Psychological Determinants of Burnout, Illness and Injury among Elite Junior Athletes

Authors: F. Moen, K. Myhre and Ø. Sandbakk

Corresponding Author:
Frode Moen
E-mail address: frmoe@online.no, Tel. : +47 932 487 50
Postal address: Department of Education, Norwegian University of Science and Technology, N-7491 Trondheim, Norway

Frode Moen is currently the head manager of the Olympic Athlete program in central Norway, where he also has a position as a coach / mental trainer for elite athletes and coaches. He also is an associate professor at the Department of Education at the Norwegian University of Science and Technology. He previously has worked as a teacher in high school where sport was his major subject, and he has been a coach for the national team in Nordic combined in Norway for several years. Frode received his Ph.D. in coaching and performance psychology from the Norwegian University of Science and Technology. His research focuses mainly on coaching in business, coaching in sport, communication, performance psychology and relationship issues.

Psychological Determinants of Burnout, Illness and Injury among Elite Junior Athletes

ABSTRACT
This article looks at how psychological variables such as passion, perceived performance, affect, worries and working alliance are associated with athlete burnout and illness and injuries among junior athletes in sport. A sample of 356 junior elite athletes from different sports such as cross country skiing, biathlon, Nordic combined, shooting, ice-hockey, ice-skating, ski jumping, alpine skiing, cycling, track and field, football, orienteering, handball, football and volleyball participated in the investigation. Our results show that harmonic passion, perceived performance, positive and negative affect, worry and working alliance are uniquely associated with athlete burnout, whereas sex, perceived performance and working alliance uniquely are associated with illness and injuries. The results are discussed in regard of applied implications and possible future research.

Keywords: passion, performance, stress, worries, athlete burnout

INTRODUCTION
Thousands of hours with deliberate practice are required to retrieve the full potentials of young athletes in sports (13). To optimize training adaptations from such high training loads, athletes are reliant on good physical and psychological health (59). However, relatively high occurrence rates of athlete burnout, illnesses and injuries have been shown among adolescent athletes (7, 8, 20, 63). Several risk factors for illness and injury have been reported, such as increasing the training load too rapidly (16), thwarting the body’s need for restitution (7), using unhealthy nutrition or weight regulation (59, 61), training and competing with pain (8, 63), using pain killers (65) as well as emotional stress stimulated by the competitive environment (14). Successively, burnout is a possible threat, as it is anticipated to be brought on by persistent devotion to challenging goals, unmet needs and unfulfilled expectations (15, 19). However, the understanding of how psychological variables are associated with athlete burnout, illness and injury is limited and indeed an important area to further develop.

The cognitive affective model developed by Smith (61) is the origin for research on athlete burnout in sport. This model claims that burnout is a reaction to chronic stress over time (61). One particular obvious stressor in sport is an athlete’s perceived inability to meet situational demands in their sports (48, 52, 61). The development of the athlete burnout construct focuses on the three central dimensions; a) emotional and physical exhaustion, b) reduced sense of accomplishments, and c) sport devaluation (52). Exhaustion is the core component in athlete burnout, and is an athlete’s feeling of fatigue and exhaustion associated with their sports, both physically and emotionally (25, 54). Reduced sense of accomplishments is an athlete’s feeling of inefficacy in their sports, whereas devaluation is when athletes lose their concern about their sports, and devaluate the importance of the sport (54).

Among highly motivated and passionate athletes, sports activities are parts of their identity (10, 69). In this regard, two distinct types of passion are observed, namely harmonious and obsessive passion (40, 70, 72). Harmonious passionate activities typically occupy a significant space in the athlete’s identity, and are in harmony with other aspects of life (70). Athletes with a high harmonious passion are likely to experience positive affect during the activity, due to a flexible and fully committed engagement and control of the activity. In contrast, obsessive passion results from a controlled internalization of the activity that occupies an overpowering space in the athlete’s identity. Athletes with high obsessive passion like the activity, but have an internal compulsion to engage even when they should not. Since athletes with high obsessive passion may experience negative emotional experiences once engagement in the passionate activity is restricted or terminated (70), possible performance impairments is likely to be experienced as threats for their identity, to stimulate a negative stress responses and subsequently intrusive thoughts and worries (18, 68). According to The Cognitive Activation Theory of Stress (CATS), a stress response is an alarm that occurs in situations that are considered novel, when there is a homeostatic imbalance, or when the athlete perceives a threat (68). An athlete with resources to cope with the situational demands normally experience the stress as positive (41), whereas athletes being in a situation beyond their control and coping resources experience negative stress (4). Motivated athletes with negative stress responses might be stimulated to work even more intense than before, ignoring signs of exhaustion and working with low enjoyment. This may subsequently increase the risk of injury, illness and burnout (26, 27, 52).

Worry represents an uncontrollable, intrusive and repetitive thought activity that trigger negative emotions due to self-initiated and/or precipitated circumstances of everyday living (67). When training is experienced as negative in athletes, intrusive thoughts and negative emotions are highly stimulated (18). Thus, depressed mood and worries are considered main psychological markers of negative training stress (28).

In order to cultivate and grow an athlete’s potential in sport, a functional working alliance between coach and athlete is crucial (33, 35, 37, 42, 47). Accordingly, the coach and athlete need to establish reciprocal emotional bonds and mutually agree on goals and tasks (2). However, little is known about what effect the athletes’ perception of the coach-athlete working alliance has on athlete burnout, illness and injury, and the other way around.

Therefore, the purpose of this study is to examine how passion, perceived performance, positive and negative affect, worries and the coach-athlete working alliance uniquely are associated with athlete burnout, illness and injury among Norwegian junior athletes. In this connection, possible sex differences were also investigated.

METHOD
For this study, five hundred and twenty-nine junior athletes from seven different Norwegian high schools for elite sports were invited to voluntarily participate in an online questionnaire. The athletes were recruited from schools specialized for elite sports, where the athletes have to document both talent and ambitions to gain admission. Training is on the schedule at school every day of the week, and the athletes normally practice their sports after school some of the days during weekdays and in the weekends in addition. Thus, the athletes in this study have ambitions to develop their potentials at elite senior level.

One week ahead of the distribution of the survey, participants were contacted via e-mail and given information about why they were selected to participate in the survey, the background and purpose of the study, that all the data would be kept confidential, that it was voluntary, and that the Norwegian Social Science Data Services (NSD) approved the project. Participants gave their consent to participate in the study by checking for read and accepted the consent form on the first page of the survey in conjunction with the distribution.

From the selection of 529 athletes, 356 (191 males and 165 females) completed the data collection, which gave a response rate of 69 %. The sample had a mean age of 18.2 years, ranging from 17 to 20 years. The athletes represented different sports such as cross country skiing, biathlon, Nordic combined, shooting, ice-hockey, ice-skating, ski jumping, alpine skiing, cycling, track and field, football, orienteering, handball, football and volleyball.

Measured variables
The general variables examined here include items and inventories such as age, gender, type of sport, performance level and type of school. In addition, the questionnaire measured psychological variables such as perceived performance, passion, positive and negative affect, worry, perceived coach athlete working alliance and athlete burnout, as well as the occurrence of injury and illness. All measurements used in this study were based on previously developed scales proven to hold both satisfactory validity and reliability. The measurements were originally in English, but were translated into Norwegian and slightly adjusted for the purpose of this study by the authors.

To assess athletes’ level and type of passion for their sports, the Passion Scale (70) was used. This scale has two subscales that contain seven items for each of the two types of passion: harmonious and obsessive. The athletes were asked to consider their interest for- and experiences with their sports, and for each item respond on a seven-point Likert scale ranging from 1 (do not agree at all) to 7 (completely agree). A sample item from the obsessive passion subscale is “I have difficulties controlling my urge to engage in my activity”, while a sample question for harmonious passion would be “My activity is in harmony with other things that are part of me. ” Subsequent studies provide both reliability and validity among adolescent athletes aged 12-18 (43, 44, 73). The Cronbach’s alpha for the measurement was .68 (harmonic) and .85 (obsessive).

Individual performance from the Athlete Satisfaction Questionnaire was used to measure athletes’ perceived satisfaction with their own progress in sport (56). This scale seeks to measure the athlete’s perceived satisfaction with his/her own task performance. The athletes were asked to consider 4 items regarding how satisfied they were with their absolute performance, improvements in performance and goal achievement in sport during the last year on a 7-point scale ranging from 1 (not at all satisfied) to 7 (extremely satisfied). An example of item “I am satisfied with the degree to which I have reached my performance goals during the season. ” The Cronbach’s alpha for the measurement was .91.

The Positive and Negative Affect Schedule (PANAS) (74) was used to measure positive and negative affect. The scale comprises subscales for positive affect and negative affect. Ten descriptors representing different emotions are used for positive affect (i. e. excited – strong – proud) and negative affect (i. e. upset – nervous – irritable), respectively. The athletes were asked to rate the extent to which they have experienced each particular emotion as an athlete within the last week, with reference to a 5-point scale rating from 1 (not at all) to 5 (very much). The PANAS has strong reported validity with measures such as general negative affect and dysfunction, depression, and state anxiety (44). The Cronbach’s alpha for the measurement was .83 (positive affect) and .85 (negative affect).

To examine the level of worry among the athletes, the Penn State Worry Questionnaire (PSWQ) was used (46). This scale consists of totally 16 items, some positively loaded and some negatively loaded. An example of a positively loaded item is “If I don’t have enough time to do everything, I don’t worry about it” and one of the negatively loaded items is: “When I’m under pressure, I worry a lot. ” The athletes were asked to rate each rated on a five-point scale ranging from 1 (not at all typical) to 5 (very typical) based on how typical or representative each of the different items were for them. To calculate one consistent score for worry, the values of the positively loaded items were inverted before the mean was calculated. An important aspect of the PSWQ is that the instrument is not related to any specific worry domain or content (46) in contrast to other worry measures (e. g. , Worry Domains Questionnaire, WDQ; 63). When it comes to the internal consistency of the PSWQ, it has consistently been shown to be high (50). The research of Pallesen et al. (50) showed that the reliability and validity in the Norwegian version of the PSWQ are in line with former studies conducted with the PSWQ (9, 46, 49). The Cronbach’s alpha for the measurement in this study was .93.

To measure athlete burnout, The Athlete Burnout Questionnaire (ABQ) was used (53, 54). The stem for each question was “How often do you feel this way?” and the athletes were requested to rate the extent to which the items address their participation motives on a five-point Likert scale anchored by (1) “Almost Never” and (5) “Almost Always”. The ABQ has three five-item subscales assessing the three key dimensions of burnout: (1) a reduced sense of accomplishment, (2) emotional and physical exhaustion, and (3) devaluation of sports participation. Examples of items covering these dimensions are respectively: “It seems that no matter what I do, I don’t perform as well as I should”,” I feel so tired from my training that I have trouble finding energy to do other things”, and “I have negative feelings toward sports”. The Cronbach’s alpha for the complete measurement in this study was was .82.
The Working Alliance Inventory (WAI) was adjusted for the sport context and used to assess coach– athlete relationship characteristics (31, 65). This 12-item questionnaire yields three central dimensions: (a) agreement on the goals pursued in the relationship (i. e. , the goal dimension); (b) agreement on tasks to be accomplished to achieve these goals (i. e. , the task dimension); and (c) the development of a personal bond between the coach and the athlete (i. e. , the bonding dimension). The athletes were asked to consider these 12 items regarding their thoughts and feelings towards their responsible coach in their sports on a 7-point scale ranging from 1 (never) to 7 (always). Examples of items covering these dimensions are “My coach and I work on mutually agreed-upon goals”, “My coach and me agree about the steps I need to take to improve in my sport” and “There is mutual trust between my coach and me” for the goal-, task- and bonding dimensions, respectively. The Cronbach’s alpha for the total measurement was .88.

Data analysis procedures
All data were tested for a normal distribution using a Shapiro-Wilk test and are presented as mean and standard deviation. Accordingly, correlation analysis between variables was conducted using the parametric Person´s correlation coefficient. Thereafter, the data were analyzed by logistic hierarchical multiple regression analysis to investigate how perceived performance, passion, stress, worry and working alliance could predict athlete burnout and illness/injuries. In this connection, burnout scores were divided into tertiles according to Raedeke and Smith (54), with scores in the upper tertile defined as high burnout, those in the middle as average burnout, and those in the bottom tertile reflecting low burnout. Cronbach’s alpha was used to calculate the internal consistency of the items in the various scales employed. An alpha value of less than 0.05 was used as the level of statistical significance. All statistical analyses were performed using SPSS 23.0 software for Windows (SPSS Inc, Chicago, IL).

RESULTS
Descriptive statistics and bivariate correlations
The correlations between the variables in the study, as well as the possible maximum scores, statistical means, standard deviations, and Cronbach’s alphas are presented in Table 1. The Cronbach’s alphas of the variables in this study varied from excellent to acceptable.

The zero order correlations between the study variables vary from zero (+/- .07 to .19) to strong (+/- .40 to .85) positive and negative relationships. Working alliance exerted the strongest correlation with athlete burnout, followed by harmonious passion, negative affect and worry (Table 1).

Descriptive statistics and Pearson correlations

The descriptive statistics also show that 106 out of the 356 junior athletes were ill or injured at the investigation point (30 %). Out of this 43 males reported to be ill or injured and 63 females (23 % of the males- and 38 % of the females in the investigation).

Regression analysis
Table 2 shows the regression statistics from the two different 3-step hierarchical regression analysis. Here, sex was entered at model 1, thereafter the passion variables, perceived performance, the stress variables and worry were entered at model 2, and finally, working alliance variable was added at model 3.

In model 1, sex contributed significantly to both regression models, with B being .19 (p less than .01) and B being .77 (p less than .01) for athlete burnout and illness/injuries respectively. This means that females exhibited significantly higher burnout scores and illness/injuries compared to males. However, when other psychological variables were entered into the equation in model 2, sex differences were only apparent when predicting illness/injuries. This was also the case when working alliance was entered in model 3. In both model 2 and 3, harmonious passion was negatively associated with levels of athlete burnout, but not with illness/injuries. Obsessive passion did not contribute significantly to the regression models in either model 2 or 3. However, perceived performance contributed to the prediction both in model 2 and 3, being negatively associated with both athlete burnout and illness/injuries. Both negative and positive stress, as well as worry contributed significantly to predicting athlete burnout in model 2 and 3. Neither of these predictions was found for illness/injuries either in model 2 or 3. In model 3, working alliance significantly contributed to the predicting of both athlete burnout and illness/injuries. The variables entered in model 3 explained 49% of the variance in athlete burnout and 16% of the variance in illness/injuries.

Summary of hierarchical regression analysis of predicting Athlete Burnout or Illness or Injuries

DISCUSSION
The purpose of this study was to examine how passion, perceived performance, affect, worries and the coach-athlete working alliance uniquely are associated with athlete burnout, illness and injury among Norwegian junior athletes, as well as to examine possible sex differences in this connection. Our main findings were as follows: 1) Females showed higher rates of burnout, illness and injuries than male; 2) Harmonic passion, perceived performance, positive affect and working alliance were all uniquely and negatively associated with athlete burnout, whereas negative affect and worry was uniquely and positively associated with athlete burnout. In the total model, harmonic passion, perceived performance, positive affect and working alliance together contributed to explain 49 % of the variance in athlete burnout. 3) Perceived performance is uniquely and negatively associated with illness and injuries, whereas working alliance is associated positively. Thus, low scores on working alliance are associated with illness and injuries. In the total model, sex differences, perceived performance and working alliance together explain 16% of the variance in illness and injuries.

Model 1 of the regressions in this study shows that females are more likely to experience athlete burnout and illness and injuries than males. The sex variable is not significant in association with athlete burnout in model 2 and 3, whereas the association is still significant in model 2 and 3 for illness and injuries. Former studies report varying degrees of sex differences in the occurrence of illness/injury, which is likely dependent on the type of sport and/or injury/illness studied (e.g. 11, 17, 51, 58). However, it has frequently been reported higher levels of burnout among female compared to male athletes (5, 12, 30). While the reason for the higher burnout rates among women may be multi-dimensional, female athletes exhibit stronger increase than males in the sport devaluation dimension of burnout through adolescence, they experience more stress due to social evaluation, and endure more stress due to issues with their coach compared to their male-counterparts (1, 22, 32). Thus, sex differences in athlete burnout may be facilitated by devaluation of sport participation, social hassles and coach-athlete relationship issues.

When entering the psychological variables such as harmonic passion, obsessive passion, perceived performance and worry in model 2, only obsessive passion was not significantly associated with athlete burnout. This highly supports the view on psychosocial stress and situational pressure as antecedents to athlete burnout (21). It also confirms that the more athletes identify with harmonious passion, the less likely they are to report symptoms of athlete burnout, which supports a growing body of research that has evidenced the adaptive role of harmonious passion in sport (3, 71, 72). Regarding illness and injuries, the only significantly associated variable in model 2 was perceived performance. When suffering from illness or injuries, high-level athletes are often unable to complete their highest prioritized training. Therefore, the association between illness and injuries and perceived performance is not unexpected, since the ability to complete planed training recently is shown to correlate significantly with perceived performance and goal attainment (55). However, since this is a cross-sectional study, it is not known whether illness and injuries are affected by other psychological over time.

Our results also show that athlete burnout correlates positively with positive affect and negatively with negative affect. Positive affect is further negatively associated with athlete burnout while negative affect on the other hand is positively associated with athlete burnout. A possible explanation of this finding is that performance impairments stimulate negative affect because the athletes might feel that they don’t have the resources to cope with the current situational demands (68). On the other hand, performance development responds opposite with positive affect because the athletes feel they can cope with their current situation. Since accumulated stress over time can become chronic (45, 60), small, daily hassles with training and competitions can ultimately lead to burnout (6, 26, 27, 57).

Further, worry correlate negatively with perceived performance and positive affect, and positively with negative affect. Worry is also found to be uniquely associated with athlete burnout. As claimed by CATS, negative affect stimulates cognitive activation such as worry which is supported by the fact that worrying lead to uncontrollable, intrusive and repetitive thought activity that trigger negative emotions (67). Overall, this might contribute to athlete burnout (29, 68).

The working alliance variable that was entered in model 3 is significantly associated with both athlete burnout and illness and injuries. A successful coach-athlete relationship is supposed to help the athletes to grow and develop their talents (36, 29, 75), and in working alliance theory, the two dimensions goal and task are aimed at growth and development. It is likely that when young athletes make agreements on goals and tasks with a competent coach, it could avoid them both from setting unrealistic goals, and from making irrational and disadvantageous choices in training and everyday life. This could further contribute to reduce the presence of risk factors of illness, injuries and burnout. Importantly, an optimal coach–athlete relationship is also dependent on mutual and causal interdependence between coaches’ and athletes’ feelings, thoughts and behaviors (35, 36, 28), and in working alliance, the bonding dimension refers to the emphatic bond between the coaches and athletes. This personal bond between coach and athlete is considered crucial for a positive outcome in terms of athlete development and performance (35), and the social support has also been linked to lower levels of mood disturbance in athletes that are restricted from performing their sport (23). It could be expected that a close personal bond lower the levels of negative affect and worry, which further reduce the risk of especially psychologically triggered burnout. In total, our findings emphasize the importance of a well-functioning coach-athlete relationship to prevent illness, injury and burnout among elite junior athletes.

CONCLUSION
Young athletes who aim to be competitive in elite sports need a good physical and psychological health to develop their potential optimally (59). Thus, athlete burnout, illnesses and injuries are possible threats for young athletes on their path towards elite sports. This study shows that harmonic passion, perceived performance, positive and negative affect, worry and working alliance are uniquely associated with athlete burnout. These variables should therefore be included in all future studies with athlete burnout. This study further shows that sex, perceived performance and working alliance uniquely are associated with illness and injuries.

The present study might be limited by the features of a cross-sectional design. In addition, the collected data is constituted by self-reporting measures, and one does not know to which extent these self-reports accurately reflect the variables under study. In the future, longitudinal studies are needed to investigate both direct and indirect relationships and how they develop over time. These studies should ideally combine self-reported data with data obtained in a more objective manner to further develop the line of research in this area. For instance, longitudinal studies that incorporate both quantitative and qualitative methods could be conducted. Future studies should also investigate if there is relations among these variables, to see if a more complex model might explain even more of the variance in athlete burnout, illness and injuries.

APPLICATIONS IN SPORT
Illness, injuries and athlete burnout are definitely threats for young athletes to grow their talents in their sports. This study shows that psychological variables such as passion, perceived performance, affect, worry and the coach-athlete relationship can be important determinants for the development or prevention of these threats. Coaches need to be aware of how these relationships develop.

ACKNOWLEDGMENTS
This study was done in cooperation with The Olympic department in middle-Norway and the Center for Elite Sports Research, Norwegian University of Science and Technology.

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