Depression is a major mental health issue.1,2 It is characterized by symptoms of sadness, low mood, and loss of interest in enjoyable activities, and is becoming an increasing concern in college-aged students.3 The prevalence of depression is 8.7% among adults aged 18 to 25 years,4 but increases to 15% to 22% in collegiate students.5 Although collegiate student-athletes are likely to encounter stressors similar to all college students (eg, term papers and examinations), they may also need to cope with physical injuries, failure to meet sport expectations, and sport performance pressure from coaches, team-mates, and family members. Seasonal affective disorder (SAD) is a type of depression that occurs during similar times of the year (ie, winter months) and is characterized by increased feelings of sadness, eating, and sleeping.6 Moreover, it has been found to occur in some student-athletes who move away from southern states to places with limited sunlight hours and colder weather (ie, northern latitudes), predisposing them to SAD. However, the relationship between symptoms of depression and SAD has not been examined in the collegiate athletic population and warrants further investigation.
Recently, researchers have suggested that approximately 20% of National Collegiate Athletic Association (NCAA) Division I collegiate student-athletes experience general symptoms of depression.7–9 Specifically, Wolanin et al.1 reported a total of 23.7% of collegiate student-athletes endorsed clinically relevant symptoms of depression, whereas 6.3% of the sample experienced moderate to severe levels of depression symptoms. Researchers have also reported that current collegiate student-athletes have a higher prevalence of depression symptoms (16.8%) compared to graduated collegiate student-athletes (8%).10 In contrast, other researchers have reported lower levels of depression symptoms in collegiate student-athletes compared to non–student-athletes.7,11,12
Few studies have examined sex differences in symptoms of depression in collegiate student-athletes. Most research suggests that female collegiate student-athletes experience significantly higher symptoms of depression (ie, greater symptom severity [2 of 3 on Likert scale] or more total symptoms) compared to male collegiate student-athletes.1,9,11 In addition, Armstrong and Oomen-Early11 reported the strongest predictors of depression symptoms were sex, social connectedness, sleep, and self-esteem.11 However, other researchers have reported no sex differences in high school and collegiate student-athletes in relation to depression symptoms.13 Sex may be a factor in depression due to hormonal differences between males and females, differences in management of stressful life events between males and females, and females tend to examine their feelings more compared to males.14 As a result, more research is needed to determine whether there are sex differences in symptoms of depression in collegiate student-athletes.
SAD is a cyclical depressive disorder occurring in similar patterns each year.15 Symptoms typically start in fall and winter and resolve during the spring and summer months, although the time periods can vary.6,15 Symptoms of SAD include both typical (eg, sad) and atypical (eg, increased appetite) symptoms of depressive disorders (eg, major depressive disorder).15,16 Patients with SAD may present with affective symptoms (eg, sadness, anxiety, and irritability) and vegetative symptoms (eg, increased appetite, increased cravings and consumption of carbohydrates, weight gain, and hypersomnia).6,15,17 Furthermore, some studies have indicated that northern latitudes, total hours of sunshine in winter months, global irradiation, vitamin D levels, and time spent outdoors may also affect seasonal disorders.18
Few studies have examined the prevalence of SAD in collegiate student-athletes. Rosen et al.19 examined midwestern university collegiate male ice hockey student-athletes and the prevalence of SAD using a modified Seasonal Pattern Assessment Questionnaire (SPAQ); 6 players (9%) experienced major symptoms associated with SAD and 16 athletes (25%) met the criteria for experiencing subsyndromal SAD. Similarly, Lodis et al.20 reported the prevalence of SAD in collegiate student-athletes to be approximately 10%. In the only study to examine sex differences in male and female collegiate student-athletes, female student-athletes exhibited a greater number of seasonal symptoms and higher total seasonal symptom score compared to male student-athletes.20 However, these studies had a small sample size and did not include a variety of collegiate male and female sports.
Individuals with a history of SAD display greater changes in depression severity and increased frequencies of negative thoughts from winter to summer months, with vegetative symptoms occurring sooner than mood disturbances.21 These mood symptoms are a result of the seasonal vegetative symptoms that occur through the diathesis-stress model.22 This model was termed a dual vulnerability process because the vegetative symptoms are high at the onset of the affective episode and rapidly decrease as the condition progresses. Patients tend to develop secondary depressive symptoms as a result of the temporal stressor that caused the increase in initial vegetative symptoms.22 However, no research to date has examined the relationship between symptoms of depression and history of SAD in a large sample of collegiate student-athletes. Moreover, little research has examined sex difference in symptoms of depression and history of SAD at the collegiate level.
The purpose of this study was to examine the prevalence and relationship between symptoms of depression and history of SAD in collegiate student-athletes. A secondary purpose of this study was to examine sex differences in symptoms of depression and history of SAD in collegiate student-athletes. We hypothesized that collegiate freshman student-athletes with a history of more SAD symptoms would have more symptoms of depression. We also hypothesized that female collegiate freshman student-athletes would have higher symptoms of depression and history of SAD compared to male collegiate freshman student-athletes.
Research Design and Participants
This study used a cross-sectional research design. Participants included male and female Division I freshman student-athletes who were attending college at a large Division I university in Michigan. Student-athletes were included regardless of scholarship status (eg, walk-on or full scholarship) or playing time. Although most were NCAA student-athletes, club cheerleading and dance were included because their medical treatment is over-seen by the same licensed athletic trainers who also treat NCAA student-athletes (ie, NCAA soccer and football). Exclusionary criteria included all student-athletes who were not freshmen. All student-athletes completed the testing at the end of the summer (last week in August or early September) during their pre-participation physical examination.
Beck Depression Inventory-II (BDI-II). The Beck Depression Inventory-II (BDI-II) was used to assess symptoms of depression in collegiate student-athletes. The BDI-II consists of 21 self-reported items that ask participants to indicate their current status for each item (except for items 16 and 18) on a scale of 0 (not experiencing it) to 3 (experiencing it all the time).23 The BDI-II items cover irritability, hopelessness, feelings of guilt, and physical symptoms such as weight loss and fatigue.23 The scores on the individual items are then totaled to provide an overall depression symptom score ranging from 0 to 63. Total scores are typically subdivided into minimal (0 to 10), mild (11 to 16), borderline clinical (17 to 20), moderate (21 to 30), severe (31 to 40), and extremely severe (over 40) depression categories.23 The BDI-II has been validated against the Hamilton Depression Rating Scale and has been found to have good positive correlation (r = 0.71)4 and high internal consistency (r = 0.91).24 The BDI-II also has high test–retest reliability at 1 week (r = 0.93)4 and has been previously used with collegiate student-athletes.12
SPAQ. SAD prevalence was determined using a modified version of the SPAQ.25 We did not ask the student-athletes specific questions pertaining to fluctuations of their weight (4 to 6 lbs) and changes in food preference because these were answered on a Likert scale in another question. Specifically, prevalence of SAD was determined by asking the collegiate student-athletes to rate on a 5-point Likert scale (0 = no change, 4 = extremely marked change) to what degree the following changes with the weather seasons (fall, winter, spring, and summer): sleep length, social activity, mood, weight, appetite, and energy level. Student-athletes were asked to think back to when those weather seasons occur and rate whether the aforementioned items changed with the changes in weather seasons and if it was a problem. A score of 8 to 10 indicates subsyndromal SAD and a score of 11 or greater indicates SAD.25 The SPAQ has been previously used with collegiate student-athletes and has been found to have good validity and reliability.19 Specifically, the 2-month test–retest reliability was r = 0.076 and the internal consistency was r = 0.81.26 In addition, the calculation of the Cronbach's alpha was 0.822 for the modified SPAQ, indicating it had a high internal consistency.
Our institutional review board considered this study exempt due to de-identifiable data and did not require student-athletes to sign a consent form for research. All incoming freshman student-athletes were required to have a full pre-participation examination and completed the paper-and-pencil surveys as part of the examination. Unfortunately, due to the nature of the study, we were not able to collect data on preexisting psychological conditions (eg, clinical depression, anxiety, or attention-deficit hyperactivity disorder) or whether athletes were taking any medication. Student-athletes reported their sex, age, height, weight, sport, and year in school. The SPAQ also asked student-athletes their hometown city and state. The BDI-II and SPAQ took approximately 10 minutes to complete and were administered by a licensed athletic trainer. Once completed, student-athletes had their survey results reviewed by sports medicine professionals to determine whether further care was necessary. If further care was required based on their symptoms of depression or SAD symptoms, a team physician and/or psychiatrist would treat them; however, this was not part of this research study.
All data were entered into an Excel (Microsoft Corporation, Redmond, WA) spreadsheet as de-identifiable data. A licensed athletic trainer was responsible for de-identifying data by assigning athletes a specific number that was then associated with their BDI-II and SPAQ scores. Means and standard deviations were calculated for sex, age, height, weight, sport, hometown city and state, and year in school. The BDI-II was summed for a total score ranging from 0 to 63 and depression scores were subdivided as noted earlier. The SPAQ was also summed for a total score ranging from 0 to 30. Frequencies and percentages were used to determine the prevalence of depression and SAD. Separate analyses of variance (ANOVAs) were conducted to determine whether there were differences between hometown (ie, warm state or cold state) and depression scores or history of SAD. To examine the relationship between depression and SAD, a Pearson correlation was used. A series of ANOVAs were conducted to determine whether there were sex differences in symptoms of depression and SAD between male and female collegiate student-athletes. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software (version 22.0; SPSS, Inc., Chicago, IL) and a 0.05 significance level was set a priori.
A total of 296 of approximately 525 Division I freshman student-athletes participated in this study for a response rate of 56.3%. There was a fairly equal distribution between males (n = 125, 57.8%) and females (n = 171 = 47.2%). The average age of participants was 18.0 ± 0.41 years, height was 68.92 ± 4.75 inches, and weight was 171.7 ± 46.5 lbs. The highest number of student-athletes participated in rowing (n = 86, 29.1%), followed by football (n = 56, 18.9%), and wrestling (n = 20, 6.8%) (Table 1). Approximately 11% (n = 33) of student-athletes were from warm states, whereas 89% (n = 263) were from colder states. A total of 37 (12%) student-athletes did not report their hometown city or state (Table 2). Two separate ANOVAs indicated that there were no differences between hometown state (warm or cold) and symptoms of depression (F(1.259) = 0.40, P = .526, chi-square = 0.002) or history of SAD (F(1.259) = 0.23, P = .63, chi-square = 0.001).
Sport Participation by Division I Student-Athletes (N = 296)
Frequency and Percentage of Student-Athlete's Home State (N = 296)
A total of 5% (n = 15) of student-athletes in this sample reported mild or greater symptoms of depression (Table 3). Only 5 (1.7%) student-athletes reported having suicidal thoughts. These athletes were followed up by a team physician and/or psychiatrist. Approximately 16% (n = 48) of all student-athletes surveyed reported symptoms of SAD and 10.8% (n = 32) reported subsyndromal SAD (Table 4). When asked if they experienced any of the six SAD changes during the weather seasons and if it was a problem, 11 student-athletes (3.7%) indicated it was a problem for them. Results indicated a significant correlation between symptoms of depression and SAD (r = 0.88, P < .001). Student-athletes with higher SAD symptoms and higher SPAQ scores also had higher symptoms of depression.
Frequency and Percentage of Depression Symptom Categories by Division I Male and Female Student-Athletes (N = 296)
Frequency and Percentage of SAD Symptom Categories by Division I Male and Female Student-Athletes (N = 296)
Results from the ANOVA indicated that there were significant sex differences for SAD symptoms between male and female collegiate student-athletes. Specifically, male student-athletes had significantly more symptoms of SAD (6.88 ± 8.0) compared to female student-athletes (4.89 ± 6.1) (F(1.294) = 5.87, P = .016, chi-square = 0.020). However, there were no significant sex differences on symptoms of depression between male (2.64 ± 5.0) and female (2.11 ± 3.8) student-athletes (F(1.294) = 1.046, P = .31, chi-square = 0.004).
Our results revealed a positive correlation between symptoms of depression and SAD. Specifically, freshman student-athletes who had increased SAD also had increased symptoms of depression. The overall findings of 5% of student-athletes exhibiting symptoms of depression was lower than that reported in the current collegiate literature.20 The combined prevalence of 26% of SAD and subsyndromal SAD was higher than the general college population. Males reported more symptoms of SAD than females, but there were no sex differences for symptoms of depression among collegiate male and female student-athletes.
Contrary to previous research, 5% of collegiate student-athletes in this study displayed symptoms of depression. There are several reasons why collegiate student-athletes in this study may have a lower prevalence of symptoms of depression than the norm. First, student-athletes were surveyed during their pre-participation examination prior to starting their academic year. Therefore, they may not have felt depressed due to the lack of academic requirements or stress felt when going through midterm and final examinations. Second, they were also surveyed prior to the start of their athletic season. Thus, they may not have exhibited symptoms of depression due to the lack of sport performance pressures from coaches, family, teammates, or friends. Third, participants in this study were freshman student-athletes just starting their collegiate careers. These athletes may have displayed symptoms of excitement and enjoyment to begin the next phase of their life. Finally, student-athletes may not have been honest in their reporting due to fear of retribution if they reported they were depressed starting their collegiate careers.
The current study found 16% of student-athletes reported SAD and 10% reported subsyndromal SAD symptoms, which was higher than previous studies.20 The higher prevalence in this study could be attributed to student-athletes not having been properly educated on SAD and therefore unable to decipher between SAD and symptoms of depression. More than 10% of the study population were from southern states and 39% were student-athletes who moved to the state of Michigan. The amount of daylight decreases in winter months in northern latitudes, which may affect those with sensitivities to light deficiencies. Vitamin D levels have been shown to significantly increase with greater objective exposures to sunlight.27 Researchers also suggest that vitamin D levels are negatively correlated with increases in depressive symptoms in healthy college females.27 More specifically, in females with insufficient or deficient levels of vitamin D, 45% exceeded depressive symptom cutoffs.27 However, more research is warranted to determine whether SAD symptoms are due to vitamin D deficiency or depressive symptoms. Due to the higher prevalence of SAD in this study, athletic trainers should be aware of those student-athletes who have a history of SAD from high school because they may be even more likely to experience SAD while at university. Particular attention should also be given to student-athletes who move farther away from home (a new region of the country for college) and those from the south who move to a more northern latitude.
The findings from the current study indicated that there are sex differences for SAD symptoms, with male student-athletes reporting more symptoms than female student-athletes. This is in contrast to the only other published study that reported female collegiate student-athletes have increased SAD symptoms compared to male collegiate student-athletes.20 Differences may be due to the larger sample size of the current study compared to Lodis et al.'s,20 as well as the timing of the administration of the SPAQ. The current study participants were administered the survey during the late summer months, whereas Lodis et al.20 administered the survey in February. Although there were sex differences in SAD symptoms, the current study did not indicate sex differences in symptoms of depression in collegiate male and female student-athletes. These findings are also in contrast to previous research that suggests that female student-athletes have increased symptoms of depression compared to male student-athletes.1,9,11 Differences may be attributed to sample size, variations in depression surveys (ie, BDI-II vs Center for Epidemiological Studies Depression), and year in education (freshman vs senior). As a result, more research is needed to determine whether there are sex differences in symptoms of depression and SAD in collegiate student-athletes.
This study had a few limitations. Most student-athletes represented in this study were from northern states, with more than half from Michigan. Therefore, findings cannot be generalized to other collegiate student-athlete populations. As previously mentioned, student-athletes were surveyed prior to the start of their academic and athletic seasons, which may have resulted in lower scores due to decreased stressors and the weather at the time of year in which they were surveyed. Therefore, caution needs to be taken when interpreting these results. Another limitation pertains to the year in school. All student-athletes were freshman and had not begun their collegiate careers; therefore, they may not have been completely honest in reporting or may have not felt the pressures of college life. In addition, student-athletes were asked to think back over time in the SPAQ; therefore, there could have been recall bias. More importantly, students were recalling from their high school seasons for the SPAQ, indicating their SAD would be present prior to entering university. This study did not include measuring vitamin D in student-athletes; therefore, it is unclear whether the increase in SAD was due to a lack of vitamin D deficiency or something else. Finally, we used a modified version of the SPAQ and not the full version due to time constraints.
This study investigated the prevalence and relationship between symptoms of depression and SAD in Division I student-athletes at a midwestern university. The results of this study suggest a higher prevalence of SAD, a lower prevalence of symptoms of depression, and a positive relationship between symptoms of depression and SAD in collegiate student-athletes. Future research should concentrate on administering depression and SAD surveys during the end of October or beginning of November when the weather seasons change and student-athletes have a potential increase in stress due to examinations and term papers. In addition, future research should expand to other areas of the country and administer serial vitamin D measures throughout the academic year.
Implications for Clinical Practice
The current study found a relationship between symptoms of depression and SAD. Collegiate student-athletes who exhibited increased SAD scores also had increased symptoms of depression. This information is important for sports medicine professionals so they can observe their collegiate student-athletes who may demonstrate SAD for an increase in symptoms of depression. Athletic trainers should also observe student-athletes who have increased symptoms of depression or SAD during the winter months.
Athletic trainers often focus heavily on the physical aspect of their sport and injury rehabilitation. However, it is becoming apparent that rehabilitation from injury and activities of daily living also has an important mental component. Athletic trainers need to be able to observe their student-athletes who may be demonstrating symptoms of depression and SAD. When surveying these athletes prior to the beginning of their freshman year, athletic trainers can become aware of any preexisting conditions that these student-athletes may experience. If these student-athletes are then surveyed frequently throughout their collegiate career, clinicians can observe any changes or new conditions over time. Treatment and referral plans can then be made so that the student-athletes are taken care of and therefore able to perform at the highest possible level. A treatment such as light therapy could easily be instituted in the athletic training room or at home to assist in resolving SAD symptoms.
- Wolanin A, Hong E, Marks D, Panchoo K, Gross M. Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport. Br J Sports Med. 2016;50:167–171. doi:10.1136/bjsports-2015-095756 [CrossRef]
- Zivin K, Eisenberg D, Gollust SE, Golberstein E. Persistence of mental health problems and needs in a college student population. J Affect Disord. 2009;117:180–185. doi:10.1016/j.jad.2009.01.001 [CrossRef]
- National Institute of Mental Health. Depression basics. http:www.nimh.nih.gov/health/publications/depression. Accessed December 2016.
- Centers for Disease Control and Prevention. Depression. https://www.cdc.gov/nchs/fastats/depression.htm. Accessed December 2016.
- Mahmoud JS, Staten R, Hall LA, Lennie TA. The relationship among young adult college students' depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues Ment Health Nurs. 2012;33:149–156. doi:10.3109/01612840.2011.632708 [CrossRef]
- American Psychological Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.
- Proctor SL, Boan-Lenzo C. Prevalence of depressive symptoms in male intercollegiate student-athletes and nonathletes. Journal of Clinical Sport Psychology. 2010;4:204–220. doi:10.1123/jcsp.4.3.204 [CrossRef]
- Rao AL, Hong ES. Understanding depression and suicide in college athletes: emerging concepts and future directions. Br J Sports Med. 2016;50:136–137. doi:10.1136/bjsports-2015-095658 [CrossRef]
- Yang J, Peek-Asa C, Corlette JD, Cheng G, Foster DT, Albright J. Prevalence of and risk factors associated with symptoms of depression in competitive collegiate student athletes. Clin J Sport Med. 2007;17:481–487. doi:10.1097/JSM.0b013e31815aed6b [CrossRef]
- Weigand S, Cohen J, Merenstein D. Susceptibility for depression in current and retired student athletes. Sports Health. 2013;5:263–266. doi:10.1177/1941738113480464 [CrossRef]
- Armstrong S, Oomen-Early J. Social connectedness, self-esteem, and depression symptomatology among collegiate athletes versus nonathletes. J Am Coll Health. 2009;57:521–526. doi:10.3200/JACH.57.5.521-526 [CrossRef]
- Kontos AP, Covassin T, Elbin RJ, Parker T. Depression and neurocognitive performance after concussion among male and female high school and collegiate athletes. Arch Phys Med Rehabil. 2012;93:1751–1756. doi:10.1016/j.apmr.2012.03.032 [CrossRef]
- Covassin T, Elbin RJ 3rd, Larson E, Kontos AP. Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms. Clin J Sport Med. 2012;22:98–104. doi:10.1097/JSM.0b013e31823403d2 [CrossRef]
- Albert PR. Why is depression more prevalent in women?J Psychiatry Neurosci. 2015;40:219–221. doi:10.1503/jpn.150205 [CrossRef]
- Rosenthal NE, Sack DA, Gillin JC, et al. Seasonal affective disorder: a description of the syndrome and preliminary findings with light therapy. Arch Gen Psychiatry. 1984;41:72–80. doi:10.1001/archpsyc.1984.01790120076010 [CrossRef]
- Tam EM, Lam RW, Robertson HA, Stewart JN, Yatham LN, Zis AP. Atypical depressive symptoms in seasonal and non-seasonal mood disorders. J Affect Disord. 1997;44:39–44. doi:10.1016/S0165-0327(97)01447-X [CrossRef]
- Donofry SD, Roecklein KA, Rohan KJ, Wildes JE, Kamarck ML. Prevalence and correlates of binge eating in seasonal affective disorder. Psychiatry Res. 2014;217:47–53. doi:10.1016/j.psychres.2014.03.012 [CrossRef]
- Magnusson A. An overview of epidemiological studies on seasonal affective disorder. Acta Psychiatr Scand. 2000;101:176–184. doi:10.1034/j.1600-0447.2000.101003176.x [CrossRef]
- Rosen LW, Shafer CL, Smokler C, Carrier D, McKeag DB. Seasonal mood disturbances in collegiate hockey players. J Athl Train. 1996;31:225–228.
- Lodis C, Sigmon ST, Martinson A, Craner J, McGillicuddy M, Hale B. Is collegiate athletic participation a protective factor in seasonality?Journal of Clinical Sport Psychology. 2012;6:113–128. doi:10.1123/jcsp.6.2.113 [CrossRef]
- Whitcomb-Smith S, Sigmon ST, Martinson A, Young M, Craner J, Boulard N. The temporal development of mood, cognitive, and vegetative symptoms in recurrent SAD episodes: a test of the dual vulnerability hypothesis. Cognitive Therapy and Research. 2014;38:43–54. doi:10.1007/s10608-013-9577-5 [CrossRef]
- Young MA, Watel LG, Lahmeyer HW, Eastman CI. The temporal onset of individual symptoms in winter depression: differentiating underlying mechanisms. J Affect Disord. 1991;22:191–197. doi:10.1016/0165-0327(91)90065-Z [CrossRef]
- Beck AT, Steer RA, Brown GK. Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.
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Sport Participation by Division I Student-Athletes (N = 296)
|Women's field hockey||11||3.7|
Frequency and Percentage of Student-Athlete's Home State (N = 296)a
Frequency and Percentage of Depression Symptom Categories by Division I Male and Female Student-Athletes (N = 296)
|Depression Total Score||Group||N||%|
|Normal (0 to 10)||Male||116||92.8|
|Borderline clinical (17 to 20)||Male||1||0.8|
|Moderate (21 to 30)||Male||0||0|
|Severe (31 to 40)||Male||1||0.8|
|Extremely severe (40+)||Male||0||0|
Frequency and Percentage of SAD Symptom Categories by Division I Male and Female Student-Athletes (N = 296)
|Normal (0 to 7)||Male||84||67.2|
|Subsyndromal SAD (8 to 10)||Male||15||12.0|