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Depression is under-recognised in the sport setting: time for primary care sports medicine to be proactive and screen widely for depression symptoms
  1. Thomas Trojian
  1. Correspondence to Dr Thomas Trojian, Division of Sports Medicine, Department of Family, Community & Preventive Medicine, Drexel University College of Medicine, Philadelphia, PA 19130, USA; ttrojian{at}drexelmed.edu

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An important role of the team physician is to provide care for the whole athlete. This includes mental health issues for instance screening for depression and knowing the factors that affect the onset of depression. The USA Preventive Service Task Force (USPSTF) recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment and follow-up.1 Most studies report prevalence rate of depression among college athletes ranges from as low as 15.6% to as high as 21%.2 Depression levels were significantly higher in current college athletes (about 17%) compared with former, graduated college athletes (8%).

The stress of sports and athletic participation place athletes at risk. Performance failure was significantly associated with depression. The statistically strongest predictors of depression in student-athletes were female gender, lower self-esteem, less social connectedness and decrease sleep. Female student-athletes had 1.32 greater odds (95% CI 1.01 to 1.73) of experiencing symptoms of depression compared to male student-athletes. Freshmen had 3.27 greater odds (95% CI 1.63 to 6.59) of experiencing symptoms of depression than their more senior counterparts.3

USPSTF recommends the use of one of these three screening tools; 9-Question Patient Health Questionnaire—Depression Screener (PHQ-9), Beck Depression Inventory-II (BDI-II), Depression Screener from the Center for Epidemiologic Studies Depression Scale (CES-D). The PHQ-9, a nine-question survey, when the cut-off is a score of 5 or more has 95% sensitivity and 88.3% specificity when scored with a cut point of 11. The CES-D, 10-question survey, when the cut-off is 22 has sensitivity 84%, specificity 60% and positive predicted value 77%.4 Most recommend a cut-off of 16 to increase sensitivity but it decreases the …

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