontario, Canada
• 6 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
• 7 Centre for Clinical Epidemiology & Evaluation, University of British Columbia, Vancouver, British Columbia, Canada

A total solar eclipse occurs when the moon temporarily obscures the sun and casts a dark shadow across the earth. This astronomical spectacle has been described for more than 3 millennia and can be predicted with high precision. Eclipse-related solar retinopathy (vision loss from staring at the sun) is an established medical complication; however, other medical outcomes have received little attention. 1

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Redelmeier DA , Staples JA. Fatal Traffic Risks With a Total Solar Eclipse in the US. JAMA Intern Med. Published online March 25, 2024. doi:10.1001/jamainternmed.2023.5234

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How to recognize signs of anal cancer, how the HPV vaccine can prevent it, and more

By Syed Husain, MBBS , Colorectal Surgeon, Clinical Associate Professor

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Anal cancer can be hard to talk about, but understanding symptoms and screening can help reduce the rate of new cases, which is currently rising in the United States.

This year, in the U.S. alone, it’s estimated that there will be about 10,540 new cases of anal cancer — up from 9,440 in 2022. While anal cancer is rare, the increase in new cases is concerning. That’s why we need to continue to educate people about the benefits of screening and focus on how to prevent anal cancer versus finding a cure.

What are the first signs of anal cancer?

The first signs of anal cancer  can seem like nothing more than a little discomfort in your anal area. In fact, one of the reasons people delay treatment is because they mistake the symptoms for hemorrhoids. While similar, hemorrhoid symptoms will last for a few days or up to a week then diminish. In anal cancer, symptoms will persist or come back after a short time of improvement.

Symptoms include:

• Bleeding from the anus or rectum
• Pain or pressure in the area around the anus
• Itching or discharge from the anus
• A lump near the anus
• A change in bowel habits

If you have any of these symptoms that don’t go away, don’t ignore them. Make an appointment with your doctor. The best chance for successful treatment is through early diagnosis.

How curable or treatable is anal cancer?

Anal cancer is curable — it responds very well to chemotherapy and radiation. But treatment can be lengthy, and there are side effects. If initial treatment fails or the cancer recurs, you’ll likely require surgery. Surgical options consist of removing the tumor and the tissue surrounding it or, in more serious cases, the complete removal of the anus and rectum and the use of a colostomy bag.

As a colorectal surgeon, I encourage anal cancer screening exams for those at high risk, because it’s one of the best ways to prevent anal cancer.

How can I prevent anal cancer?

About 90% of anal cancers are associated with human papillomavirus (HPV) infection. While HPV infection can increase your risk, it doesn’t mean you’ll develop anal cancer.

The HPV vaccine  is one way to protect against types of HPV that increase your likelihood of developing anal cancer.

Another way to prevent anal cancer is through screenings. According to the latest research, anal cancer screenings can help reduce the risk of developing the cancer by more than half.

Not everyone needs to be screened, but those at high risk should be. People with high risk for anal cancer include:

• HIV-positive gay men
• Men who have sex with men, even if they’re HIV-negative
• Women who’ve been diagnosed with a cervical or vaginal HPV infection
• Women and men who engage in anal intercourse

For most people, screening consists of a simple anal pap test, which collects a small number of cells from the anus with a swab. The test checks for signs of precancerous cells or cancer. If abnormal cells or HPV infection are found, a patient will be referred for additional testing.

If you’re at higher risk for anal cancer, you should have regular screenings. People who have had vaginal or vulvar precancerous lesions (dysplasia) or cancer should be screened every year. These patients may require more intensive screening.

Our clinic can help you understand if you’re at higher risk of developing the disease and provide screenings and other services to assess and reduce your overall risk, including:

• HPV vaccinations
• Sexually transmitted infection screening and treatment
• Cervical Pap tests
• Social services and support
• Education and awareness programs for patients, physicians, the community at-large and local LGBTQIA+ populations

What to look for in a doctor or treatment facility if you have anal cancer symptoms

If you have anal cancer symptoms or an anal cancer diagnosis, you want to see an expert with experience in providing comprehensive anal cancer care and treatment. The OSUCCC – James offers Ohio’s only Anal Cancer Screening Clinic , which provides comprehensive anal cancer screening and diagnostic services.

Our clinic is one of the few screening centers in the nation. Being a screening center that’s part of a large, comprehensive cancer center gives us a unique advantage in that we see more anal cancer cases than most cancer hospitals and have the expertise and diagnostic resources to treat it.

Our team of specially trained experts offer a variety of treatment options and clinical trials that other facilities can’t or don’t have access to.

Learn more about anal cancer and the treatments available at the OSUCCC – James

Call 800-293-5066 to schedule an appointment.

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