Systematic review of stress-related injury vulnerability in athletic and occupational contexts

- Injury is consistently associated with both exposure to stressors and the intensity of stress responses.
- Few studies assessed both exposures and stress responses; none estimated risk from exposure-contingent stress responses.
- Stress and injury assessments vary; harmonized assessment strategies would be valuable for future research.
- Existing research designs reveal little about the dynamics of stress-related injury vulnerability.

Injury is a pervasive, expensive and, to some extent, preventable problem. Stress is a psychological risk factor for injury but little is known about how stress processes compare in athletic and occupational contexts. This paper reviews research on stress-related injury vulnerability in athletic and occupational contexts to characterize and compare samples, methods, and conclusions from the perspective of an integrated model of stress-related injury vulnerability. A comprehensive search of four major databases identified research in both athletic (n = 34) and occupational contexts (n = 22). Studies were coded to extract characteristics of the samples, research designs, measures, and conclusions about stress-injury relations. Studies used more prospective than cross-sectional or case control research designs. Injury was most frequently defined as missing one subsequent day of training or work (35.7%). Approximately 75% of the identified studies in each context indicated a positive association between stress and injury occurrence. The consistency of findings suggested a robust stress-related injury vulnerability for both exposures and responses, however, caution is warranted due to the diversity of measures and surveillance periods and the lack of experimental designs. New hypotheses are identified to refine models of stress-related injury vulnerability in athletic and occupational contexts.