Depression is common among athletes following sport injury, yet few studies have explored the severity of postinjury depression. Among those studies, only one examined gender differences although women in the general population are more likely than men to experience depression. No research to date has used interviews to assess depression despite their standard use among mental health professionals. In a quasi-experimental design, we used a self-report checklist and a clinical interview to compare depression among male and female athletes at 1 week, 1 month, and 3 months postinjury. Results revealed significant effects of group (injured vs. control) and time (since injury), and these effects were different for the two depression measures. We also explored the sensitivity and specificity of the user-rated checklist in identifying severely depressed athletes compared with the interview. Findings underscore the importance of multimodal approaches and clinical judgment when evaluating athletes' postinjury depression symptoms.

Younger women being treated for breast cancer consistently show greater depression shortly after diagnosis than older women. In this longitudinal study, we examine whether these age differences persist over the first 26 months following diagnosis and identify factors related to change in depressive symptoms. A total of 653 women within 8 months of a first time breast cancer diagnosis completed questionnaires at baseline and three additional timepoints (6, 12, and 18 months after baseline) on contextual/patient characteristics, symptoms, and psychosocial variables. Chart reviews provided cancer and treatment-related data. The primary outcome was depressive symptomatology assessed by the Beck Depression Inventory. Among women younger than age 65, depressive symptoms were highest soon after diagnosis and significantly decreased over time. Depressive symptoms remained stable and low for women aged 65 and older. Age was no longer significantly related to depressive symptoms in multivariable analyses controlling for a wide range of covariates. The primary factors related to levels of and declines in depressive symptomatology were the ability to pay for basics; completing chemotherapy with doxorubicin; and decreases in pain, vasomotor symptoms, illness intrusiveness, and passive coping. Increased sense of meaning/peace and social support were related to decreased depression. Interventions to reduce symptoms and illness intrusiveness, improve a sense of meaning and peace, and increase social support, may help reduce depression and such interventions may be especially relevant for younger women.

Background Cancer survivors may experience posttraumatic growth (PTG), positive psychological changes resulting from highly stressful events; however, the longitudinal course of PTG is poorly understood. Purpose To determine trajectories of PTG in breast cancer survivors and associated characteristics. Methods Women (N=653) participating in a longitudinal observational study completed questionnaires within 8 months of breast cancer diagnosis and 6, 12, and 18 months later. Group-based modeling identified PTG trajectories. Chi-square tests and ANOVA detected group differences in demographic, medical and psychosocial variables. Results Six trajectory groups emerged. Three were stable at different levels of PTG, two increased modestly, and one increased substantially over time. Trajectory groups differed by age, race, receipt of chemotherapy, illness intrusiveness, depressive symptoms, active-adaptive coping, and social support. Conclusions This first examination of PTG trajectories in US cancer survivors elucidates heterogeneity in longitudinal patterns of PTG. Future research should determine whether other samples exhibit similar trajectories and whether various PTG trajectories predict mental and physical health outcomes.

Changes in anterior knee laxity (AKL), genu recurvatum (GR) and general joint laxity (GJL) were quantified across days of the early follicular and early luteal phases of the menstrual cycle in 66 females, and the similarity in their pattern of cyclic variations examined. Laxity was measured on each of the first 6 days of menses (M1-M6) and the first 8 days following ovulation (L1-L8) over two cycles. The largest mean differences were observed between L5 and L8 for AKL (0.32 mm), and between L5 and M1 for GR (0.56 • ) and GJL (0.26) (p < 0.013). At the individual level, mean absolute cyclic changes in AKL (1.8 ± 0.7 mm, 1.6 ± 0.7 mm), GR (2.8 ± 1.0 • , 2.4 ± 1.0 • ), and GJL (1.1 ± 1.1, 0.7 ± 1.0) were more apparent, with minimum, maximum and delta values being quite consistent from month to month (ICC 2,3 = 0.51-0.98). Although the average daily pattern of change in laxity was quite similar between variables (Spearman correlation range 0.61 and 0.90), correlations between laxity measures at the individual level were much lower (range −0.07 to 0.43). Substantial, similar, and reproducible cyclic changes in AKL, GR, and GJL were observed across the menstrual cycle, with the magnitude and pattern of cyclic changes varying considerably among females. © Joint laxity continues to be a variable of interest as we seek to uncover the underlying risk factors for ACL injury in females.

Background This longitudinal study sought to identify groups of breast cancer survivors exhibiting distinct trajectories of depressive symptoms up to 24 months following diagnosis, and to describe characteristics associated with these trajectories. Methods 653 women completed baseline questionnaires within 8 months of breast cancer diagnosis on patient characteristics, symptoms, and psychosocial variables. Depressive symptoms were assessed at baseline and 6, 12, and 18 months after baseline. Chart reviews provided cancer and treatment-related data. Finite mixture modeling identified trajectories of depressive symptoms measured with the Beck Depression Inventory (BDI). Results Six distinct trajectories were identified. Just over half of the sample had consistently very low (3.8%) or low (47.3%) BDI scores well below the traditional BDI cut-point of 10 thought to be indicative of clinically significant depression; 29.2% had consistently borderline scores; 11.3% had initially high scores that declined over time, but remained above the cut-point; 7.2% showed increased BDI over time; and a small but unique group (1.1%) reported chronically high scores above 25. Women in groups with lower depressive symptom levels were older, had less rigorous chemotherapy, fewer physical symptoms (fatigue and pain), and lower levels of illness intrusiveness. Conclusions Approximately 20% of women had levels of depressive symptoms indicative of clinical depression that were maintained two years post-diagnosis. Factors related to trajectory membership such as illness intrusiveness, social support, fatigue, pain, and vasomotor symptoms suggest targets for possible intervention. Impact Results demonstrate the heterogeneity of depressive symptoms following breast cancer and the need for continued screening post treatment.

Objective To determine the extent to which select lower extremity alignment characteristics of the pelvis, hip, knee, and foot are related to the Q angle. Design Descriptive cohort study design. Setting Applied Neuromechanics Research Laboratory. Participants Two hundred eighteen participants (102 males, 116 females). Assessment of Risk Factors Eight clinical measures of static alignment of the left lower extremity were measured by a single examiner to determine the impact of lower extremity alignment on the magnitude of Q angle. Main Outcome Measures Q angle, pelvic angle, hip anteversion, tibiofemoral angle, genu recurvatum, tibial torsion, navicular drop, and femur and tibia length. Results Once all alignment variables were accounted for, greater tibiofemoral angle and femoral anteversion were significant predictors of greater Q angle in both males and females. Pelvic angle, genu recurvatum, tibial torsion, navicular drop, and femur to tibia length ratio were not significant independent predictors of Q angle in males or females. Conclusions Greater femoral anteversion and tibiofemoral angle result in greater Q angle, with changes in tibiofemoral angle having a substantially greater impact on the magnitude of the Q angle compared with femoral anteversion. As such, the Q angle seems to largely represent a frontal plane alignment measure. As many knee injuries seem to result from a combination of both frontal and transverse plane motions and forces, this may in part explain why Q angle has been found to be a poor independent predictor of lower extremity injury risk.

Purpose To examine the relationships between anterior knee laxity (AKL), genu recurvatum (GR), and general joint laxity (GJL) with sagittal plane energetics in males and females during a drop jump task. Methods A total of 68 females and 50 males were measured for AKL, GR, and GJL and were instrumented to obtain neuromuscular and biomechanical data on their dominant limb during the initial landing phase of a 45-cm drop jump. Multiple linear regressions determined the extent to which the three joint laxity variables combined to predict hip, knee, and ankle work absorption and stiffness. Associations between joint laxity and joint kinematics, joint kinetics, and muscle activation amplitudes were also investigated to further interpret significant relationships. Results Higher AKL and GJL and lower GR combined to predict greater knee work absorption (R2 = 0.210, P = 0.002) and stiffness (R2 = 0.127, P = 0.033) and lower ankle stiffness (R2 = 0.115, P = 0.048) in females. These associations were modulated through greater peak knee extensor moments and flexion angles, lower hamstring activation, and lower ankle extensor moments. In males, joint laxity had little impact on knee energetics, but a significant association was observed between greater GJL and decreased ankle stiffness (R2 = 0.209, P = 0.012), a product of both greater peak ankle flexion and decreased ankle extensor moment. Conclusions Females with greater AKL and GJL and lower GR demonstrated a landing strategy that increased work absorption and stiffness about the knee, whereas females with greater GR demonstrated a landing style that reduced knee work absorption and stiffness. The findings suggest that AKL, GR, and GJL may represent distinct risk factors and support the need to consider more comprehensive laxity profiles as they relate to knee joint function and anterior cruciate ligament injury risk.

Younger women with breast cancer consistently show greater psychological distress than older women. This study examined a range of factors that might explain these age differences. A total of 653 women within 8 months of a first-time breast cancer diagnosis provided data on patient characteristics, symptoms, and psychosocial variables. Chart reviews provided cancer and treatment-related data. The primary outcome was depressive symptomatology assessed by the Beck Depression Inventory. A succession of models that built hierarchically upon each other was used to determine which variables could account for age group differences in depression. Model 1 contained age group only. Models 2–5 successively added patient characteristics, cancer-related variables, symptoms, and psychosocial variables. As expected, in the unadjusted analysis (Model 1) younger women were significantly more likely to report depressive symptomatology than older women (p < 0.0001). Age remained significantly related to depression until Model 4 which added bodily pain and vasomotor symptoms (p = 0.24; R = 0.27). The addition of psychosocial variables in Model 5 also resulted in a model in which age was nonsignificant (p = 0.49; R2 = 0.49). Secondary analyses showed that illness intrusiveness (the degree that illness intrudes on specific areas of life such as work, sex life, recreation, etc.) was the only variable which, considered individually with age, made the age group-depression association nonsignificant. Age differences in risk of depression following a breast cancer diagnosis can be explained by the impact of cancer and its treatment on specific areas of a woman’s life.