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Objectives: To explore the relationship between potential psychological risk factors and injury risk in circus artists.

Design: Historical cohort study.

Setting Cirque du Soleil training programme.

Participants: Forty-seven circus artists training to become Cirque du Soleil artists.

Assessment of risk factors: Artists completed the validated REST-Q questionnaire (19 domains) during their first 2 weeks of training.

Main outcome: Injury risk ratio.

Results: Of the five a priori exposures of interest, injury, emotional exhaustion, self-efficacy and fatigue were associated with an increase in injury risk (risk ratios between 1.8 and 2.8), but Conflicts/Pressure was not (risk ratio=0.8). Of the several specific psychological aspects that are considered risk factors for injury, low self-efficacy had the strongest relationship.

Conclusions: Most of the strong psychological risk factors for injuries previously identified in athletes also appear to be risk factors in circus artists

A secondary data analysis of a prospective cohort study was conducted to explore how different definitions of injury affect the results of risk factor analyses. Modern circus artists (n=1281) were followed for 828 547 performances over a period of 49 months (2004–2008). A univariate risk factor analysis (age, sex, nationality, artist role) estimating incidence rate ratios (IRR) with 95% confidence intervals (95% CI) was conducted using three injury definitions: (1) medical attention injuries, (2) time-loss injuries resulting in ≥1 missed performances (TL-1) and (3) time-loss injuries resulting in >15 missed performances (TL-15). Results of the risk factor analysis were dependent on the injury definition. Sex (females to male; IRR=1.13, 95% CI; 1.02–1.25) and age over 30 (<20 years to >30 years; IRR=1.37, 95% CI; 1.07–1.79) were risk factors for medical attention injuries only. Risk of injury for Europeans compared with North Americans was higher for TL-1 and TL-15 injuries compared with medical attention injuries. Finally, non-sudden load artists (low-impact acts) were less likely than sudden load artists (high-impact acts) to have TL-1 injuries, but the risk of medical attention injuries was similar. The choice of injury definition can have effects on the magnitude and direction of risk factor analyses.