CHICAGO — Children who play sports are less likely to experience withdrawn and depressive symptoms compared with their counterparts who do not engage in sports, new research suggests.

Investigators at Boston University School of Medicine found kids who participated in one or fewer sports had a higher incidence of withdrawn behavior and depressive symptoms, suggesting playing two or more sports "may be the magic number."

"We found a statistically significant difference between children who played two or more sports vs those who played zero or one," study investigator Punit Matta, MS, told Medscape Medical News.

The findings were presented here at the American Academy of Child & Adolescent Psychiatry (AACAP) 66th Annual Meeting.

A Promising Early Intervention

The existing literature shows an association between sports participation and mental-health benefits in adolescents and adults. Nevertheless, few studies have examined the potential link in children younger than 12.

The investigators hypothesized that encouraging children to participate in sports may be an effective early intervention for at-risk children. This led them to investigate the association between sports participation in children and symptoms of mental illness.

"Originally, we were interested in examining the relationship between attention problems and physical activity," said study coinvestigator Andrea Spencer, MD. "Then we realized that the Child Behavior Checklist [CBCL] dataset would allow us to look at this question for a much wider set of symptoms. And what we found was really interesting."

The study was a secondary analysis of data from 206 children (ages 6-11; 51% male; 85% Hispanic or Latinx). Parents of the children had all completed a CBCL during a well-child visit at an urban community health center between January 2013 and June 2015.

"The Hispanic or Latinx population is one of the gaps in the literature that we identified," said Spencer. "Many of the studies that have looked into this question have focused on Caucasian samples, as well as people who are older, such as adolescents and adults."

The researchers measured sport count by using CBCL items that ask guardians to list the sports their child plays. They measured domains of psychiatric symptoms by using the eight syndrome scales of the CBCL: anxious/depressed; withdrawn/depressed; somatic complaints; social problems; thought problems; attention problems; rule-breaking behavior; and aggressive behavior.

Linear regression analyses determined the association, if any, between measures of mental illness symptoms (total number of CBCL syndrome scale elevations and individual syndrome scale elevations) and sports participation.

After controlling for covariates, investigators found a higher number of sports was significantly associated with lower scores on with Withdrawn/Depressed subscale (beta estimate, -1.044; t value, -2.37; P = .0186). Nevertheless, the other CBCL syndrome subscales were not significantly associated with sport count (all P < .05).

Interestingly, both age and ethnicity were also significantly associated with the Withdrawn/Depressed subscale. Indeed, older children had higher scores on the subscale (beta estimate, 0.958; t value, 3.05; P =.0026). Contrarily, Latinx children had lower Withdrawn/Depression subscale scores compared to non-Latinx children (beta estimate, 3.158; t value, 2.10; P =.0368)

In a post-hoc analysis, children whose parents reported one or fewer sports had twice the odds of having clinically elevated Withdrawn/Depressed syndrome scores on the CBCL than those playing two or more sports (odds ratio 2.339; 95% confidence interval, 1.127 - 4.853).

These findings may help primary care physicians identify a promising early intervention strategy for children with withdrawn, depressive symptoms.

"There's been a huge movement in primary care right now to screen for social determinants and connect children with resources. But nobody is asking these children systematically about sports participation," said Spencer.

"The most compelling thing I can think of is to suggest sports as the intervention," Matta added. "Because one of the big challenges with treating children this age is that you don’t want to give them powerful drugs and you don’t know how therapy will work."

Confidence, Relationship Builder

Commenting on the findings for Medscape Medical News, Samantha Kennedy, DO, assistant professor of psychiatry at Michigan State University in East Lansing, said she has personally witnessed the benefits of sport in her patient population.

"Perhaps one theory behind the results is that children involved in more sports participate year-round, rather than just for one season," said Kennedy.

Yet as vital as physical activity may be in these children, Kennedy also saw benefit in the camaraderie that accompanies sports participation.

"The children are instantly with a group of people and have something in common," she explained. "So it can be really easy to start talking to the other kids on the team, and from there they can grow confidence to talk about things other than sports.

"What’s more, playing sports keeps kids busy, so they're not using substances or out doing other things they shouldn’t be doing."

Spencer concluded that the findings might spur insurers to broaden their coverage.

"Ultimately, it may be less expensive for the health insurance companies to pay for a child with initial symptoms to go into sports, rather than wait until they're 12 or 13 [years old] and need an intervention that’s more involved and more expensive," she said.

"It’s all about expanding the modes of treatment that pediatricians can provide to children at risk," Matta added.

The research was supported by the Louis Gerstner Foundation. Matta, Spencer, and Kennedy have disclosed no relevant financial relationships.

American Academy of Child & Adolescent Psychiatry (AACAP) 66th Annual Meeting: Abstract 2.26. Presented October 16, 2019.

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