Roughly 27 million individuals between the ages of 6–17 years participate in sports in the United States (1). Sports participation provides many benefits to both physical and psychological health (2–4), including improved mood, decreased risk for depressive and anxiety symptoms, improved social relationships, and overall quality of life (5, 6). These benefits may be particularly pronounced during adolescence, as physically active youth have less severe depressive symptoms compared to youth who do not participate in sports (7). However, less is known on the short and long-term psychological effects of sports participation among adolescent athletes. As such, it is imperative to understand the short and long-term associations between sports participation and psychological health in the adolescent population, including anxiety ratings, depressive symptoms, grit, fatigue, peer relationships, and body appreciation.

Participating in sports during adolescence has been found to improve anxiety and depressive symptoms later in life (8–11). Adolescent recreational sport athletes with at least 2 years of participation had lower levels of anxiety and depressive symptoms compared to participants that did not participate in recreational sports (8). Furthermore, adolescents participating in organized sports for more than 1 year had better mental health outcomes (i.e., less anxiety and depressive symptoms) compared to those who did not participate in organized sports, with the strongest association being among those who participated in organized sports for 4–5 years (8). Additionally, involvement in school sports during adolescence has been associated with less severe depressive symptoms in young adulthood (9). However, adolescent female athletes reported more severe anxiety and depressive symptoms than their male peers, and consequently, had higher sports participation dropout rates (12, 13). Thus, it is critical to identify how mental health and wellness measures change over the course of time during adolescence, particularly among female adolescent athletes.

Although studies have examined the association of sports participation and anxiety and depressive symptoms later in life, it is not well understood how sports participation may be influenced by one's grit. Grit is defined as the persistance to strive for long-term goals despite setbacks and challenges (14, 15). Tedesqui and Bradley found that grit scores were not associated with previous sports participation (16), while Cocic et al. demonstrated that organized sports participation among elite youth soccer players was assoicated with higher grit levels (17). Higher grit levels were also found to be associated with less anxiety and depressive symptoms among non-athletes (15). However, to the best of our knowledge, no studies to date have examined how one's grit may change from a post-season assessment to a longer-term (e.g., 6-month) follow-up assessment among female adolescents. Thus, it is important to better understand the longitudinal changes of grit and sports participation among this population.

In addition to anxiety symptoms, depressive symptoms, and grit, other psychological components such as peer relationships, fatigue, and body image may also each be modified through organized sports participation (18–21). Among school-aged children, researchers identified a positive association between peer relationships and sports participation (18). Furthermore, persistent physical inactivity in adolescents (exercise <3 times/month) is associated with poor long-term (over 1–2 years) peer relationships (19). Lastly, youth who participated in both individual and team sports or team sports alone had greater peer relationships compared with children who just participated in individual sports (20). Participating in organized sports has also been found to reduce fatigue and improve body image among adolescent females compared to those who were not actively involved in sports (21). Of note, psychological benefits were strongest for girls who participated in sports compared to boys, and differed based on sport type (21). However, most of these findings were in both male and female adolescents, and little remains known on the longitudinal effects of sports participation and peer relationships, fatigue, and body image among female adolescent athletes, specifically. Therefore, understanding how sports participation affects psychological measures at various points in time, such as immediately post-season and 6 months after the end of the season, may give better insight into promoting female adolescent health outcomes.

The primary purpose of this study was to examine if female adolescent athletes demonstrated changes on measures of mental health and wellness (anxiety ratings, depressive symptoms, grit, fatigue, peer relationships, and body appreciation) 6-months following the end of a sport season compared to an immediate post-season assessment. We hypothesized that mental health measures for each domain (anxiety ratings, depressive symptoms, grit, fatigue, peer relationships, and body appreciation) would be worse 6 months after the end of the season compared to the post-season assessment. Our secondary purpose was then to examine if adolescent athletes who were actively participating in organized sports 6 months after the end of the season reported different mental health and wellness ratings compared to athletes who were no longer participating in organized sports at the 6-month follow-up.

We enrolled 84 participants at the start of the athletic season, all who identified that they would be participating in flag football in the upcoming season. Of the 84 participants who were initially enrolled in the study, 13 did not return for the immediate post-season follow-up, and 12 did not return for the 6-month post-season follow-up. As such, those 25 individuals were excluded from the analysis, and our study included a total of 59 female adolescent athletes. Those who were included and excluded from analysis were not significantly different in their age at the time of enrollment (16.3 ± 1.1 vs. 16.6 ± 1.0 years of age; p = 0.21). All participants indicated that they lived in zip codes in the top 50th percentile of socioeconomic advantage nationally (Table 1). While many participants reported flag football was the primary sport that they participated in, other sports were also identified (e.g., soccer, basketball, lacrosse) as primary sports (i.e., flag football was a secondary sport) (Table 1).

For our primary purpose, we observed that participants reported significantly higher anxiety ratings at the 6-month follow-up assessment compared to the immediate post-season assessment (median [interquartile range] at post-season = 7 [(3, 8)] vs. 6-month follow-up = 7 [(4, 10)]; Figure 1A). However, there were no significant differences between time points for depressive symptoms (Figure 1B), grit (Figure 1C), peer relationships (Figure 1D), fatigue (Figure 1E), or body appreciation (Figure 1F).

For our secondary purpose, we observed that N = 32 (54%) of the enrolled participants reported active organized sport participation at the 6-month follow-up assessment. Those who reported active sports participation also reported significantly higher volumes of physical activity overall per week than those who did not (10.5 ± 7.2 h/week vs. 4.4 ± 6.0 h/week; p < 0.001; mean difference = 6.14, 95% CI = 3.01, 9.27). Among those who reported active participation in sports, the median number of sports played was 1 [IQR = 0, 1]. In contrast, the two groups did not significantly differ in their physical activity volume at the initial pre-season evaluation (8.1 ± 6.5 h/week vs. 7.2 ± 3.8 h/week; p = 0.53).

There were no statistically significant differences between those who did and did not continue to participate in sports at the 6-month follow-up assessment for anxiety ratings, depressive symptoms, grit, peer relationships, or fatigue, with small effect sizes noted for each comparison (Figures 2A–E; Cohen's d values = 0.02–0.41). However, those who were actively participating in organized sports at the 6-month follow-up assessment reported significantly higher body appreciation ratings than those who did not, with a moderate effect size noted (Figure 2F; Cohen's d = 0.67). After covariate adjustment (post-season rating, physical activity level, age, and BMI), active organized sports participation at the 6-month assessment was significantly associated with better body appreciation ratings (Table 2; β = 3.65; 95% CI = 1.08, 6.23; p = 0.006), but not with anxiety ratings (p = 0.79), depressive symptoms (p = 0.46), grit (p = 0.08), peer relationships (p = 0.39), or fatigue (p = 0.33).

We examined if female adolescent athletes participating in flag football reported different measures of mental health and wellness at an immediate post-season assessment relative to an assessment 6-months following the end of the season. We hypothesized that mental health measures for all 6 domains (anxiety ratings, depressive symptoms, grit, fatigue, peer relationships, and body appreciation) would be different among adolescent females 6 months following the end of the season compared to the immediate post-season assessment. We only observed a significant difference in anxiety ratings, with participants reporting significantly higher anxiety ratings at the 6-month follow-up assessment compared to the post-season assessment. Our hypothesis was otherwise not supported, as there were no significant changes between time points for depressive symptoms, grit, peer relationships, fatigue, or body appreciation.

Our secondary purpose was to examine whether adolescent athletes who were actively participating in organized sports 6 months after the end of the season reported different mental health and wellness ratings compared to athletes who were no longer participating in organized sports or who were out of season. Contrary to our hypothesis, we found no significant differences between those who did and did not report active sports particiatoin at the 6-month follow-up assessment for anxiety ratings, depressive symptoms, grit, peer relationships, or fatigue. However, those who reported active organized sports participation at the 6-month follow-up reported significantly higher body appreciation ratings than those who did not, supporting our hypothesis.

Of the 59 female adolescent athletes in our study, anxiety ratings were worse at 6-month follow-up than immediately post-season. This finding was different than other studies that support long-term sports participation as a method to decrease anxiety levels (8–11). However, in our study sample, only 54% of the participants reported active organized sports participation at the 6-month follow-up and could be one reason for this increased level of anxiety symptoms over time. However, we recognize that this is one of several potential factors that may have influenced this finding, particularly given that anxiety symptoms were rated in reference to the past week, so everyday contextual factors may have influenced ratings. Nonetheless, given the role of routine physical activity as a strategy to cope with anxiety ratings among adolescents, the lack of regular physical activity engagement in about half of our participants may have had some influence within this group change across time. Past work reported that recreational sport athletes with ≥2 years of participation had lower levels of anxiety and depressive symptoms compared to participants that did not participate in recreational sports (8). In contrast, our timeline of a 6-month follow-up assessment may not have been long enough to see pronounced changes across other quality-of-life domains, as the strongest association in this past work was identified for those who participated in organized sports for 4–5 years (8). Lastly, there are multiple variables that could influence anxiety ratings, unrelated to sports participation or physical acitivity, with some examples including stress from school, household environment, and parents or peer relationships. Our findings suggest that female adolescent flag football athletes may require longer than 6 months post-season to see long-term changes for their mental health. Additionally, healthcare providers and coaches should be aware of the changes in anxiety-ratings months after the end of a season, and should promote ongoing sports participation to improve mental health.

We observed that those who reported active organized sports participation at the 6-month follow-up assessment reported higher body appreciation ratings than those who did not. This finding supports the idea that sports participation can serve as a method to enhance body image, particularly among adolescent female athletes. Alternatively, it is possible that individuals with higher body image were more likely to continue participating in sports. Regardless of the causal direction, previous research has consistently demonstrated a strong association between sports participation and improved body image (38–40). A study among Norwegian adolescent athletes observed that sports participation was a positive predictor of body appreciation (38). Other studies have examined the assocations of sport-specific factors and body appreciation among athletes. For example, one study found that there were no significant differences in body appreciation scores among adolescent athletes participating in weight-sensitive sports (i.e., dance, wrestling, gymnastics, running) compared to less weight-sensitive sports (i.e., football, basketball, hockey) (41). Furthermore, adolescent athletes who participated in more years of organized sports and who had better performance results at the most recent competition reported higher body appreciation scores compared to their peers who had fewer years of participation and worse performance results (39). Lastly, in a sample of competitive adolescent rock climbers, body appreciation and competitive success were moderately associated (40). Our sample may have reported higher body appreciation ratings with ongoing sports participation due to the benefit of sports improving self-confidence, self-esteem, and body image. To the best of our knowledge, this study is the first to have assessed longitudinal change in body appreciation related to sports participation among adolescent female athletes. The findings of our study suggest that even 6 months of ongoing sports participation may help promote higher body appreciation scores.

We found no significant differences in depressive symptoms, peer relationships, grit, or fatigue immediately post-season and 6 months later. Contrary to our hypothesis, we did not observe that peer relationship ratings were associated with active organized sports participation. Past work suggests that participants of team sports had greater peer relationships compared to participants of individual sports (20). Team sports, like flag football, encourage social development through teamwork, expanding participants' circle of friends, and building connections. However, our study sample included not only flag football athletes, but those who participated in a variety of other sports as well (both individual and team sports). In addition, persistent physical inactivity in adolescents is associated with poor peer relationships and increased fatigue (21). Our findings may not have shown a significant association between these outcomes and active organized sports participation due to the large percentage (46%) who were not actively involved in playing organized sports at the 6-month follow-up, and the lower physical activity volume of those who were not participating in sports than those who did. Thus, it is important for coaches, parents, and healthcare providers to encourage sustained sports participation for long-term mental health benefits.

Our study had several limitations. We assessed self-reported anxiety and depressive symptom severity through well established and validated questionnaires, and while these are useful ratings-based tools, they were not intended to provide any sort of diagnosis such as what one would receive from a qualified healthcare provider. We also estimated physical activity using one-week self-reported data, which may or may not reflect true physical behavior activity over a longer period of time. In addition, we assessed differences in mental health 6 months post-season to avoid participant dropout, which may not have been a long enough timeframe prospectively to track significant changes. Another limitation is that all participants indicated that they lived in zip codes of the top half of socioeconomic advantage, which limits the generalizability of our findings to those of lower socioeconomic status. Furthermore, we did not include a control group of non-athletes and our sample size was relatively small and included a somewhat homogenous sample of participants. Thus, further study is required to understand how mental health is affected in a group of adolescents who do and do not participate in sports over time. We also acknowledge that only primary sports were identified and reported, and that participants may have participated in additional sports during the study period. However, strengths of our study include the longitudinal study design and examination of mental health measures in a population of adolescent female athletes participating in flag football, which is a newer and less-studied sport.

Adolescent female athletes participating in flag football reported significantly higher anxiety ratings at the 6-month follow-up assessment compared to the immediate post-season assessment, and nearly half reported not participating in organized sports at the 6-month follow-up assessment. There were no significant differences across time for depressive symptoms, grit, peer relationships, fatigue, or body appreciation. However, those who reported active organized sports particaiptoin at the 6-month follow-up assessment reported significantly higher body appreciation ratings than those who did not. Our findings suggest that healthcare providers, coaches, and parents should encourage long-term participation in sports for improved body appreciation scores among female adolescent athletes. Additionally, as anxiety ratings increased 6 months following the end of a sports season, participating in multiple seasons may help improve long-term mental health among adolescent athletes. As flag football increases in popularity and is an additional team sport opportunity among adolescent female athletes, future directions include prospectively examining the relationship of mental health measures and engagement in organized sports into adulthood. It is important in future work to monitor mental health measures at various time points post-season to better understand how sustained sports participation affects mental health measures long-term.