Psychological distress among dancers seeking outpatient treatment for musculoskeletal injury.
The purpose of this study was to investigate the incidence and magnitude of clinically significant psychological symptoms among outpatient injured dancers presenting for musculoskeletal issues and to identify features of "at risk" dancer-patients who might require additional psychological support when injured. The Brief Symptom Inventory® (BSI), a highly reliable and valid screening tool for psychological distress, was administered to first- and last-visit injured dancers at an orthopedic clinic in the Netherlands from February to May 2008. In all, 153 BSI surveys were completed, including 82 among first-visit patients and 71 among end-treatment patients. Scores were examined for the influence of age, gender, dance level, style, pain, perceived level of artistic compromise, and anatomic location of injury. Dancers' scores were compared to normative values for adult non-psychiatric patient community members. Ninety-two dancers (60.1%) met requirements for clinical referral to a psychologist or psychiatrist, having scored two or more standard deviations (SD) above the norm in at least one of nine psychopathological symptoms. Across first- and last-visit groups, dancers met referral criteria for an average of four psychopathological symptoms. First-visit dancers demonstrated higher distress than the general population on 90% of BSI dimensional symptoms and last-visit dancers on 50%. On the Global Symptom Index, a summary score for overall distress and the best measure of psychological discomfort, 46.6% of dancers demonstrated "above average" distress (≥ 1 SD) compared to the general population, and 19.6% demonstrated "high" (≥ 2 SD) or "very high" (≥ 2.5 SD) distress. Compared to academy level pre-professional students, professionals showed reduction in BSI scores on somatic, cognitive, interpersonal sensitivity, anxious, hostile, phobic, and global scores following resolution of injury, particularly among those greater than 25 years of age. Students and professionals less than 25 years of age demonstrated little change in scores from the initial visit to the end of treatment. In addition, students worsened in somatization and depression domains over time, suggesting perseverative or brooding behavior and poor coping skills. Amateurs overall scored average or below average on the BSI compared to the general population at both time points. It is concluded that healthcare providers should be made aware that outpatient injured dancers presenting for musculoskeletal assessment may additionally have high levels of psychological distress, and this may warrant formal evaluation by a mental health professional.
Hospital for Special Surgery, Department of Physiatry, 535 East 70th Street, New York, New York, USA. mamie.air@gmail.com.
Mary Elizabeth
ME
Air
D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D003615:Dancing / Q000293:injuries*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System / Q000293:injuries*; D063806:Myalgia / Q000209:etiology; D009426:Netherlands / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D011795:Surveys and Questionnaires