Sports Medicine Handbook - NCAA

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performance, poor relationship with a coach). An adjustment disorder can also progress into major depressive disorder. Establishing a relationship with mental health services Athletics departments should identify and foster relationships with mental health resources on campus or within the local community that will enable the development of a diverse and effective referral plan addressing the mental well-being of their studentathletes and staff. Because studentathletes are less likely to use counseling than nonathlete students, increasing in teraction among mental health staff members, coaches and student-athletes will improve compliance with referrals. Athletics departments can seek psychological services and mental health professionals from the following resources. • Athletics department sports medicine services. • Athletics department academic services. • University student health and counseling services. • University medical school. • University graduate programs (health sciences, education, medical, allied health). • Local community. Screening for depression and related risk for suicide One way to ensure an athletics department is in tune with studentathletes’ mental well-being is to systematically include mental health check-ups, especially around highrisk times such as the loss of a coach, significant injury, being cut Depression: Intervention for Intercollegiate Athletics from the team and catastrophic events. Members of the sports medicine team and/or licensed mental health professionals should also screen athletes for depression at pre-established points in time (e.g., pre-participation, exit interviews). Research indicates that sports medicine professionals are better equipped to assess depression with the use of appropriate mental health instruments; simply asking about depression is not recommended. A thorough assessment on the part of a mental health professional is also imperative to differentiate major depression from dysthymia and bipolar disorder, and other conditions, such as medication use, viral illness, anxiety disorders, overtraining and illicit substance use. Depressive disorders may co-exist with substance-abuse disorders, panic disorder, obsessivecompulsive disorder, anorexia nervosa, bulimia nervosa and borderline personality disorder. For depression screening, it is recommended that sports medicine teams use the Center for Epidemiological Studies Depres sion (CES-D) Scale published by the National Institute for Mental Health (NIMH). The CES-D is free to use and available at www.nimh.nih.gov. Other re sourc es include such programs as QPR (Question, Persuade, Refer) Gate keeper training; the Jed Found ation U Lifeline; and the Screening for Mental Health Depression and Anxiety Screenings. Information about these programs, and ways to incorporate them into studentathlete check-ups, can be found at <strong>NCAA</strong>.org/health-safety. Seeking help Most individuals who suffer from depression will fully recover to lead productive lives. A combination of counseling and medication appears to be the most effective treatment for moderately and severely de pressed individuals. Although some improvement in mood may occur in the first few weeks, it typically takes three to four weeks of treatment to obtain the full therapeutic effect. Medication should only be taken and/or stopped under the direct care of a physician, and the team physicians should consult with psychiatrists regarding complex mental health issues. A referral should be made to a licensed mental health professional when coaches or sports medicine staff members witness any of the following with their studentathletes: • Suicidal thoughts. • Multiple depressive symptoms. • A few depressive symptoms that persist for several weeks. • Depressive symptoms that lead to more severe symptoms or de structive behaviors. • Alcohol and drug abuse as an attempt at self treatment. • Overtraining or burnout, since depression has many of the same symptoms. Coaches and sports medicine staff members should follow the following guidelines in order to help enhancing student-athlete compliance with mental health referrals: • Express confidence in the mental health professional (e.g., “I know that other student-athletes have felt better after talking to Dr. Kelly.”). • Be concrete about what counseling is and how it could help (e.g., “Amy can help you focus more on your strengths.”). 79
80 Depression: Intervention for Intercollegiate Athletics • Focus on similarities between the student-athlete and the mental health professional (e.g., “Bob has a sense of humor that you would appreciate.” “Dr. Jones is a former college student-athlete and understands the pressures student-athletes face.”). • Offer to accompany the studentathletes to their initial appointment. • Offer to make the appointment (or have the student-athlete make the appointment) while in your office. • Emphasize the confidentiality of medical care and the referral process. The following self-help strategies may improve mild depression symptoms: • Reduce or eliminate the use of alcohol and drugs. • Break large tasks into smaller ones; set realistic goals. • Engage in regular, mild exercise. • Eat regular and nutritious meals. • Participate in activities that typically make you feel better. • Let family, friends and coaches help you. • Increase positive or optimistic thinking. • Engage in regular and adequate sleep habits. Table 1 DEPRESSIVE SIGNS AND SYMPTOMS Individuals might present: • Decreased performance in school or sport. • Noticeable restlessness. • Significant weight loss or weight gain. • Decrease or increase in appetite nearly every day (fluctuating?). Individuals might express: • Indecisiveness. • Feeling sad or unusually crying. • Difficulty concentrating. • Lack of or loss of interest or pleasure in activities that were once enjoyable (hanging out with friends, practice, school, sex). • Depressed, sad or “empty” mood for most of the day and nearly every day. • Recurrent thoughts of death or thoughts about suicide. • Frequent feelings of worthlessness, low self-esteem, hopelessness, helplessness or inappropriate guilt. Table 2 MANIC SIGNS AND SYMPTOMS Individuals might present: • Abnormal or excessive elation. • Unusual irritability. • Markedly increased energy. • Poor judgment. • Inappropriate social behavior. • Increased talking. Individuals might express: • Racing thoughts. • Increased sexual desire. • Decreased need for sleep. • Grandiose notions.
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2011-12 NCAA® Sports Medicine Hand
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2 PREFACE The health and safety pri
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4 FOREWORD Shared Responsibility fo
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6 Sports Medicine Administration Oc
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8 Medical Evaluations, Immunization
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10 Medical Evaluations, Immunizatio
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12 Emergency Care and Coverage Guid
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14 Lightning Safety Dangerous Locat
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16 Catastrophic Incident in Athleti
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18 Dispensing Prescription Medicati
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20 Nontherapeutic Drugs July 1981
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22 NCAA Alcohol, Tobacco and Other
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24 Preseason Preparation directly d
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26 Preseason Preparation NCAA Footb
Page 29 and 30: 28 Medical Disqualification of the
Page 31 and 32: 30 Cold Stress and Cold Exposure to
Page 33 and 34: 32 Cold Stress and Cold Exposure Re
Page 35 and 36: 34 Prevention of Heat Illness The A
Page 37 and 38: 36 Prevention of Heat Illness Refer
Page 39 and 40: 38 Assessment of Body Composition J
Page 41 and 42: 40 Assessment of Body Composition i
Page 43 and 44: 42 Assessment of Body Composition p
Page 45 and 46: 44 Nutrition and Athletic Performan
Page 47 and 48: 46 Nutrition and Athletic Performan
Page 49 and 50: 48 Dietary Supplements or muscle ma
Page 51 and 52: 50 “Burners” (Brachial Plexus I
Page 53 and 54: 52 “Burners” (Brachial Plexus I
Page 55 and 56: 54 Concussion or Mild Traumatic Bra
Page 61 and 62: 60 Skin Infections in Athletics In
Page 63 and 64: 62 Skin Infections in Athletics Ski
Page 65 and 66: 64 Skin Infections in Athletics Ref
Page 67 and 68: 66 Menstrual-Cycle Dysfunction Janu
Page 69 and 70: 68 Blood-Borne Pathogens and Interc
Page 75 and 76: 74 The use of local injectable anes
Page 77 and 78: 76 The Use of Injectable Corticoste
Page 79: 78 Depression: Intervention for Int
Page 83 and 84: 82 Participation by the Student-Ath
Page 85 and 86: 84 Pregnancy in the Student-Athlete
Page 87 and 88: 86 The Student-Athlete with Sickle
Page 89 and 90: 88 should provide an environment in
Page 91 and 92: 90 Protective Equipment June 1983
Page 93 and 94: 92 Protective Equipment Sport 5. Fo
Page 95 and 96: 94 Protective Equipment Mandatory P
Page 97 and 98: 96 Eye Safety in Sports January 197
Page 99 and 100: 98 Mouthguards January 1986 • Rev
Page 101 and 102: 100 Head and neck injuries causing
Page 103 and 104: 102 Guidelines for Helmet Fitting a
Page 105 and 106: 104 Use of Trampoline and Minitramp
Page 108 and 109: Appendixes Also found on the NCAA w
Page 110 and 111: NCAA Legislation Involving Health a
Page 112 and 113: Tobacco Use Medical Expenses Medica
Page 114 and 115: Student-Athlete Welfare and Safety
Page 116 and 117: NCAA Injury Surveillance Program Su
Page 118 and 119: Figure 1 Competition and Practice I
Page 120 and 121: Acknowledgements John R. Adams West
Page 122: The NCAA salutes the more than 400,
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Sports Medicine Handbook - NCAA

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