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Female participation in NCAA athletics has grown significantly since the passage of Title IX—the 1972 U.S. federal law that prohibits sex-based discrimination in educational programs and activities receiving federal funding—yet much of the existing research continues to focus on male athletes, leaving important gaps in our understanding of women’s experiences in collegiate sports. One underexamined area with important public health implications is the role of coach–athlete relationships in shaping female athletes’ mental health, access to resources, and overall collegiate experience. This exploratory study draws on in-depth interviews with 19 former female NCAA athletes to examine how their relationships with coaches influenced their athletic careers, mental health, and perceptions of support. Participants represented a range of sports and competitive levels, allowing for variation in experiences across contexts. Findings reveal that coach–athlete relationships are not only central to performance and motivation but also serve as key sources of emotional, social, and material support—or, in some cases, stress and disengagement. The quality and impact of these relationships were shaped by competitive pressures, team dynamics, and institutional expectations. This study underscores the importance of relational context in understanding the broader landscape of female NCAA athletes’ experiences and suggests that coach–athlete dynamics merit greater attention in both research and athletic program development. These findings underscore the relevance of coach–athlete dynamics as a public health concern, particularly in relation to mental health and emotional well-being in competitive sports environments. Supporting healthier relational cultures in collegiate athletics is essential for promoting positive health outcomes among female student-athletes.

Purpose of Review Over 500,000 college students compete in the three divisions of the National Collegiate Athletic Association (NCAA) each year. The rates of most mental health issues among collegiate student-athletes approximate the rates among non-athlete college students. In recent years, greater attention has been given to recognizing and treating the mental health concerns of student-athletes. This paper examines some of the specific mental health considerations that may arise when working with student-athletes. Recent Findings Using a biopsychosocial-structural framework, we were able to identify several broad categories of factors that influence the mental health of student-athletes. Within those categories we identified specific diagnoses (such as physical injury), life events (such as early retirement from sport), ways of thinking (including stigma against mental health treatment), and external influences (such as racism and sexism) that impact the mental health of student-athletes. Summary Mental health concerns among college students are common. When working with student-athletes, there are biopsychosocial-structural factors that affect the mental health of student-athletes in unique ways compared to their non-athlete college student counterparts.

ObjectiveThe Concussion in Sport Group guidelines recommend a multifaceted approach to help clinicians make return to sport decisions. The purpose of this study was to identify the most common multifaceted measures used to define clinical recovery from sport-related concussion in young athletes (high school and/or college level) and to summarise existing knowledge of criteria used to make return to sport decisions.DesignSystematic review.Data sourcesThe PubMed (MEDLINE), SPORTDiscus and Embase electronic databases were searched from 1 January 2000 to 1 March 2017 by three independent reviewers.Eligibility criteriaInclusion criteria: elementary, high school and college age groups, and a specific definition of clinical recovery that required two or more measures. Exclusion criteria: review articles, articles using the same sample population, case studies, non-English language and those that used one measure only or did not specify the recovery measures used.Study qualityStudy quality was assessed using the Downs and Black Criteria.ResultsOf 2023 publications, 43 met inclusion criteria. Included articles reported the following measures of recovery: somatic symptom resolution or return to baseline (100%), cognitive recovery or return to baseline (86%), no exacerbation of symptoms on physical exertion (49%), normalisation of balance (30%), normal special physical examination (12%), successful return to school (5%), no exacerbation of symptoms with cognitive exertion (2%) and normalisation of cerebral blood flow (2%). Follow-up to validate the return to sport decision was reported in eight (19%) articles. Most studies were case–control or cohort (level of evidence 4) and had significant risk of bias.ConclusionAll studies of sport-related concussion use symptom reports to define recovery. A minority of studies used multiple measures of outcome or had clearly defined recovery criteria, the most common being a combination of a self-reported symptom checklist and a computerised neurocognitive test. Future studies ideally should define recovery a priori using objective physiological measures in addition to symptom reports.

After highly publicized stories of student-athletes’ struggles with mental health, the spotlight on mental health and well-being in this special issue coincides with a broader growing concern for the long-term impact of competitive sport participation on student-athlete health and wellness. The end of a competitive sport career represents a potentially vulnerable life transition. As demonstrated in the literature, the unique aspects of elite sport culture shape student-athletes’ perceptions of their identity, health, and health behaviors, which have implications for how student-athletes navigate their health and well-being as they transition away from the embedded health care structure inherent to elite sport. Given evidence indicating that student-athletes may face mental and physical health concerns after retirement from sports, targeted transitional strategies are needed to provide patient-centered care in this population. In this article, we briefly summarize current understanding of sport transition and highlight some key findings from studies conducted by the contributing authors’ research groups exploring the impact of sport career transitions on student-athlete well-being. We also reflect on limitations of the existing research and transition models and, in turn, propose potential directions for adopting a nuanced and multidimensional framework to explore interconnected transition domains. We conclude by offering recommendations for sports medicine professionals to consider in future research, programming, and policies to promote student-athletes’ holistic well-being through this critical transition.

ContextLean sports, such as endurance running, have been at the forefront of disordered eating and body image research, particularly in female populations. Yet little is known about how athletic men and women differ in body-checking behaviors, a known risk factor for body dissatisfaction and disordered eating, across sport type and athletic status.ObjectiveThe purpose of this study was to examine gender differences on measures of eating behavior and body checking between full-time collegiate student-athletes and nonathletes.DesignCross-sectional study.SettingNational Collegiate Athletic Association Division I collegiate athletics.Patients or Other ParticipantsTwo hundred fifty-nine full-time college students (n = 174 student-athletes, 85 nonathletes).Main Outcome Measure(s)Primary outcomes included self-reported disordered eating behavior and body-checking behavior through the Eating Attitudes Test-26 and the Body Checking Questionnaire (BCQ) and the Male BCQ (MBCQ). We explored differences based on sport type, team, individual, or nonathlete, and gender identity.ResultsThere was a statistically significant multivariate main effect of gender, F10,464 = 9.219, P < .001, ηp2 = 0.166, and a significant multivariate interaction of gender and sport type, F15,699 = 2.806, P = .001, ηp2 = 0.057. Follow-up comparisons for team-sport athletes showed that women scored significantly higher (P < .001) on the MBCQ compared with men. Women team-sport athletes also scored significantly higher on the MBCQ than women nonathletes (P < .001). Conversely, nonathlete men scored significantly higher on the MBCQ than men team- and individual-sport athletes (P = .003 and P = .048, respectively).ConclusionsFindings suggest that body-checking behaviors traditionally studied as masculine occur more frequently in women than men. This effect seems to be driven by women team-sport athletes, who reported engaging in more body-checking behaviors on the MBCQ than nonathletes. Therefore, assessments based on traditional views of maleness and femaleness may overlook significant risk factors for eating disorders in college athletes.

Objective To investigate the intervention effects of transcranial pulsed current stimulation (tPCS) on sleep quality in Student-Athlete with different types of sleep disorders. Methods Thirty Student-Athlete with morning-type (MT) sleep disorders and 30 with evening-type (ET) sleep disorders were recruited, aged 18–22 years, including 45 males and 15 females. Participants within each disorder type were equally divided into an experimental group (EXP, n  = 15) and a control group (CON, n  = 15) using a random number table. All groups received intervention for 28 consecutive days at a fixed time (stimulation intensity: 1.5 mA; duration: 30 min). The EXP received active stimulation, while the CON received sham stimulation. Heart Rate Variability (HRV) parameters and Pittsburgh Sleep Quality Index (PSQI) scores were collected from all participants before and after the intervention. Results (1) The ET group had lower baseline PSQI scores and HRV parameters than the MT group. (2) Following the tPCS intervention, the EXP exhibited significant decreases in PSQI ( P  = 0.007, = 0.231) scores and Low Frequency (LF) power, along with significant increases in the Root Mean Square of Successive Differences (RMSSD, P  < 0.001, = 0.633), Standard Deviation of NN intervals (SDNN, P  < 0.001, = 0.399), and High Frequency (HF, P  < 0.001, = 0.541) power. These changes were also significantly different compared to the CON ( P  < 0.05). (3) Post-intervention, the MT experimental group showed greater improvement in PSQI scores, whereas the ET experimental group exhibited a more significant increase in HRV indices. Conclusion (1) A 4-week tPCS intervention can improve sleep quality and increase parasympathetically-mediated HRV indices in Student-Athlete with sleep disorders. (2) Differential tPCS intervention time windows exist for Student-Athlete with sleep disorders based on their chronotype. (3) tPCS intervention administered between 18:00 and 19:00 yields greater improvement in sleep quality for the MT group compared to the ET group.

Social support can positively influence both physical and psychological recovery from sport-related injury. However, few studies have examined the influence of the quantity, quality, and timing of social support on athletes’ psychological health following injury. This study examined the effects of changes in social support on post-injury depressive and anxiety symptoms among college-student athletes. We conducted a prospective cohort study among Division I college-student athletes. Participants completed surveys at baseline and at multiple time points post-injury until return to play (RTP). A total of 597 injuries sustained by 389 student athletes (n = 400 (67.0%) males; n = 238 (39.9%) football players; n = 281 (47.1%) freshman) were included. The overall amount of social support increased from baseline to 1-week post-injury (p < 0.05) and then remained unchanged until RTP. The overall satisfaction with the support received increased from baseline to 1-week post-injury (p < 0.05) but decreased (p < 0.05) from 1-week post-injury to RTP. Increases in satisfaction with the support received were associated with decreases in post-injury depressive (β = −0.404), p < 0.0001) and anxiety symptoms (β = −0.406), p < 0.0001). Interventions involving social support may help hasten college-student athletes’ psychological recovery from injury.

Psychological skills training improves performance in athletes. However, authors of few studies have looked at the efficacy and satisfaction of mental skills training programs for collegiate athletes. To evaluate the satisfaction of collegiate athletes with a 6-session mental skills course and to assess changes in mental toughness and coping skills before and after the course. Cohort study. Division I collegiate athletic teams. Fifty-four Division I female athletes (mean age = 19.8 years) participated in the program, and 42 (77.7%) completed precourse assessments, which subsequent evaluations were matched to. The Athletic Coping Skills Inventory (ACSI; range, 0-84) and Mental Toughness Index (MTI; range, 8-56) assessed coping skills and mental toughness precourse, immediately postcourse, and 4 months postcourse. Satisfaction was assessed on a 10-point scale. For participants with paired precourse and immediately postcourse data (n = 37, 68.5%), MTI scores improved by a mean 2.6 points (95% CI = 1.1, 4.1; P = .001), and ACSI scores improved by a mean 4.0 points (95% CI = 0.6, 7.4; P = .02). At the 4-month follow-up (n = 25, 46.2%), no change was detected from precourse in mean MTI score (P = .72), but a significant increase of 3.4 points in mean ACSI (95% CI = 0.4, 6.4; P = .03) occurred. Overall satisfaction had a median score of 9/10 (interquartile range, 8-10) at postcourse, and 18 participants (48.6%) shared positive free-text comments regarding course delivery, content, and impact. No negative feedback was reported. Mental toughness and coping skills scores significantly improved at postcourse assessment, with coping skills scores maintaining their effect at 4 months. The improvements identified spark the question of the potential impact of mental skills training programs when studied in larger athlete populations or over more sustained periods of time. Athletes reported being highly satisfied with course content and reported overall positive experiences.

Background Sleep plays a vital role in the recovery of athletes, yet many student-athletes struggle with poor sleep quality. The literature has reported that chronotypes, which reflect different circadian phases, are related to poor sleep quality and lifestyle habits. However, there is a lack of findings specific to student-athletes. This study aimed to investigate differences in subjective sleep quality and related lifestyle habits among student-athletes based on their chronotype. Methods Student-athletes were defined as university athletic club members. A cross-sectional web-based survey collected data from 665 student-athletes at three Japanese universities (male: 70.7%; mean age: 19.7 ± 0.8 years). Chronotypes were assessed using the Morningness-Eveningness Questionnaire, while subjective sleep quality was measured using the Pittsburgh Sleep Quality Index. Lifestyle habits included skipping breakfast, taking caffeinated drinks, using a smartphone/cellphone after lights out, and morning practice. Subjective sleep quality and these lifestyle habits were compared among chronotypes using one-way analysis of covariance (ANCOVA), along with binomial and ordinal logistic regression analyses, adjusted for sex and age. Results The chronotype distribution was 15.9% eveningness, 72.9% intermediate, and 11.1% morningness. Individuals with later chronotypes had a higher prevalence of poor sleep quality. Additionally, a higher percentage of those with later chronotypes skipped breakfast and used a smartphone/cellphone after lights out. A lower percentage of later chronotypes also participated in morning practice ≥ 4 days/week. However, morning practice ≥ 4 days/week was associated with poor subjective sleep quality only among student-athletes with an evening chronotype, not among those with intermediate or morning chronotype. Conclusion Addressing poor lifestyle habits and promoting earlier chronotypes may be crucial for improving subjective sleep quality in student-athletes with an evening chronotype.

In student-athletes, the struggle to maintain a balance between athletic and academic performance results in poor mental health. Positive mental health prevents mental health problems. There is very little research on this topic, due to the focus on mental health problems, and the lack of measurement tools. The purpose of this study is to examine the potential of psychological capital (PsyCap) as a psychological resource for the positive mental health of student-athletes. Also, we aim to validate the Psychological Capital Questionnaire (PCQ-24) adapted to the sports context. This research is grounded in the conservation of resources theory, and the broaden-and-build theory. Data were collected using purposive sampling from student-athletes (N = 301). Self-report measures were used and their reliability, validity, and model fitness were evaluated using confirmatory factor analysis. Structural equation modeling was applied for model testing. The competing models for first-order and second-order PsyCap were tested. PsyCap as a synergistic resource has a stronger relationship with positive mental health than each of its dimensions. Furthermore, as an independent psychological resource, only self-efficacy and optimism positively correlated with positive mental health. Additionally, this study shows that the adaptation of PCQ-24 in the sports context was not successful, PCQ-21 is a reliable and valid measure of sport PsyCap. The findings of this study have implications for student-athletes, coaches, sports psychologists, and mental health professionals.