Associations Between Emotional Distress and Injury Occurrence in Physically Active Students

Background/Objectives: Negative emotional states such as depression, anxiety, and stress have been proposed as psychological correlates of injury occurrence, yet evidence regarding their independent and combined effects remains inconsistent, particularly with respect to sex differences. The present investigation focused on whether the relationship between adverse emotional states and injury occurrence differs between men and women among physically active young adults. Methods: The study was conducted with a cross-sectional design and included 418 university students (199 men and 219 women; mean age: men 20.73 ± 0.85 years; women 20.56 ± 0.74 years). Participants' anthropometric characteristics included body height (men, 182.19 ± 7.10 cm; women, 168.17 ± 6.01 cm) and body weight (men, 79.63 ± 9.87 kg; women, 60.86 ± 9.05 kg). Symptoms of depression, anxiety, and stress were measured using the Depression Anxiety Stress Scale (DASS-21), and injury history within the previous 12 months was obtained via a structured self-report injury questionnaire. Logistic regression models were used to evaluate associations between emotional states and injury occurrence, including assessment of linear, non-linear, and interaction effects. Analyses were stratified by sex and adjusted for training weekly load and training experience. Complementary profile analysis was conducted to assess emotional state configurations by injury occurrence. Results: Linear models provided the most parsimonious representation of the associations between emotional states and injury occurrence, with no support for non-linear or interaction effects. In sex-stratified multivariable models, anxiety was modestly associated with injury occurrence in males (OR = 1.05; 95% CI: 1.00-1.11), whereas depression and stress were not significant correlates. No significant associations were observed in females. Profile analysis revealed distinct emotional dimensions but showed no differences in overall profile level or shape between injured and non-injured participants. Conclusions: Negative emotional states demonstrated limited and predominantly additive associations with injury occurrence. Anxiety showed a small, sex-specific association in males, while overall emotional state measures exhibited limited explanatory value for injury occurrence.