{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:15:53Z","timestamp":1787019353413,"version":"build-2736575974"},"reference-count":49,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T00:00:00Z","timestamp":1707696000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"American Medical Society of Sports Medicine"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sports Health: A Multidisciplinary Approach"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There are little to no data on whether any associations exist between sport specialization and mental health in youth softball athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis:<\/jats:title>\n                    <jats:p>Highly specialized youth softball athletes will have worse self-reported depression and anxiety symptom scores compared with low and moderate specialized athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cross-sectional survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>An online cross-sectional survey was distributed in the fall of 2021 to a national sample of female youth softball athletes between the ages of 12 and 18 years. Sport specialization status was determined using a 3-point specialization scale that classifies either low, moderate, or high. The patient health questionnaire-9 (PHQ-9) and the 7-item general anxiety disorder scale (GAD-7) were used to assess self-reported symptoms of depression and anxiety. Comparison also included sports participation and specialization behaviors between specialization groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 1283 subjects (mean age, 15.1 \u00b1 1.7 years) fully completed the survey. After adjusting for covariates, lower scores were reported on both the PHQ-9 and GAD-7 by highly specialized athletes compared with moderate or low specialization athletes (PHQ-9, high = 8.6 \u00b1 0.4; moderate = 11.2 \u00b1 0.3; low = 10.9 \u00b1 0.5;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01; GAD-7, high = 6.5 \u00b1 0.4; moderate = 8.6 \u00b1 0.3; low = 8.4 \u00b1 0.4,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01). Conversely, higher scores were reported on both scales for athletes who received private softball coaching compared with those who did not (PHQ-9, 11.5 \u00b1 0.3 vs 9.0 \u00b1 0.3;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01; GAD-7, 8.8 \u00b1 0.3 vs 6.9 \u00b1 0.3,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01). Finally, athletes who reported an arm overuse injury in the previous year reported higher PHQ-9 scores (10.8 \u00b1 0.3 vs 9.8 \u00b1 0.3;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>While sport specialization, as measured by the validated 3-point scale, was not associated with increased anxiety and depression symptom scores, other aspects of specialization behavior such as private coaching or overuse injury history were associated with worse scores on these scales, indicating potential concern for anxiety and depression. However, although the differences we observed were statistically significant, they did not exceed the minimal clinically important difference values that have been established for the PHQ-9 (5 points) or GAD-7 (4 points).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>This project is a first step toward understanding the sport specialization behaviors and their influence on the mental health of youth softball athletes. Focusing on investigating specialization behaviors further may reveal to be a better indicator of risk of developing anxiety and depression symptoms compared with utilizing the 3-point specialization scale.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19417381241228539","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T04:25:50Z","timestamp":1707711950000},"page":"184-194","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["A National Survey on the Relationship of Youth Sport Specialization Behaviors to Self-Reported Anxiety and Depression in Youth Softball Players"],"prefix":"10.1177","volume":"16","author":[{"given":"Anne Marie","family":"Zeller","sequence":"first","affiliation":[{"name":"DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1353-7785","authenticated-orcid":false,"given":"Aaron","family":"Lear","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Akron General, Akron, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0268-0460","authenticated-orcid":false,"given":"Eric","family":"Post","sequence":"additional","affiliation":[{"name":"United States Olympic and Paralympic Committee, Colorado Springs, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"McNulty","sequence":"additional","affiliation":[{"name":"Mia Bella Pediatrics, Mission Viejo, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Bentley","sequence":"additional","affiliation":[{"name":"University of Alabama, Tuscaloosa, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,2,12]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19169943"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-047189"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-0657"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/1941738118800446"},{"issue":"3","key":"e_1_3_2_6_2","article-title":"Sports specialization and intensive training in young athletes","volume":"138","author":"Brenner JS and AAP Council on Sports Medicine and Fitness","year":"2016","unstructured":"Brenner JS and AAP Council on Sports Medicine and Fitness. Sports specialization and intensive training in young athletes. Pediatrics. 2016;138(3):e20162148.","journal-title":"Pediatrics"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-394-18"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40279-021-01520-y"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-101583"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2013-093299"},{"key":"e_1_3_2_11_2","unstructured":"Eads B. The Top 15 Softball Stories of 2022: #9. . . Mental & Emotional Health Pressures Lead to Anxiety Depression & Even Suicides in Young Athletes. https:\/\/extrainningsoftball.com\/the-top-15-softball-stories-of-2022-9-mental-emotional-health-pressures-lead-anxiety-depression-even-suicides-in-young-athletes-dec-23-2022\/. Accessed July 27 2023."},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1037\/0022-3514.75.5.1363"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10942-007-0055-4"},{"key":"e_1_3_2_14_2","unstructured":"Flett GL Hewitt PL Boucher DJ Davidson LA Munro Y. Perfectionism in children the child-adolescent perfectionism scale: development validation and association with adjustment. https:\/\/hewittlab.psych.ubc.ca\/files\/2014\/11\/CAPS.pdf. Accessed October 15 2019."},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsams.2018.05.018"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.4065\/77.4.371"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1249\/JSR.0000000000000809"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/1941738118778510"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546514567298"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-380-18"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2020-102699"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967116644241"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2021.10412"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-0997"},{"key":"e_1_3_2_26_2","unstructured":"Love K. Everyone is going through something. The Players\u2019 Tribune. https:\/\/www.theplayerstribune.com\/articles\/kevin-love-everyone-is-going-through-something. Accessed July 27 2023."},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200412000-00006"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-0478.20"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967121S00170"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-0679.21"},{"key":"e_1_3_2_31_2","unstructured":"Meister A Lavanchy M. Athletes are shifting the narrative around mental health at work. Harvard Business Review. https:\/\/hbr.org\/2021\/09\/athletes-are-shifting-the-narrative-around-mental-health-at-work. Accessed July 27 2023."},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-379-18"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/104012371702900404"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/1941738115598747"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1177\/1941738115614811"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1123\/jsep.2019-0235"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1080\/00913847.2017.1313077"},{"issue":"3","key":"e_1_3_2_38_2","first-page":"490","article-title":"Sport athletes may be less likely to suffer anxiety or depression than individual sport athletes","volume":"18","author":"Pluhar E","year":"2019","unstructured":"Pluhar E, McCracken C, Griffith KL, Christino MA, Sugimoto D, Meehan WPIII. Sport athletes may be less likely to suffer anxiety or depression than individual sport athletes. J Sports Sci Med. 2019;18(3):490-496.","journal-title":"J Sports Sci Med"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/1941738119886855"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ptsp.2018.05.014"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-100715"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-0852"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/7056075"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-018-1014-1"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-018-5955-y"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2020.01.032"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2018.11.049"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13034-022-00453-2"},{"key":"e_1_3_2_49_2","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000000631"},{"key":"e_1_3_2_50_2","doi-asserted-by":"publisher","DOI":"10.1177\/19417381211014867"}],"container-title":["Sports Health: A Multidisciplinary Approach"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19417381241228539","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19417381241228539","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19417381241228539","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:47:36Z","timestamp":1777589256000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19417381241228539"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,12]]},"references-count":49,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1177\/19417381241228539"],"URL":"https:\/\/doi.org\/10.1177\/19417381241228539","relation":{},"ISSN":["1941-7381","1941-0921"],"issn-type":[{"value":"1941-7381","type":"print"},{"value":"1941-0921","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,12]]}}}