Confinement as a result of the COVID-19 pandemic has led to changes in the lifestyle and mental health of athletes, which may expose them to certain psychological disorders (1). Taheri et al. (2) found that COVID-19 lockdowns had a negative impact on athletes’ mental health, leading to higher levels of depression, anxiety, and stress. As far as we know, little is known about the psychological impact of the COVID-19 pandemic lockdowns on college athletes, especially those infected by COVID-19. Therefore, it is important to study athlete behavior during the COVID-19 pandemic to identify factors and develop relevant intervention strategies that can help improve the consequences of COVID-19 pandemic or similar situations in the future. Suicidality is a complex series of processes (3), ranging from suicidal ideation, suicide planning, self-harm, suicide attempts, and ultimately death by suicide, which is rare before adolescence, but is very common among adolescents and college students worldwide. The prevalence of self-injurious behavior (e.g., cutting oneself, burning oneself) is also high among college students (4). Suicidality and self-injurious behavior are highly correlated with suicidal ideation and self-harm attempts (5), and are strongly associated with the finalization of suicidal behavior.

In current study, students who possess certain sporting abilities and pass the sports training examination of regular institutes of higher learning or the recruiting examination of elite sports teams are referred to as college athletes. In contrast to other college students, university athletes’ primary responsibility is to represent their institution by competing in local, state, and national competitions in order to support their institution’s and the country’s competitive sports programs. They are susceptible to mental health issues due to the overload of training, increased risk of injury, ambiguity around their sporting future, and ongoing pressure from school and competition (6). College athletes are the youth strength of the new era, with the dual pressure of education and training (7), and their suicidal behavior not only cause panic and emulation among their peers, but also damage the family structure and affect the safety building of schools and society. The stress-diathesis model (8) states that stressful events are an important factor in causing individuals to commit suicide. Stressful events, such as the outbreak of the COVID-19 pandemic, lead to the possibility that some college athletes may be infected by COVID-19 and develop psychological stress and distress regurgitation, which may culminate in a suicide behavior. Therefore, the issue of suicide among college athletes needs further attention, especially the study of SSIB among college students.

Distress rumination, a state in which individuals reflect on distressing events affected by negative life and emotions (9), is a potential factor that increases the risk of suicidal ideation (10). Studies have shown that college students who experience distressing ruminations after a traumatic event are more likely to have severe SSIB (11, 12). Similarly, another study found that distress rumination was a predictor of suicidal ideation (13). Furthermore, the stress-diathesis model shows that the behavioral and psychological disorders is the result of the interaction between stress and individual susceptibility (14). Whereas traumatic events are an important source of stress, painful rumination is a susceptibility factor that can jointly influence the level of suicidal ideation (15). It follows that distress rumination is an important predictor of suicidal ideation. Resilience is the ability of an individual to adapt well in the face of life adversity, trauma, tragedy, threat, or other major life stressors, and it implies the “ability to bounce back” in the face of life stresses and setbacks (16). Psychological resilience have been shown to have an impact on SSIB. Research has shown that mental resilience has a negative predictive effect on self-injurious behavior or suicidal ideation (17), and the lower the level of mental resilience, the higher the frequency of self-injury. Mental resilience not only serves as a protective factor to weaken the negative effects of negative events on individuals, but also reduces the likelihood of suicidal ideation (18).

Depression is a mood disorder characterized by depressed mood, including symptoms such as sadness and despair, reduced interest and inattention, which can jeopardize an individual’s academic life and interpersonal interactions, and even lead to suicide in severe cases (19). Numerous studies have shown that depression is an important risk factor for triggering SSIB and is strongly associated with suicidal ideation and behavior (20–22). Suicide is the most serious consequence of depression, where the prevalence of depression is about 2 to 9% (23). A Meta-analysis showed that the type of mental disorder most strongly associated with suicide attempts was depressive disorder (24). According to Eriksons theory of psychological development, college students are at a critical stage of rapid physical and mental development and are vulnerable to psychosocial factors (25). Seo et al. (26) have found that reducing the level of depression in individuals plays an important role in suppressing suicidal ideation and reducing suicidal behavior. Besides, the interaction between stressful life events and ruminative thinking has been found to increase the risk of depressive symptoms (27). Research has found that distress rumination, as a negative cognitive style, is a key susceptibility factor for depression (28). And individuals with higher levels of ruminative thinking experience more intense negative emotions, which subsequently increase the risk of developing depressive mood.

However, there are few studies on college athletes that support this pathway. Therefore, the main purpose of this study was to explore the relationship and mechanisms of distress rumination, resilience, depression, and SSIB in our college athletes, which can play an important role in reducing SSIB and improving quality of life in college athletes. Four hypotheses were proposed in this study: (H1) distress rumination is related to SSIB; (H2) resilience may play a mediating role between distress rumination and SSIB; (H3) depression may play a mediating role in distress rumination and SSIB; (H4) resilience and depression may play a mediating role in distress rumination and SSIB (H3) depression may play a mediating role in distress rumination and SSIB; (H4) resilience and depression may play a chain mediating role in distress rumination and SSIB.

SSIB among athletes is worthy of attention among college athletes (41), especially during and after the COVID-19 pandemic. Our major findings were as follows: first, distress rumination was associated with SSIB in college athletes who were infected with COVID-19; second, depression mediated the association between distress rumination and SSIB; third, resilience mediated the association between distress rumination and SSIB; fourth, depression and resilience played a serial mediating role between distress rumination and SSIB. In general, the results supported our four hypotheses.

This research found that resilience played a part of the mediating role between distress rumination and SSIB in Chinese college athletes who were infected with COVID-19, and the mediating effect accounted for 27.27% of the total effect. A previous study showed that distress rumination among college students was negatively correlated with resilience (42); that is, the more severe the distress rumination, the lower the level of resilience. The same result was obtained in this study. Individuals who ruminate on their distress may not be able to concentrate on their task or training because of the painful thoughts, resulting in a range of negative emotions and negative perceptions about the future (9), thus reducing their level of resilience. Resilience may reduce the negative impact of distress rumination on SSIB. Mental toughness, as an important indicator to resist external stress, can give timely defusion and recovery to maintain a good mental state when encountering setbacks (43). Research has shown that psychological resilience can improve individuals’ negative emotions in the face of adversity and can serve as an internal defense mechanism to regulate SSIB (44). And high-level resilience increases the resistance to negative emotions precisely when college athletes infected with COVID-19 engage in distress rumination, allowing them to confront this public health emergency. As a result, they will be able to actively mobilize their positive energy against frustration and reduce distress rumination (16, 18). Targeted individualized health education can be provided during the care process to allow them to fully understand the process of recovery from infection and cooperate with treatment; at the same time, modern communication media can be used to establish social groups to share past recovery experiences, build confidence and increase psychological resilience from both the medical and nursing perspectives. In addition, transfer stimulation can be used to mitigate their falling into negative thinking when they are alone by using music, radio, and meditation training appropriately, thus reducing the degree of influence of ruminative thinking on SSIB. Besides, from the perspective of school education, sports teams can be equipped with special psychological intervention counselors.

The results of this study showed that depression played a partial mediating role between distress rumination and SSIB, which was consistent with the previous research result (45). The mediating effect of depression accounted for 63.64% of the total effect, indicating that depression plays the most important mediating role in the present study. Depression, as a negative emotional experience can lead to a series of cognitive-behavioral impairments in severe cases, increasing the individual’s intrinsic harmfulness, such as suicidal ideation and suicidal behavior (46). Depressed individuals are chronically immersed in negative emotions, their social functioning is impaired, their sense of belonging in interpersonal interactions is low and their sense of burden is high, and individuals can develop suicidal ideation (47). Zhang et al. (48) showed that the level of distress rumination can predict the depression of adolescents, which was consistent with the conclusions of this study. A stressful event (such as infected by COVID-19) can disrupt an individual’s ability to self-regulate and solve problems, reduce the utilization of social support, adversely affect the utilization of superior resources in college athletes, and aggravate the level of painful rumination. As a typical response style, distress rumination is an important cognitive risk factor for depression (49). Hyperrumination is characterized by excessive attention to negative information, difficulty in controlling or stopping rumination, and can also associate the self with negative information, thus perpetuating negative cognitive tendencies, which in turn cause and sustain depression. When college athletes who were infected with COVID-19 have high-level distress rumination, they will repeatedly think about the dangers of COVID-19 pandemic as well as their own negative emotions and behaviors, exacerbating depressive symptoms. Additionally, depressed college athletes who have a high propensity to ruminate raises their sense of hopelessness, which is a significant risk factor for the emergence of suicidal ideation and eventually raises the probability of suicidal behavior (25, 28). Therefore, depression plays a mediating role in the prediction effect of rumination on SSIB of college students. For government and schools, it is important to reduce the depression of college athletes who were infected with COVID-19 to reduce the impact of distress rumination on SSIB.

Finally, the distress rumination level of college athletes who were infected by COVID-19 can also affect SSIB through the chain mediating effect of resilience and depression, and the mediating effect accounted for 9.09% of the total effect. The results of this study showed that resilience was negatively correlated with depression, indicating that the higher an individual’s resilience, the lower their level of depression. It is found that resilience, as an internal positive coping mechanism for individuals to cope with negative life events, can cushion depression. College athletes with higher mental toughness level in orthopedics have stronger confidence and courage in the face of difficulties, which has a positive impact on the improvement of their depressive symptoms. Study have shown that individual resilience has a significant negative predictive effect on depression (50), and resilience plays a certain role in the relationship between negative life events and depression. That is, high individual resilience can alleviate the negative impact of negative life events. According to Lazarus’ stress coping theory (51), individuals will spontaneously cope with stressful events through a series of emotions (such as depression) or behavioral strategies. Meanwhile, the resources available to them (such as resilience) will in turn regulate their efforts. Based on this, we speculate that the level of resilience of college athletes who were infected by COVID-19 might be reduced if they constantly regurgitated the pain caused by the COVID-19 event. After the level of mental resilience is reduced, they will have a harder time regulating their emotions, so their depression level may rise, the inner negative emotions are difficult to resolve, and eventually lead to SSIB. According to the mixed model of emotional intelligence (52), emotional intelligence is a mental health protective factor that includes five key components: self-awareness, self-management, internal drive, empathy, and social skills, and has been shown to be significantly associated with depression and resilience. Individuals with distress rumination are generally immersed in a state of negative emotions, exhibit weaker self-management skills, have difficulty regulating their emotions, and eventually tend to develop suicidal ideation or self-injurious behavior.

In contrast to the mediation effect, which can clearly analyze both direct and indirect effects between variables and explain the internal relationships, prior studies have mainly concentrated on the application of multiple logistic regression to explore the influencing factors of SSIB. The internal mechanism of distress rumination on SSIB is clarified by our research findings. To the best of our knowledge, our research is the first to discover that there is a chain mediating effect of resilience and depression in the effect of distress rumination on SSIB. That is to say, our research hypothesis is valid, which provide theoretical basis and empirical support for reducing or delaying the occurrence of SSIB among college athletes who were affected with COVID-19. Practically, the likelihood of development to SSIB may be decreased by identifying distress rumination and intervening with their depression and resilience to meet their requirements. College athletes who were infected with COVID-19 can be guided and assisted by the government or educators to lessen their distress rumination (e.g., by providing timely psychological counseling), in the true sense of encouraging and creating conditions for them to lessen depression, and enhance their resilience, thereby reducing the likelihood of their SSIB. For college athletes who frequently engage in distress rumination, positive individualized mental health interventions can be implemented in schools to help them better manage the dual stresses of coursework and training, reduce their SSIB, improve their well-being, and ultimately enhance their competition performance.

There were some limitations in our study. First, the design of the cross-sectional study reduced the ability to draw causal correlations between variables. Second, this study’s conclusions may not apply to collegiate players from different backgrounds. In addition, the sample selected for this study was soccer athletes and it is worth further testing whether this mechanism still exists in other types of athletes (e.g., badminton players, basketball players).

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Ethics approval was obtained from the Ethics Committee of Shandong University (No. 2021-1-114). All methods comply with the current guidelines and regulations which follow the Declaration of Helsinki. The participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. The patients/participants provided their written informed consent to participate in this study.

This study was designed and carried out by LigZ and XZ, who also gathered data. LiaZ organized and evaluated the data. The first draft was written by XZ and ZL. LiaZ and LigZ took part in the project’s statistical analysis phase. LigZ offered thorough feedback on various sections of the paper. All authors contributed to the article and approved the submitted version.

This research was supported by the Social and Science Planning Project of Shandong Province (no. 20DTYJ03) and the Graduate Research Innovation Fund of Shandong University (no. 2021YJKTYB06).

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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