Association of Mental Health, Quality of Life, and Sport Specialization Using the Wisconsin Sport Specialization Questionnaire Among Adolescent Athletes.

BACKGROUND: Higher sport specialization levels have been associated with increased mental health issues. A recently validated questionnaire, the Wisconsin Sport Specialization Questionnaire (WISSQ), may provide clarity about the degree of sport specialization to investigate associations with mental health/quality of life (QoL) among adolescent athletes. PURPOSE: To examine the association of sports specialization, as measured by the WISSQ, and mental health/QoL outcomes among uninjured adolescent athletes, as well as the effect of age on the interaction between mental health/QoL outcomes and sport specialization. STUDY DESIGN: Cross-sectional study; Level of evidence, 2. METHODS: During the preseason assessment, performed in July and August from 2023 to 2025, participants completed the WISSQ and the Patient-Reported Outcomes Measurement Information System (PROMIS) Global 25 (Version 1.1). A multiple linear regression model was constructed that evaluated the association between 6 PROMIS domains and WISSQ ratings, adjusting for age, sex, and self-reported physical activity volume. To address the secondary purpose, linear regression models with an interaction term were used to examine the association between each PROMIS domain and age with sport specialization. RESULTS: A total of 251 uninjured adolescent athletes completed the study (mean ± SD age, 15.9 ± 1.4 years). The mean WISSQ rating was 54.1 (SD, 15.4). Results from the multivariable linear regression model indicated that higher depressive symptoms (β = 0.46; 95% CI, 0.16-0.76; P = .003) and pain interference ratings (β = 0.30; 95% CI, 0.02-0.57; P = .03) were significantly associated with higher WISSQ ratings, after adjusting for baseline physical activity, age, sex, and history of anxiety or depression diagnosis. For the secondary purpose, there was a significant interaction between fatigue and age group on sport specialization (β coefficient = 0.49; 95% CI, 0.02-0.95; P = .04). The relationship between fatigue and sport specialization differed by age: a stronger association occurred among older adolescents than younger adolescents. There were no other age × QoL interactions. CONCLUSION: This study demonstrated that higher depressive symptoms and pain interference ratings were significantly associated with higher WISSQ ratings. In addition, there was a significant interaction between fatigue and age group, with a stronger association identified among older adolescents. Higher specialized and older adolescent athletes may be more at risk for developing mental health/QoL concerns and may benefit from more targeted screening.