Burnout in adolescent elite athletes
A pilot study on an Austrian student sample
Abstract
Abstract:Objectives: Adolescent elite athletes are generally exposed to considerable stress. This study investigated the extent and intensity of burnout in adolescent athletes attending an elite Austrian sports school. Methods: The German version of the Athlete Burnout Questionnaire (ABQ) and additional questions on burnout-related risk factors were applied to a sample of 63 students. Results: The data show a substantial burden of burnout in the student sample, compared to a sample of adult endurance athletes. Burnout was negatively associated with training duration and with a perspective onto a professional sports career, and positively associated with thoughts about finalizing sports, with the number of injuries, and with high levels of success-related psychic pressure. Conclusions: Burnout in adolescent elite athletes at an Austrian sports school was evident in number and severity. Psychological factors like doubts on the career, perceiving a professional perspective in sports, self-efficacy, or sense-making may interact with contextual factors in a circular way.
Introduction
Burnout and in consequence, depression, seems to be an important problem in sports [1, 2]. At least since the suicide of the prominent goalkeeper Robert Enke in 2009, this issue got a big attention in the public and in science, with consequence of the development of treatment and prevention programs [3, 4]. In this context, sports psychiatry has also evolved considerably [5]. In psychiatry, there is a debate if burnout should be seen as a moderate form or as a precursor of depression and other stress related diseases, or if it should be conceptualized as a subclinical or clinical phenomenon of its own [6, 7]. In psychiatric classification systems as DSM-5 or ICD-10, burnout is not classified as a specific diagnosis. Here we follow a conceptualization of burnout which is independent of any psychiatric disorders. The classical definition of burnout by Maslach [8, 9] encompasses the dimensions of exhaustion (physical, mental, and emotional), cynicism/depersonalization and low personal accomplishment. In the domain of sports, Raedeke [10] defines burnout as a “… syndrome of physical and emotional exhaustion, sports devaluation, and reduced athletic accomplishment.” In empirical studies on athlete burnout, depersonalization was not found as a salient feature, and in consequence it was replaced by the concept of sport devaluation, “…meaning that athletes stop caring about sport and their own performance” [11, 12]. The dimensions which were conceptualized by Raedeke [8] define the dimensions of the Athlete Burnout Questionnaire, which was used in this study on young athlete’s burnout: emotional/physical exhaustion, devaluation of sports and reduced sense of accomplishment. Even though Gerber et al. [13] showed that around one in 10 young athletes suffered from burnout and/or depressive symptoms of clinical relevance, most of the existing studies on burnout in sports focused on trainers and coaches, and found a lower frequency than in adult elite and non-elite athletes. There are few studies in young athletes on prevalence rates or risk factors for depression [14, 15, 16].
Models have been developed to explain the etiology of athlete burnout. These are the “Investment Model of Burnout and Dropout” by Schmidt and Stein [17], which focuses on the continuity of practicing or drop-out from sports from a commitment perspective and the “Cognitive-Affective Model of Stress and Burnout” [18]. The “Cognitive-Affective Model of Stress and Burnout” considers stress as a core factor of burnout, resulting from a lasting imbalance between demands and resources. Achievement expectations and engagement of parents, coaches, managers, or others exerting pressure on young athletes may prevent the experience of internal control, self-efficacy, and autonomy. Intensive engagement in training and sports-related activities contribute to a one-dimensional identity development of defining oneself exclusively as an athlete. Tension and dissonance may result from conflicts between sports-related obligations and other demands (e.g., school, parents, peers). Real or perceived restrictions to sports and prevention of activities with peers out of the context of sports may produce conflicts, dissonances or resistance, with the consequence of questioning the value of sports or sometimes of creating identity crises.
The development of a valid systemic model of the emergence of burnout from multiple internal (cognitive, emotional, behavioral, motivational) and external (expectations of others, organizational structures, competition) factors would need to include the assessment of a broad variety of risk and protective factors. More than cross-sectional measures, as in the present study, longitudinal studies could contribute to an understanding of the (nonlinear) interactions of relevant components. A first step onto this challenging aim is to collect data on some contributors and on the burnout intensity in student athletes. Because there are few studies on prevalence rates or risk factors for burnout and depression in young athletes [14, 15, 16], we tried to get a first estimate of the burnout burden and related factors in a sample of Austrian sports students.
Methods and materials
Participants
The sample of the study comprised all 63 students of an elite sports college in Austria, attending the first to fifth upper grades without exception. The most common sports disciplines were judo, volleyball, and athletics. The average age of the subjects was 16.4 years (SD: 1.48, range from 14 to 19 years), 31 students were female and 32 were male. Two thirds of the students were primarily engaged in individual sports with one third in team sports. The intended perspective of the students is the graduation of a general qualification for university entrance and for some of them an elite athlete career. All students agreed to participate. Written informed consent was obtained from all participants according to the Declaration of Helsinki. An additional ethical vote of the appropriate committee was not required because the study just based on a survey, with reference on a document from the ethics committee of Salzburg county.
Measures
Adolescent burnout was assessed in a cross-sectional panel by the German version of the Athlete Burnout Questionnaire (ABQ-D) [19, 12]. The factor analysis of the ABQ-D is reported by Krause [20]. Ziemainz et al. [19] reported on a good internal consistency (mean Cronbach’s Alpha: .80) and on retest reliabilities between .70 and .90, depending on the subscale. For an application of the ABQ-D on a sample of 785 endurance athletes [11] Cronbach’s Alphas ranged between .55 (“devaluation of sports” scale), what can be seen as not sufficient, and .85 (“emotional/physical exhaustion” scale). The 15 items of the ABQ-D have to be answered on a 5-step Likert scale, from 1 = almost never to 5 = very often. The items contribute to three subscales (“emotional/physical exhaustion”, “devaluation of sports”, “reduced sense of accomplishment”) and to a total score. The scores of the subscales and the total score are calculated by averaging the items.
In addition to the ABQ-D, additional questions assessed risk factors found in previous research [21]: the duration of weekly training (<10 hours, 10–20 hours, >20 hours), the duration of leisure activities (<10 hours, 10–20 hours, >20 hours), the option of a personal future in the domain of competitive sports (“Do you see your professional future in the field of competitive sports (e.g., as an athlete, trainer, or coach)?”: no, perhaps, yes), and the frequency of injuries or medical traumata (never, 1 or 2 times, more than 2 times), internal and external pressure, stress due to the double burden of school/sport, quality of sleep, physical pain, and the use of analgesics.
Data analysis
Descriptive statistics on mean scores (total scores and subscales) were calculated by SPSS. Inter-item correlations and correlations between items, subscales and total scores of the ABQ-D were based on Pearson correlations. Corrections for multiple comparisons were realized by the method of False Discovery Rates [22]. For group comparisons we used Analysis of Variance (ANOVA as implemented in SPSS 21.0). Control for covariates in ANOVA and correlations was not done.
Results
The mean score of the total ABQ-D scale and the mean scores of the subscales (“emotional/physical exhaustion”, “devaluation of sports”, “reduced sense of accomplishment”) are reported in Table 2 (minimum: 1, maximum: 5). Given the cut off score for “medium level severity” of burnout (scores of >3 on at least two subscales of the ABQ-D), 12 (21.8%) students can be classified as experiencing “medium level intensity”, and 5 students (9.1%) fulfill the criterion of severe burnout (scores of more than 3 on all three subscales). Compared with the sample of adult endurance athletes tested by Ziemainz et al. [11], the total burnout score and the subscale scores (except for the “reduced sense of accomplishment” scale) of the student sample are considerably higher (Table 1).
The classification of the students to the categories of the four additional questions is presented in Table 2. It should be noted that 52/63 (83%) reported one or more severe injuries or medical traumata. The classification of the students onto the three levels was compared to the total burnout score and the scores of the ABQ-D subscales (Table 3). Athletes with higher burnout scores had lower weekly training duration. Athletes with an option for a personal future in competitive sports had reduced burnout levels. The frequency of injuries and medical traumata was associated with higher burnout levels and with the “devaluation of sports” subscale. For the duration of leisure activities, no relation to burnout scores was found.
Finally, the additional items were cross-correlated with the total score and the subscales of the ABQ-D. Only one item (“Sometimes I think about finishing my engagement in competitive sports”) revealed significant correlations with the burnout total score (.73, p < .01), the “devaluation of sports” subscale (.57, p < .05), and the “reduced sense of accomplishment” subscale (.75, p < .01). The probabilities (p values) were corrected for multiple comparisons (False Discovery Rate) [22].
The items of the additional questionnaire revealed some important descriptive information on the burnout and stress burden of the student sample. Given a 5-step Likert-type answer scale (never, seldom, sometimes, often, very often), the following percentages referred to the answer levels “often” and “very often”. 29% of the students reported not enough time for school related learning, 22% experienced too much pressure from their social environment, 43% exerted too much pressure of success, 29% thought about finishing their college carrier, 62% underwent training despite feeling pain, 43% participated in sports competitions despite feeling pain, 13% took analgesics during training, 14% took analgesics during sports competitions, 27% felt overwhelmed by the double burden of sports and academic studies, 10% reported sleep problems before sports competitions, 14% reported sleep problems before academic examinations, and 8% reported bodily complaints (e.g., pain) before academic examinations.
Discussion
The preliminary results of this study demonstrate that a significant percentage of the college students of an Austrian elite sports college experience burnout and stress. 21.8% of the sample can be classified as experiencing a medium level of burnout, 9.1% as experiencing severe burnout. Together, these are just under one third of the students. This prevalence goes in line with the findings of Gerber et al. [13]. Compared with the adult athletes from the study of Ziemainz et al. [11], the rate of the medium burnout level is almost six times higher, and the rate of the severe burnout level is seven times higher. This may indicate health problems in some part of this group and may point to the need for screening, more detailed diagnosis [23] and, if necessary, treatment. Prevention programs also seem to be useful [4].
In contrast to Granz et al. [21], there is no increased burnout intensity with more invested time in training, but with less time invested in training. Burnout may lead to less time invested in training via reduced identification with sports as indicated by the burnout subscale “sport devaluation”.
Burnout scores are lower if students perceive a professional future in their activities in competitive sports. No association of burnout to time spent in leisure activities was found, but to the number of injuries and medical traumata, 62% underwent training despite feeling pain, 13% consumed analgesics during the training, 14% consumed analgesics during sports competitions. Higher burnout levels (total score and the “reduced sense of accomplishment” subscale) were correlated with doubts on the future of the sports career and with thoughts about finishing the sports-related engagement. Taking a closer look to stress- and burnout-related complaints and reasons, the highest values were scored on self-related pressure, requests, and demands and on the inner fight against pain (e.g., more pressure of success from the inside than from the outside/social environment; training and sports competitions in despite pain; thoughts about finishing the career).
It seems that it is not so much the objective conditions (e.g., time invested in training) which are associated with burnout, but mental processes like doubts on continuing the career, perceiving a professional perspective in sports, experiencing self-efficacy, sense-making, and other reasons of coherence and fitting one’s engagement and one’s own self-evaluation [24]. For these psychological factors, Antonovsky’s “sense of coherence” concept could be an appropriate frame of interpretation: beside understandability, especially manageability and meaningfulness – or in more active terms: sense making [25] – of one’s own experiences, conditions of life, and challenges play an important role for resilience and the reproduction of (mental) health [26].
Psychological factors may interact with contextual factors in a circular way and constitute increasing and self-stabilizing feedback loops. External stress, for example, can amplify symptomatology. Perspectives in sports are also important. In the study, lower levels of symptoms were shown, if students perceive a professional future in their activities in competitive sports. In consequence, the relationship of school and academic strain to challenges caused by training and sports should be reflected [27] and included in any treatment or support. Support should also include intelligent and multi-perspective psychological concepts for mental training and coaching of adolescent and young adults in the context of personality development and academic as well as sporting challenges have to be developed. The focus has to be also on the support of personal development potential. Taking a closer look at stress related complaints, the highest values were scored on self-related pressure, requests, demands and on the inner fight against pain (e.g., more pressure of success from the inside than from the outside/social environment; training and sportive competitions in despite of pain). Overall, it is important to be able to deal with pressure appropriately in sports and skills to manage pressure should be incorporated into prevention program.
Limitations
Limitations of the study include the small sample, the cross-sectional nature of the study, the lack of control for confounders, and the use of self-report measures only. Longitudinal studies would help understand the interaction of components and could be realised by app-based process monitoring technologies (e.g., the Synergetic Navigation System) [28, 29]. With reference to multiple time series (process data), e.g. day by day measurements, mathematical models on overload and psychological symptoms (prediction studies) could be built, as was realized for understanding psychological change dynamics in psychotherapy [30, 31]. In this context, factors such as training duration, load, and intensity could also be included, as well as physiological complaints, physical pain, analgesic use, and preinjury psychological states [32]. The Recruitment of the sample could also be more differentiated. Differentiation according to age and type of sport would be useful.
Conclusion
Nearly one third of the students of an elite Austrian sports school experience significant burnout and stress. Almost two third of the students underwent training in spite of feeling pain and almost a sixth took analgesics during training. Implementation of screening and specialist medical support e.g. from sports psychiatry seem to be necessary. Prevention programs should also be provided. Support also appears to be useful in terms of the relationship between burnout and the number of injuries. If students perceive a professional future in their competitive sports, burnout seems to be lower. In terms of psychological processes, coherence and sense-making of one’s own experiences in sports may interact with contextual factors in a circular way and seem to be important for resilience and the reproduction of (mental) health.
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