The Role of Psychosocial Risk Factors for Injury in Elite Youth Ice Hockey

Objective: To determine the risk of injury associated with athletic identity, attitudes toward body checking, competitive state anxiety, and reinjury fear in elite youth ice hockey. Also, to determine if there is an elevated risk of subsequent injury associated with return to play before medical clearance. Design: Cohort study. Setting: Hockey arenas, Calgary, Alberta. Participants: A total of 316 male participants from 18 elite (A, AA, AAA), Bantam (age, 13-14 years), and Midget (age, 15-17 years) teams. Assessment of Risk Factors: At season commencement and postinjury, participants completed the Athletic Identity Measurement Scale, Competitive State Anxiety Inventory-2R, Body Checking Questionnaire, and fear of reinjury questions. Main Outcome Measures: Hockey injury resulting in medical attention, the inability to complete a hockey session, and/or missing a subsequent hockey session. Results: Players scoring below the 25th percentile in athletic identity were at increased risk of a first injury [incidence rate ratios (IRR), 1.53; 95% confidence interval (CI), 1.05-2.22], but scoring above the 25th percentile was associated with subsequent injury (IRR = 2.28; 95% CI, 1.01-6.04). There was no increase in risk associated with return to play before clearance (IRR, 1.58; 95% CI, 0.30-5.42). Conclusions: Athletic identity was implicated as an injury risk factor in this population. Return to play before medical clearance was not a risk factor in this study, but the point estimate warrants additional investigation.