Competitive Anxiety as a Predictor of the Occurrence, Quantity, and Severity of Injuries in Young Cuban Athletes

1. Introduction

The study of the etiology of sports injuries has evolved significantly, increasingly incorporating psychological components as key elements for a comprehensive understanding of the phenomenon. Among these, competitive anxiety has emerged as a central construct, having been identified as a factor that can compromise both the athlete's optimal performance and physical integrity. Its influence is exerted through interference in cognitive processes (such as attention and decision-making) and in the coordination of motor functions, thus increasing susceptibility to technical errors and, consequently, the risk of injury [1]. The theoretical model of Andersen and Williams stands as a fundamental pillar for framing this interaction. This integrative model proposes that vulnerability to injury is the result of a complex transaction between situational stressors (historical, cognitive, physiological, and behavioral) and the athlete's coping resources [1].

From this perspective, contemporary research has expanded on these postulates, confirming that psychological factors not only influence the incidence of injuries, but also the rehabilitation processes and performance after the injury occurs [2]. In soccer players, for example, it has been documented that injury induces alterations in pre-competitive anxiety and mood, affecting return to sport [3]. Subsequent research has consolidated the notion that effective prevention must necessarily incorporate psychological variables alongside traditional physical and biomechanical ones [4]. More recently, it has been argued that the risk of injury is not only associated with stress, but also with a specific profile of negative emotional states that includes high anxiety, depressive symptoms, and low self-confidence, which increases the athlete's vulnerability [5].

This evidence positions psychological factors as essential components in explanatory models of sports injury. Specifically, competitive anxiety has been associated with an increased risk of musculoskeletal injuries, mediated by its negative impact on concentration, emotional regulation, and muscle tension [1]. This association is particularly relevant in high-intensity, contact team sports. A recent systematic review focusing on basketball, handball, and volleyball [6] not only confirms the high injury burden in these sports but also explicitly identifies the need for in-depth research into psychosocial risk factors, beyond purely physical and technical ones. This call from the literature reinforces the relevance of studying variables such as competitive anxiety in these specific contexts.

In youth populations, recent findings lend relevance to this association. Sánchez-Ruiz et al. demonstrated in young soccer players that high levels of competitive anxiety predicted a higher incidence of injuries, a relationship that was moderated by the competitive category, being more intense at higher levels of demand [7]. This study suggests that anxiety not only increases the likelihood of injury but may also be linked to its severity and frequency, depending on the sporting context. However, its exclusive focus on soccer highlights a critical gap pointed out by Milić et al. [6]: the lack of longitudinal and comprehensive research on psychological predictors in other team sports with similar dynamics, where competitive pressure and injury risk are equally high.

Convergently, a recent meta-analysis corroborates the bidirectional nature of this relationship, establishing that anxiety predisposes to injury and, in turn, the experience of injury exacerbates anxiety symptoms, creating a potentially harmful cycle for the athlete's health [8]. However, not all research has found confirmatory evidence of the relationship between the two variables. Several studies have not found significant relationships between competitive anxiety and injuries [9,10], while it was recently determined that this relationship may be conditioned by other factors, since although significant relationships between injury and somatic anxiety were found in the total sample, when the analysis was segmented, these relationships were not found in younger athletes [7].

In the specific context of Cuba, research on sports injuries has shifted from epidemiological approaches to an incipient integration of the psychological dimension. Longitudinal studies such as that by Martínez-Estupiñán on child athletes, which reported a high incidence of injuries, already pointed to the need to incorporate psychosocial factors into prevention programs [11]. Continuing along these lines, Ríos Garit and Pérez Surita identified that both competitive anxiety and extreme levels of self-confidence were associated with a higher incidence of injuries in high-performance basketball players, providing local empirical evidence on this interaction [12]. Recently, evidence has also been obtained on the relevance of competitive anxiety as a significant predictor of injuries when interacting with psychological skills in Cuban athletes from various team sports [13].

Despite these advances, inconsistencies in the accumulated evidence persist. The synthesis by Milić et al. [6] highlights that, although the epidemiology of injuries in sports such as basketball, handball, and volleyball is well known, there is a notable lack of studies designed to examine causal relationships, particularly with psychological variables in these populations. Therefore, the main objective of this study is to determine the role of competitive anxiety as a predictor of the occurrence, number, and severity of injuries in young Cuban athletes in team sports, responding to the call for recent research to delve deeper into psychosocial predictors in these sports contexts.

2. Materials and Methods

2.1. Study Design

A cross-sectional and correlational study was conducted on volleyball, basketball, baseball, and soccer teams in the province of Villa Clara at the end of the special preparation stage of the 2024-2025 training macrocycle (between May and June 2025). The aim was to analyze the population of young athletes participating in team sports in the province of Villa Clara who were in the preparation stage for the main competition of 2025.

2.2. Participants

A total of 131 athletes aged between 12 and 23 years (M=16.49) and with between 1 and 13 years of practice (M=7.08) were studied. Males predominated with 79.4% (n=104). The least represented sport was volleyball and the under-23 category in general, as shown in Table 1. A non-probabilistic sample was taken based on the following criteria:

Inclusion

-Young athletes in team sports who are training for the 2025 championship.

Exclusion

-Athletes who did not give their consent to participate.

-Athletes whose parents or guardians do not approve of their participation in the study.

2.3. Instruments

Data on injuries were obtained by reviewing the medical records of athletes at the Provincial Sports Medicine Center in Villa Clara. The variables Injury (Uninjured, Injured); Number of injuries (1 injury, 2 injuries, more than 2 injuries) and Severity of injury (Mild, Moderate, Severe, Very Severe) are classified as qualitative.

Competitive Sport Anxiety Inventory, Spanish version [14]: this instrument was used to assess competitive anxiety. It consists of 27 items distributed across three subscales that measure cognitive anxiety, somatic anxiety, and self-confidence with four Likert-type response options (1= Not at all; 2= A little; 3= Moderately; 4= Very much). The direct and total scores of the three subscales with adequate reliability indices (α=.82 for Cognitive Anxiety; α=.81 for Somatic Anxiety; α= 76 for Self-Confidence and α=.85 for Competitive Anxiety) were taken into account.

2.4. Procedures

The summary of injury data was provided by each sports medicine specialist after reviewing the medical records. The CSAI-2 instrument was administered in printed form, at each sport's venue, in agreement with the head coach, and in the morning. In each sport, it was administered by the corresponding sports psychology specialist. Before beginning the tests, their characteristics, how to complete them, and the objectives of the study were explained in detail, with an emphasis on the accuracy of the information.

2.5. Ethical considerations

The study is part of the project “Tools for the biopsychosocial prevention of injuries in team sports,” which is associated with the Sectoral Program “Sport and Human Development” of the National Institute of Sport, Physical Education, and Recreation of Cuba. The research was approved by the Scientific Council of the Provincial Center for Sports Medicine of Villa Clara and the Medical Research Ethics Committee (0101/2025). Its development strictly adhered to the ethical precepts of scientific research contained in the Declaration of Helsinki [15].

2.6. Data analysis

Empirical frequency distribution was used to describe the distribution of cases in terms of the presence of injury, number of injuries, and severity of injuries. Descriptive statistics such as mean, deviation, asymmetry, and kurtosis were used for the variables of age, sporting experience, and competitive anxiety with its dimensions. The Kolmogorov-Smirnov test for normality of data for a sample indicated a non-normal distribution. Consequently, the Mann-Whitney U test was used to compare the variables of age, sporting experience, and competitive anxiety among athletes according to the presence or absence of injuries. The Kruskal-Wallis test was used to compare these same variables in relation to the number and severity of injuries suffered. The effect size was calculated for Mann-Whitney U using the r coefficient, obtained from the standardized Z statistic (r= Z/√N) following the recommendations of Fritz et al. [16]. For multiple group comparisons with Kruskal-Wallis, the effect size was calculated using epsilon squared (ε² = H/N-1) according to Tomczak and Tomczak [17]. A binary logistic regression model was used to predict the injury variable, and ordinal regression models were used for the variables of number and severity of injuries. The SPSS version 25.0 software package for Windows was used, considering a 95% confidence interval.

3. Results

Figure 1 describes the injuries during the 2024-2025 training macrocycle. There are a high occurrence and notable number of injuries, although those of lesser severity predominate.

Table 2 shows the values of the descriptive statistics and the normal distribution test of the data. Only the competitive anxiety variable has a normal distribution. Self-confidence and cognitive anxiety exhibit high values.

Table 3 describes the results of the comparison of chronological age, sporting experience expressed in years of practice, and competitive anxiety. Only self-confidence does not differ significantly between injured and non-injured athletes. Injured athletes have higher competitive anxiety with a moderate effect size (r=.31), which is configured through higher cognitive and somatic anxiety with small individual effects (r=.27 and r=.24, respectively).

Table 4 shows that the number of injuries suffered significantly differentiates competitive anxiety as a general variable, but at the expense of cognitive and somatic anxiety, in that order. A large effect is obtained in general competitive anxiety (ε²=.12), cognitive anxiety (ε²=.08), and somatic anxiety (ε²=.06), as well as a moderate effect in self-confidence (ε²=.02), although not significant.

Table 5 analyzes the differences in variables in relation to the severity of injuries. It can be seen that competitive anxiety as a general variable differs significantly depending on the severity of injuries, with a very large effect size (ε²=.17). In this regard, cognitive anxiety (ε²=.12) and somatic anxiety (ε²=.08) differ significantly with a large effect in both cases.

Table 6 shows the logistic regression data for predicting injury. It can be seen that cognitive and somatic anxiety are significant predictors of injury, but self-confidence is not. For each point increase in cognitive anxiety, the probability of injury increases by 9.7%, while somatic anxiety increases by 11%. The model explains between 10.9% and 14.7% of the variability with a good fit.

Table 7 shows the results of the ordinal regression to predict the number and severity of injuries. With regard to the number of injuries, the three dimensions of competitive anxiety are significant predictors. However, the variable that best predicts the number of injuries is cognitive anxiety, followed by somatic anxiety and self-confidence, all in a positive regard. With regard to the severity of injuries, the results follow the same logic; however, the data show that the three dimensions of competitive anxiety predict severity to a greater extent than the number of injuries (Severity = 20.3%-21.8%, Number = 13%-14%).

4. Discussion

It was found that most athletes had suffered minor injuries at least once during the preparation period analyzed. These data confirm the negative epidemiological behavior of injuries from an early age in team sports [6,11]. This finding in young athletes coincides with the results reported by a previous study in a sample of older high-performance athletes in the same context [18]. The contrasting evidence highlights the importance and necessity of a sports injury care system focused on timely prevention.

With regard to the relationship between competitive anxiety and injuries in these young athletes, it was found that competitive anxiety reaches significantly higher levels in those who have been injured more frequently and, especially, in those who have suffered more severe injuries. This finding reinforces the concept of sports injuries as a multifactorial phenomenon in which psychological factors play a relevant role [1,19,20].

On the other hand, overall competitive anxiety showed a moderate effect size in the comparison between injured and uninjured athletes, which coincides with the results shown in the meta-analysis by Chow et al. [8], where a significant relationship is established between mental health variables and sports injuries in adolescents. This suggests that anxiety is a relevant factor within a more complex process that includes physical demands, workload, and contextual factors.

A more specific analysis showed that cognitive anxiety was the dimension with the greatest predictive weight, both in terms of the number and severity of injuries. In this regard, excessive worry, anticipation, or intrusive thoughts can compromise concentration and increase the likelihood of errors. Likewise, somatic anxiety showed significant predictive power, both in the occurrence and in the number and severity of injuries. These findings are consistent with other studies that argue that negative emotional states are associated with physiological alterations that can affect coordination and increase the occurrence of injuries [5,21].

Competitive anxiety explained a greater percentage of variance in injury severity than in the mere occurrence of injury. This result suggests that anxiety not only increases the likelihood of injury but may also be linked to mechanisms that aggravate the damage. Along the same lines, previous studies [5,22] suggest that negative emotional profiles can intensify the physiological response to stress and limit the ability to adapt to risky situations. In this regard, a study of young soccer players found that the physiological and cognitive changes caused by high levels of competitive anxiety increased the risk of injury [23].

In this regard, competitive anxiety may also be interpreted within a broader framework of psychological demands in sport. Although variables such as mental workload [24] or emotional exhaustion [25] were not directly assessed in this study, previous literature suggests that these factors may interact with anxiety, amplifying cognitive overload and reducing attentional efficiency. This interaction could partially explain why anxiety shows a stronger association with injury severity than with mere occurrence, as higher psychological demands may impair both perception and response to risk situations.

With regard to self-confidence, although no significant association was found with the occurrence of injury, its predictive capacity in terms of the quantity and severity. This suggests that self-confidence may not influence whether an athlete gets injured, but rather how they behave once exposed to risk situations. Excessively high levels of self-confidence could lead to risk-taking behaviors, underestimation of dan-ger, or delayed recognition of physical warning signals, contributing to more frequent or more severe injuries. This interpretation highlights the need to consider not only deficits but also maladaptive excesses in psychological variables.

This result is similar to that found in the Cuban population by Ríos Garit and Pérez Surita [12], who identified that extreme levels of self-confidence may be associated with a higher incidence of injury. In this regard, very high self-confidence can be a risk factor, which would increase the probability of recurrence or aggravation of the injury. This leads to the need for interventions focused on developing skills for the proper management of anxiety in competition and maintaining optimal levels of self-confidence in these young Cuban athletes, but more markedly in those who have been injured more often and have suffered more serious injuries.

From an applied perspective, the results support the need to implement psychological intervention programs aimed at the proper management of competitive anxiety and the maintenance of optimal levels of self-confidence. In line with other studies, affective injury prevention should incorporate mental health aspects into sports preparation plans [4,13,26]. Furthermore, the evidence obtained confirms that competitive anxiety is a significant predictor of the number and severity of injuries in these young athletes, reinforcing the need to adopt a biopsychosocial approach to sports injury prevention in Cuba, integrating the assessment and training of psychological variables into the athlete's preparation process [13].

Among the limitations of the study are its cross-sectional design, which prevents definitive causal relationships from being established, and the use of self-reports for the assessment of anxiety. Furthermore, the study sample is not representative of the population of young Cuban team sport athletes, so the findings have limited scope in this regard. Despite the contributions of this study, the predictive analysis of competitive anxiety and its dimensions without interaction with other variables did not allow us to determine its role in the network of injury risk factors.

Future longitudinal studies would allow for analysis of the directionality of the relationship and exploration of mediating variables such as training load, sleep clarity, or coping strategies in a representative sample of the Cuban sports population. It is also considered necessary to analyze the role of competitive anxiety in the occurrence, frequency, and severity of injuries, taking into account sports experience and the specific sport.

5. Conclusions

Competitive anxiety reached higher levels in young athletes who have been injured more frequently, but especially in those who have suffered more severe injuries. Not all dimensions of competitive anxiety have the same degree of influence on the occurrence of injury. However, an increase in the number and severity of injuries can be predicted when all dimensions of competitive anxiety in-crease. Although the regression models indicate that competitive anxiety is a significant predictor of injury-related variables, the proportion of explained variance remains moder-ate. This suggests that anxiety should be considered as one contributing factor within a multifactorial model, where physical, contextual, and other psychological variables also play a relevant role. Therefore, the predictive capacity of anxiety should be interpreted with caution, avoiding deterministic conclusions. Despite these limitations, the findings suggest that very highly competitive anxiety can be a risk factor, which raises the need for interventions focused on developing skills for the proper management of anxiety in competition and maintaining optimal levels of self-confidence in these young Cuban athletes, but more so in those who have been injured more often and have suffered more serious injuries.