The Influence of Race, Socioeconomic Status, and Physical Activity on the Mental Health Benefits of Sport Participation During COVID-19

Abstract

Background: The purpose of this study was to compare the benefits of sport participation with no sport participation during the COVID-19 pandemic and determine the moderating effects of race and ethnicity, socioeconomic status (SES), and physical activity (PA) on mental health in adolescent athletes.

Hypothesis: Sport participation would be associated with greater improvements in mental health for athletes from racial and ethnic minority and lower SES groups compared with White and high SES groups. PA would mediate <30% of the mental health benefits of sport participation.

Study design: Cross-sectional study.

Level of evidence: Level 4.

Methods: In May 2021, adolescent athletes completed an online survey (demographics, sport participation, measures of anxiety and depression, PA). Participants were classified as those who played sports (PLY) and those who did not (DNP). Mental health symptoms for the PLY and DNP groups were compared via analysis of variance models that controlled for demographic variables. Moderating analyses assessed the interaction of sport participation status by (1) race and ethnicity (White/non-White) and (2) SES (high/low) with mental health. Mediation analyses assessed the degree that PA scores explained the differences in anxiety and depression between the 2 groups.

Results: Participants included 4874 adolescent athletes (52% female; age, 16.1 ± 1.3 years; PLY, 91%). Athletes who returned to sport from racial minority groups and low SES had greater decreases in anxiety (race and ethnicity: interaction estimate (b) = -1.18 ± 0.6, P = 0.04; SES, b = -1.23 ± 0.5, P = 0.02), and depression (race and ethnicity: b = -1.19 ± 0.6, P = 0.05; SES, b = -1.21 ± 0.6, P = 0.03) compared with White and high SES athletes, respectively. PA explained 24% of anxiety (P < 0.01) and 20% of depression scores (P < 0.01).

Conclusion: Athletes who identify as a racial or ethnic minority and from areas of lower household income experienced disproportionately greater negative mental health impacts from sport restrictions during COVID-19.

Clinical relevance: Improving access to sports in traditionally underserved areas may have significant mental health impact for adolescents.

Keywords: COVID-19; anxiety; depression; mental health; minorities; public health; youth.

Figure 1.

Prevalence of anxiety symptoms for adolescent athletes who did or did not participate in sports during the COVID-19 pandemic. GAD-7 category percentages were estimated when controlling for age, sex, teaching delivery method, school, percentage of students eligible for free and reduced lunch, and concern over COVID-19. GAD-7, General Anxiety Disorder-7 Item survey.

Figure 2.

Prevalence of depression symptoms for adolescent athletes who did or did not participate in sports during the COVID-19 pandemic. PHQ-9 category percentages were estimated when controlling for age, sex, teaching delivery method, school, percentage of students eligible for free and reduced lunch, and concern over COVID-19. PHQ-9, Patient Health Questionnaire-9 item survey.

Figure 3.

Interaction between racial minority status (yes/no) and sport status (PLY/DNP) on GAD-7 and PHQ-9 scores. DNP, did not play sports; GAD-7, General Anxiety Disorder-7 Item survey; PHQ-9, Patient Health Questionnaire-9 item survey; PLY, played sports.

Figure 4.

Interaction between socioeconomic status (high/low) and sport status (PLY/DNP) on GAD-7 and PHQ-9 scores. DNP, did not play sports; GAD-7, General Anxiety Disorder-7 Item survey; PHQ-9, Patient Health Questionnaire-9 item survey; PLY, played sports.