title: The psychological factor 'self-blame' predicts overuse injury among top-level Swedish track and field athletes: a 12-month cohort study.
abstract: BACKGROUND
  Athletes' psychological characteristics are important for understanding sports injury mechanisms. We examined the relevance of psychological factors in an integrated model of overuse injury risk in athletics/track and field.
  
  
  METHODS
  Swedish track and field athletes (n=278) entering a 12-month injury surveillance in March 2009 were also invited to complete a psychological survey. Simple Cox proportional hazards models were compiled for single explanatory variables. We also tested multiple models for 3 explanatory variable groupings: an epidemiological model without psychological variables, a psychological model excluding epidemiological variables and an integrated (combined) model.
  
  
  RESULTS
  The integrated multiple model included the maladaptive coping behaviour self-blame (p=0.007; HR 1.32; 95% CI 1.08 to 1.61), and an interaction between athlete category and injury history (p<0.001). Youth female (p=0.034; HR 0.51; 95% CI 0.27 to 0.95) and youth male (p=0.047; HR 0.49; 95% CI 0.24 to 0.99) athletes with no severe injury the previous year were at half the risk of sustaining a new injury compared with the reference group. A training load index entered the epidemiological multiple model, but not the integrated model.
  
  
  CONCLUSIONS
  The coping behaviour self-blame replaced training load in an integrated explanatory model of overuse injury risk in athletes. What seemed to be more strongly related to the likelihood of overuse injury was not the athletics load per se, but, rather, the load applied in situations when the athlete's body was in need of rest.
authors.affiliation: Athletics Research Center, Linköping University, Linköping, Sweden Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Unit for Health Analysis, Centre for Healthcare Development, County Council of Östergötland, Linköping, Sweden.
authors.forename: Toomas
authors.identifier: http://orcid.org/0000-0001-6049-5402
authors.initials: T
authors.lastname: Timpka
authors.affiliation: Athletics Research Center, Linköping University, Linköping, Sweden Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Jenny
authors.initials: J
authors.lastname: Jacobsson
authors.affiliation: Athletics Research Center, Linköping University, Linköping, Sweden Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Dahlström
authors.affiliation: Athletics Research Center, Linköping University, Linköping, Sweden Department of Clinical Science, Intervention and Technology, Pediatric Unit, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Kowalski
authors.affiliation: Athletics Research Center, Linköping University, Linköping, Sweden Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Department of Orthopaedics and Rehabilitation, Moi University, Eldoret, Kenya.
authors.forename: Victor
authors.initials: V
authors.lastname: Bargoria
authors.affiliation: Athletics Research Center, Linköping University, Linköping, Sweden Department of Medical and Health Sciences, Linköping University, Linköping, Sweden Unit for Health Analysis, Centre for Healthcare Development, County Council of Östergötland, Linköping, Sweden.
authors.forename: Joakim
authors.initials: J
authors.lastname: Ekberg
authors.affiliation: Athletics Research Center, Linköping University, Linköping, Sweden Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Sverker
authors.initials: S
authors.lastname: Nilsson
authors.affiliation: Athletics Research Center, Linköping University, Linköping, Sweden Department of Molecular Medicine and Surgery, Center for Sports Trauma Research and Education, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Renström
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D012090:Cumulative Trauma Disorders / Q000523:psychology*; D015444:Exercise / Q000523:psychology; D005260:Female; D006167:Guilt; D006801:Humans; D008297:Male; D008960:Models, Psychological; D009042:Motivation; D010465:Perception; D000068958:Return to Sport; D012307:Risk Factors; D012649:Self Concept; D011795:Surveys and Questionnaires; D013548:Sweden; D014142:Track and Field / Q000293:injuries* / Q000523:psychology; D055815:Young Adult
keywords: Athletics; Epidemiology; Injuries; Psychology