A Qualitative Study Exploring Factors Linked to Adolescent Athletes’ Mental Health During Sports Injury

Adolescent athletes have specific developmental risks for sports injury and the onset of mental health problems. Research has typically focused on mental health during specific sports injury phases, such as rehabilitation, with little consideration for factors linked to adolescence. This qualitative study retrospectively explored factors influencing adolescent athletes’ mental health across the injury course, emphasising developmental, social, environmental and sport-cultural contexts. Semistructured interviews were conducted with 27 athletes aged 16–21 years who had sustained a severe time-loss injury in the past 6 months. Participants completed a visual timeline to support reflections on mental health from injury onset to rehabilitation or return to sport. Data were analysed using reflexive thematic analysis, combining inductive and deductive approaches. Five themes described factors linked to fluctuating mental health. ‘Finding my inner strength’ explores how injury introduced vulnerability to developing personal identities, which led to self-blame for injury-risk behaviour, training through pain and social withdrawal. ‘Making sense of my emotions’ describes how injury triggered overwhelming worries, amplified by unexplained pain and losing sport as a coping strategy. ‘Learning to look after myself’ considers how athletes’ growing independence and emotional autonomy can be thwarted by parents during injury, prompting frustration and lowered self-esteem. ‘Accepting peer judgement and support’ explores how worries about peer evaluation led to concealing injury and social withdrawal, and social exclusion prompted lowered mood and self-esteem. ‘Adapting to the system’ describes how diagnostic uncertainty and rigid or unsupportive sport cultures caused frustration and lowered self-esteem, and prevented help-seeking. Cognitive flexibility and emotion regulation skills at the individual level, and social support and mental health literacy at interpersonal and organisational levels, were positive for adolescents’ mental health at challenging points during injury. These factors may make suitable intervention targets to support athlete mental health while injured.