title: Stages of psychological impact after diagnosis with serious or potentially lethal cardiac disease in young competitive athletes: a new model.
abstract: OBJECTIVE
  Sudden cardiac death (SCD) in sports is a tragic event. Pre-participation cardiovascular screening is required before participation in high school and college athletic programs and is universally endorsed by major medical societies. The medical impact of a diagnosis may be life-saving; however, the detection of disease should not be the sole endpoint of care. Physicians have an obligation to attend to both the medical and psychological well-being of their patients.
  
  
  OBJECTIVE
  To determine the psychological impact of being diagnosed with cardiac disease in young competitive athletes.
  
  
  METHODS
  Athletes diagnosed with cardiac conditions were recruited to participate in a semi-structured interview, which was analyzed by sport psychology experts using qualitative research. Individuals shared reactions and experiences regarding diagnosis, lifestyle implications, coping strategies, major concerns, and overall impact on psychosocial functioning.
  
  
  METHODS
  Young competitive athletes from across the United States.
  
  
  METHODS
  25 athletes (52% male, 80% Caucasian, median age 17.7) participated. Diagnoses included: 5 hypertrophic cardiomyopathy, 8 Wolff Parkinson White, 4 long QT syndrome, 3 atrial septal defect, 2 supraventricular tachycardia, and 3 other.
  
  
  METHODS
  Interviews were analyzed using consensual qualitative research (CQR) to identify domains, categories, and core ideas.
  
  
  RESULTS
  Athletes progressed through 4 stages of psychological impact including: 1) immediate reactions and challenge to athlete identity, 2) grief/coping, 3) adaptation, and 4) acceptance. Risk factors for increased psychological morbidity included: higher level of competition, permanent disqualification from sports, persistent reminders (e.g. daily medication, monitoring heart rate during activity), and unanticipated outcomes (e.g. failed procedures). Those undergoing simple corrective procedures came to terms with their diagnosis quickly with little impact on daily life. Few athletes described emotional support mechanisms provided by medical programs. Diagnosis often led to new goals such as mentoring or coaching. All athletes diagnosed through advanced cardiovascular screening stated they would repeat the process.
  
  
  CONCLUSIONS
  Athletes diagnosed with cardiac disease represent an emotionally vulnerable population and experience 4 stages of psychological adjustment not previously described. This proposed model of psychological impact should be used to develop improved support mechanisms, awareness, and education to assist athletes diagnosed with serious or potentially lethal cardiac disease.
authors: Department of Family Medicine, Greenville Health System, University of South Carolina Greenville School of Medicine, Greenville, SC, USA. Electronic address: iasif@sc.edu.
authors: Irfan M
authors: IM
authors: Asif
authors: Department of Family Medicine, Carolinas Medicine Center, Charlotte, NC, USA.
authors: David
authors: D
authors: Price
authors: Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA.
authors: Leslee A
authors: LA
authors: Fisher
authors: Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA.
authors: Rebecca A
authors: RA
authors: Zakrajsek
authors: Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA.
authors: Leslie K
authors: LK
authors: Larsen
authors: Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA.
authors: Johannes J
authors: JJ
authors: Raabe
authors: Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN, USA.
authors: Matthew P
authors: MP
authors: Bejar
authors: Department of Family Medicine, University of Washington, Seattle, WA, USA.
authors: Ashwin L
authors: AL
authors: Rao
authors: Department of Family Medicine, University of Washington, Seattle, WA, USA.
authors: Kimberly G
authors: KG
authors: Harmon
authors: Department of Family Medicine, University of Washington, Seattle, WA, USA.
authors: Jonathan A
authors: JA
authors: Drezner
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D056352:Athletes / Q000523:psychology*; D003955:Diagnostic Tests, Routine / Q000523:psychology; D004562:Electrocardiography / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D015994:Incidence; D008297:Male; D018580:Mandatory Testing / Q000706:statistics & numerical data; D000067450:Psychology, Sports; D013177:Sports / Q000523:psychology* / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Athlete; ECG; Electrocardiogram; Exercise; Prevention; Psychology; Sport; Sudden cardiac death