Background Previous research indicates that psychological factors is associated with injury incidence. The associations between health burden, psychological health and coaching style have, to our best knowledge not been investigated.

Objective Explore associations between health burden, need-supportive coaching and athlete burnout after three years in elite sports high school.

Design Mixed prospective and retrospective cohort study. We collected health data for 124 weeks, the first 26 weeks prospectively, the remaining 98 weeks retrospectively by interview. Participants completed a web-based survey at the end of the study period.

Setting Three Norwegian High School Sport Academies.

Patients (or Participants) 210 students, of which 202 graduated after three years, 8 dropped out before graduation.

Interventions (or Assessment of Risk Factors) We measured health burden using The Oslo Sports Trauma Research Centers Questionnaire on health problems, results are presented per 1000 arbitrary units. Participants completed the ‘The Supportive Coach’ (SC), a ten-item questionnaire that measures the athlete’s perceived support from the coach in the psychological domains of autonomy, competence and relatedness, on a 1–5 scale. We used linear regression for statistical analysis.

Main Outcome Measurements The Athlete Burnout Questionnaire (ABQ) score. ABQ measures symptoms of athlete burnout on a 1–5 scale.

Results Average ABQ-score was 2.3 (mean, 95% confidence interval: 2.2 to 2.4). Average yearly health burden was 0.96 (median, range 0.03–6.9). Average SC-score was 4.0 (median, range: 1.3 to 5.0). Health burden, adjusted for coaching style and major life events, was associated with increasing symptoms of burnout (B: 0.1, 0.09 to 0.21, p<0,001). Need-supportive coaching is associated with decreasing symptoms, (B: -0.24, -0.35 to -0.14, p<0.001).

Conclusions An increasing health burden is associated with increasing symptoms of athlete burnout. A need-supportive coach is associated with decreasing symptoms. Coaches should be aware of symptoms of burnout in ill and injured athletes, and consider using a need-supportive approach.