The psychological impact of COVID-19 infection on athletes: example of professional male football players

The team behind the team: prevalence and correlates of mental health problems among professional football team medical and allied staff?

This study aimed to evaluate depression, anxiety, and stress prevalence and correlates among professional football team medical and allied health staff (MAHS) in Turkey. An online survey was sent to all MAHS (n = 865) attending the professional development accreditation course organized at the end of the 2021-2022 football season in Turkey. Three standardized scales assessed depression, anxiety, and stress. A total of 573 staff participated (response rate = 66.2%). 36.7% of MAHS reported at least moderate severity depression, 25% anxiety, and 80.5% stress. Younger (26-33 years) and less experienced (6-10 years) MAHS reported higher stress scores than their older (50-57 years) and more experienced (>15 years) counterparts (p = 0.02 and p = 0.03, respectively). Masseurs (compared to team doctors) and staff without a second job (compared to those with a second job) reported higher depression and anxiety scores (p = 0.02, p = 0.03, p = 0.03, p = 0.02, respectively). Depression, anxiety, and stress scores of MAHS whose monthly income was less than $519 were higher than those whose income was more than $1036 (all p < 0.01). Findings demonstrated that professional football team MAHS suffer from symptoms of mental-ill-health at substantial rates. In light of these results, organizational policies should be implemented to proactively support the mental health of MAHS working in professional football.

Epidemiology of Injury and Illness in North American Professional Men's Soccer: Comparing COVID-19 Lockdown With Previous Seasons

BACKGROUND

After COVID-19 lockdown, studies across Europe and Asia examined its effect on professional soccer injury rates and severity; however, COVID-19 lockdown influence on injuries in United States men's professional soccer has not been evaluated.

HYPOTHESIS

Injury and illness rates during the 2020 season were higher than the previous 2 seasons.

STUDY DESIGN

Retrospective observational cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Medical staff from participating Major League Soccer (MLS) clubs entered injuries and athletic exposures during the study period into a league-wide electronic medical record system. Injury rate and severity were analyzed to examine differentials between the 2020 COVID season and historical controls.

RESULTS

The injury incidence rate per 1000 hours in 2020 was 10.8, ie, higher than 2018 (5.4) and 2019 (5.0) (P < 0.05). Training injury incidence rate increased in 2020 (8.9) compared with 2018 (2.5) and 2019 (2.6) (P < 0.05), whereas match injury incidence decreased in 2020 (18.3) compared with 2018 (24.0) and 2019 (22.7) (P < 0.05). Incidence rates of lower extremity muscle injuries (6.04), anterior cruciate ligament (ACL) injuries (0.17), and concussions (0.49) were also higher in 2020 compared with 2018 (2.5, 0.07, 0.27) and 2019 (2.36, 0.05, 0.22) (P < 0.05). More injured players in 2020 missed >90 days (17.7%) than in 2018 (10.2%) and 2019 (10.1%) (P < 0.05). Incidence of all non-COVID-19 illness was higher in 2020 (3.93) than 2018 (1.53) and 2019 (1.32) (P < 0.05).

CONCLUSIONS

During 2020, there were significant increases in incidence rates of overall injuries, training injuries, lower extremity muscular injuries, ACL injuries, concussions, and non-COVID illness, along with a higher percentage of players missing >90 days compared with the 2 previous seasons.

CLINICAL RELEVANCE

These results may help clarify the effects of future MLS inseason work stoppages and periods of restricted training.

Impact of COVID-19 on football attacking players' match technical performance: a longitudinal study

This study examined the impact of COVID-19 on 28 indicators of match technical performance (MTP) for football attacking players upon their return to play. Analyzing data from 100 players in the Big Five European football leagues, covering 1500 matches each before and after COVID-19 over 3 years (2020-2023), revealed significant differences in 76% of players' MTP indicators. Notably, 14 indicators, particularly the five indicators linked to scoring, significantly decreased post-COVID-19. On average, players needed 3.09 matches to regain pre-infection MTP levels. The impact varied across player groups, with those in the elite group showing a milder effect; they required an average of 2.64 matches for recovery, compared to the control group's 3.55 matches. We found that, with increasing age, the majority of players' MTP indicators did not exhibit significant changes, both before and after they contracted COVID-19. In conclusion, the study highlighted the negative impact of COVID-19 on football attacking players' MTP. Players in the elite group experienced fewer adverse effects than those in the control group. This insight assisted coaches and managers in evaluating the impact of COVID-19 and similar virus-induced illnesses on players' MTP, enabling them to formulate training regimens for recovery and specific match tactics upon players' return to play.

Which athletes are more vulnerable to mental health symptoms during the COVID-19 crisis? A cross-sectional study

The present study evaluated the mental health (MH) of athletes according to a range of variables, including SARS-CoV-2 infection status and sport-specific factors. An online survey was sent to 1636 Turkish professional athletes incorporating standardized scales assessing athlete-specific stress, depression, and anxiety. A total of 579 professional athletes (29% SARS-CoV-2 positive) participated in the study. While female athletes reported higher anxiety scores than males (p < 0.01), the depression scores of the athletes who had been infected with SARS-CoV-2 were significantly higher than athletes who were not infected (p = 0.03). Higher athlete-specific stress, depression, and anxiety scores were associated with participating in an individual sport, experiencing chronic pain, severe sports injury history, and performance concerns (all p < 0.01). MH symptoms in athletes were associated with being infected with SARS-CoV-2, female gender, participating in an individual sport, and performance concerns. MH assessments should be undertaken with athletes to detect vulnerabilities and enable appropriate and timely MH interventions.

Mental health correlates of athletic shame and guilt among elite-level youth athletes in Turkey

OBJECTIVES

This study evaluated the mental health correlates of athletic shame and guilt among elite-level youth athletes and provided psychometric data on the Turkish version of the Athletic Perceptions of Performance Scale.

DESIGN

Cross-sectional.

METHODS

An online survey was sent to 645 Turkish elite-level youth athletes incorporating standardized scales assessing athletic shame, guilt, and symptoms of high prevalence mental disorders. A subset of participants (n = 45) provided test-retest data at 30 days.

RESULTS

A total of 301 elite youth athletes participated (M = 16.42 ± 0.49 years; 48.7 % response rate) equally representing team and individual sports. Confirmatory factor analysis validated the Turkish version of the Athletic Perceptions of Performance Scale and test-retest data supported temporal stability. Female athletes (compared to male athletes) and athletes participating in an individual sport (compared to participating in a team sport) reported higher athletic shame-proneness scores (p < 0.01 and p = 0.04; respectively). The Turkish version of the Athletic Perceptions of Performance Scale shame-proneness and no-concern scores were associated with athlete-specific stress, anxiety, and depression scores. The Turkish version of the Athletic Perceptions of Performance Scale guilt-proneness was associated with athlete-specific stress and anxiety scores.

CONCLUSIONS

Findings provide cross-cultural validation of the Athletic Perceptions of Performance Scale assessing athletic shame and guilt, demonstrating that female athletes and athletes participating in an individual sport were more likely to experience athletic shame-proneness. Results suggest that athletes experiencing shame-proneness and performance concerns may benefit from supportive coaching and/or mental health supports.

Impact of the COVID-19 pandemic on the psychological aspects and mental health of elite soccer athletes: a systematic review

Introduction

Investigation of the psychological impact on soccer athletes during the pandemic is essential given their unique challenges, including training disruptions and competition postponements. Understanding these effects will allow the development of specific strategies to preserve the mental health and performance of elite athletes, contributing to effective interventions with both short and long-term benefits.

Objective

To analyze the impact of the COVID-19 pandemic on the psychological aspects and mental health of elite soccer athletes.

Method

The review adhered to PRISMA criteria, and the study protocol was registered in the International Prospective Register of Systematic Reviews (CRD42022341545). Searches were conducted until July 2023 in databases including Cochrane, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science. Only original, peer-reviewed studies in English, Portuguese, or Spanish assessing the impact of the COVID-19 pandemic on the psychological aspects and mental health of elite soccer athletes were included.

Results

The search identified 1,055 records and 43 studies were included in this review between 2020 and 2023. In total, the sample included 16,321 soccer athletes of different age groups. Anxiety, depression, mood states, and mental well-being were the most investigated variables. Increased levels of anxiety, depression, and worsening mental well-being were observed in elite soccer athletes. Maintaining fitness during the pandemic showed positive results. Other variables, such as coping, resilience, and sleep quality monitoring, were less widely investigated. Evaluating methodological quality was considered regular for observational and experimental studies.

Conclusion

The study reveals a negative impact of the COVID-19 pandemic on elite soccer athletes, considering psychological aspects and their mental health, notably heightened anxiety and depression. Observational methods predominated, showing mood swings linked to individual characteristics and fitness maintenance efforts. Studies with better-designed methodological approaches and controlled experimental interventions are recommended in the future to mitigate the negative effects of the pandemic on soccer players.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?, identifier (CRD42022341545).

Mental health symptoms and correlates among amateur football players: a cross-sectional study

The objective of this study was to evaluate mental health problems reported by Turkish amateur football players. A total of 4516 Turkish amateur football players were invited to complete an anonymous online survey including demographic and COVID-19 pandemic related questions, the Patient Health Questionnaire-9, General Anxiety Disorder-7 scale, and Athlete Psychological Strain Questionnaire. A total of 1263 players participated in the study (27.9% response rate). Single players reported higher depression and anxiety scores than married players. Higher depression, anxiety, and athletes-specific stress scores were reported by players with an annual income <$5,000 and those reporting an income loss >75% during the COVID-19 pandemic. Players with a sports injury history, psychiatric illness, sleep problems, and perceived inadequate social and/or organizational support reported poorer indices relative to their counterparts. Implementation of mental health screening among amateur football players may assist in detecting vulnerabilities and initiating appropriate timely intervention.

Comparative Study of the Long-Term Impact of the COVID-19 Pandemic on Mental Health and Nutritional Practices Among International Elite and Sub-Elite Athletes: A Sample of 1420 Participants from 14 Countries

BACKGROUND

Although several studies have shown that the Coronavirus Disease 2019 (COVID-19) lockdown has had negative impacts on mental health and eating behaviors among the general population and athletes, few studies have examined the long-term effects on elite and sub-elite athletes. The present study aimed to investigate the long-term impact of COVID-19 lockdown on mental health and eating behaviors in elite versus sub-elite athletes two years into the pandemic. A cross-sectional comparative study was conducted between March and April 2022, involving athletes from 14 countries, using a convenient non-probabilistic and snowball sampling method. A total of 1420 athletes (24.5 ± 7.9 years old, 569 elites, 35% women, and 851 sub-elites, 45% women) completed an online survey-based questionnaire. The questionnaire included a sociodemographic survey, information about the COVID-19 pandemic, the Depression, Anxiety and Stress Scale-21 Items (DASS-21) for mental health assessment, and the Rapid Eating Assessment for Participants (REAP-S) for assessing eating behavior.

RESULTS

The results showed that compared to sub-elite athletes, elite athletes had lower scores on the DASS-21 (p = .001) and its subscales of depression (p = .003), anxiety (p = .007), and stress (p < .001), as well as a lower REAP-S score indicating lower diet quality (p = .013).

CONCLUSION

In conclusion, two years into the pandemic, elite athletes were likelier to have better mental health profiles than sub-elite athletes but surprisingly had lower diet quality.

Psychological changes in athletes infected with Omicron after return to training: fatigue, sleep, and mood

Background

This study aims to analyze the changes of approximately 1 month in fatigue, sleep, and mood in athletes after returning to training following infection with the COVID-19 Omicron strain and provide recommendations for returning to training after infection.

Methods

Two hundred and thirty professional athletes who had returned to training after being infected with COVID-19 in December 2022 were recruited to participate in three tests conducted from early January 2023. The second test was completed approximately 1 week after the first, and the third was completed about 2 weeks after the second. Each test consisted of completing scales and the exercise-induced fatigue measure. The scales included a visual analog scale, the Athens Insomnia Scale for non-clinical application, and the Depression-Anxiety-Stress scale. The exercise task was a six-minute stair climb test, and athletes evaluated subjective fatigue levels before and after exercise using another Visual Analog Scale and the Karolinska Sleepiness Scale.

Results

After returning to training, athletes' physical fatigue decreased initially but increased as training progressed. Cognitive fatigue did not change significantly. The exercise task led to elevated levels of physical fatigue after a longer duration of training. Sleep quality problems decreased rapidly after the start of training but remained stable with prolonged training. Depression levels continued to decline, while anxiety levels only reduced after a longer duration of training. Stress levels decreased rapidly after the start of training but did not change with prolonged training.

Conclusion

Athletes who return to training after recovering from COVID-19 experience positive effects on their fatigue, sleep, and mood. It is important to prioritize anxiety assessment and interventions during the short period after returning and to continue monitoring fatigue levels and implementing recovery interventions over a longer period of time.

Soccer Players' Sleep Quality and Training Load Were Affected by the COVID-19 Lockdown: An International Survey

BACKGROUND

The effect of the 2020 COVID-19 lockdown on athlete sleep and training behavior is documented, albeit without a worldwide soccer-specific focus.

METHOD

Soccer (football) players (N = 1639; 30 countries; age 22.5 [5.7] y; 81% ≤25 y; 56% male; 30% elite; 66% Muslim) answered a retrospective, cross-sectional questionnaire related to their behavioral habits before and during COVID-19 lockdown (survey period July to September 2020), including (1) Pittsburgh Sleep Quality Index PSQI, (2) Insomnia Severity Index (ISI), (3) bespoke questions about training behaviors, and (4) Muslim player focused sleep and training behavior questions.

RESULTS

During lockdown (compared to prelockdown), PSQI (P < .001; moderate effect size [ES]) and ISI (P < .001; moderate ES) scores were higher in the overall sample and in elite versus nonelite (PSQI: P < .05; small ES and ISI: P < .001; small ES), >25 years versus ≤25 years (PSQI: P < .01; small ES and ISI: P < .001; moderate ES), females versus males (PSQI: P < .001; small ES), <1 month versus >1 month lockdown (PSQI: P < .05; small ES and ISI: P < .05; small ES), and players maintaining versus reducing training intensity (PSQI: P < .001; moderate ES and ISI: P < .001; small ES). Muslim players (41%) reported unfavorable sleep and/or training behaviors during Ramadan in lockdown compared to lockdown outside of Ramadan.

CONCLUSIONS

Specific subgroups appear more vulnerable to lockdown effects, with training-intensity maintenance moderating negative effects relative to sleep. Policy and support (respectful of subgroup nuances) during lockdown-like challenges that facilitate training (including intensity) appear prudent, given their favorable relationship with sleep, mental health, and physical health, in the present data and elsewhere.

Psychological and Mental Sequelae in Elite Athletes with Previous SARS-CoV-2 Infection: A Systematic Review

During the COVID-19 pandemic, many athletes from several sporting disciplines were infected with the SARS-CoV-2. The aim of this systematic review is to summarize the current scientific evidence on the psychological sequelae and mental health of elite athletes who have been infected by the virus. The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement; three databases were searched: PubMed, ISI Web of Knowledge, and Scopus. The initial search resulted in 2420 studies; after duplicate removal and screening by title and abstract, 41 articles were screened by full-text. A total of four eligible articles were included in the review. All included articles measured depression and anxiety in athletes who had suffered from COVID-19, while in three papers levels of stress were measured. Overall, the only two questionnaires used in more than one study were the DASS-21 and the APSQ. In our systematic review, we highlighted that mental and psychological health in elite athletes has the same importance as physical health. This statement suggests that these examinations should be introduced and performed during the competitive sports' medical examinations conducted at the start of the sporting season, which currently consists only of the examination of physical parameters. Due to lack of studies on the topic, the results of our review show that mental health in athletes with a history of SARS-CoV-2 infection is an issue that requires more investigation, considering the evidence of clinical consequences. The importance of post-infection psychological sequelae is significant in assessing possible repercussions on the athletes' sporting performance.

Competing against COVID-19: what about the mental health problems of athletes with disabilities?

OBJECTIVES

Although there is growing interest in athletes' mental health (MH), there is a paucity of research exploring MH in athletes with disabilities (AWD). The purpose of this study was to evaluate the impact of the COVID-19 pandemic on the psychological state of AWD.

MATERIALS AND METHODS

An online survey including demographic questions, SARS-CoV-2-related questions, and standardized scales assessing depression, anxiety, stress, coronavirus anxiety (CAS), and nonspecific psychological distress was distributed to AWD.

RESULTS

A total of 362 athletes (183 AWD) participated in the study (response rate 31.2%). AWD infected with SARS-CoV-2 reported higher depression, anxiety, and CAS scores than AWD not infected with SARS-CoV-2 (Z = -2.10, ES = 0.15 Z = -3.45, ES = 0.25; Z = -2.43, ES = 0.18; respectively). Female AWD reported higher anxiety scores compared to males (Z = -2.25, ES = 0.16). Depression (Z = -2.80, ES = 0.20), stress (Z = -2.12, ES = 0.15) and K-10 (Z = -2.02, ES = 0.14 scores of individual sport AWD were higher than team sports AWD.

CONCLUSION

MH problems in AWD were associated with a wide range of variables such as being infected with SARS-CoV-2, female gender, competing in an individual sport, and having performance concerns. In light of these results, MH assessment should be undertaken for AWD to ensure appropriate and timely intervention.

Examining the mental health status of referees in the turkish professional football league

OBJECTIVE

The purpose of the study was to evaluate the mental health (MH) status of referees who officiate in the Turkish professional football leagues.

METHOD

An online survey was sent to all referees in the Turkish professional football leagues (n = 630) incorporating standardized scales assessing depression, anxiety, and stress.

RESULTS

A total of 433 referees participated in the study, yielding a response rate of 68.7%. Younger referees (18-27 years) reported higher depression (p = 0.01), anxiety (p < 0.01), and stress (p < 0.01) scores than older (>38 years) refereees. Depression, anxiety, and stress scores of single referees were higher compared to married referees (all p < 0.01). Lower-level referees reported higher depression (p < 0.01), anxiety (p = 0.01), and stress (p < 0.01) scores than their higher-level counterparts. Higher depression, anxiety, and stress scores were also associated with less income, performance concerns, severe injury history, and inadequate social support.

CONCLUSION

MH problems in referees were associated with a wide range of variables including younger age, being single, refereeing at lower-levels, performance concerns, and inadequate social support. In light of these results, MH assessments should be undertaken with referees to detect which officials are at greater risk of MH problems. Doing so will help to enable appropriate and timely MH interventions.

Effects and Causes of Detraining in Athletes Due to COVID-19: A Review

Several aspects of systemic alterations caused by the SARS-CoV-2 virus and the resultant COVID-19 disease have been currently explored in the general population. However, very little is known about these particular aspects in sportsmen and sportswomen. We believe that the most important element to take into account is the neuromuscular aspect, due to the implications that this system entails in motion execution and coordination. In this context, deficient neuromuscular control when performing dynamic actions can be an important risk factor for injury. Therefore, data in this review refer mainly to problems derived in the short term from athletes who have suffered this pathology, taking into account that COVID-19 is a very new disease and the presented data are still not conclusive. The review addresses two key aspects: performance alteration and the return to regular professional physical activity. COVID-19 causes metabolic-respiratory, muscular, cardiac, and neurological alterations that are accompanied by a situation of stress. All of these have a clear influence on performance but at the same time in the strategy of returning to optimal conditions to train and compete again after infection. From the clinical evidence, the resumption of physical training and sports activity should be carried out progressively, both in terms of time and intensity.

Assessing Knowledge, Preventive Practices, and Depression Among Chinese International Students and Local Korean Students in South Korea During the COVID-19 Pandemic: An Online Cross-Sectional Study

Depression among university students and international university students is an increasing problem globally. This study aimed to clarify the differences on the conditions and determinants of the knowledge, preventive practices and depression of the Chinese international students and local Korean students in South Korea during the COVID-19 pandemic. An online cross-sectional questionnaire including general demographic characteristics, COVID-19-related knowledge, preventive practice, and the Patient Health Questionnaire (PHQ-9) was applied from March 23 to April 22, 2020. A total of 533 university students (171 Chinese international students and 362 local South Korean students) were included in the study. The majority of both Chinese international students and local South Korean students had a good comprehension of COVID-19. Chinese international students in South Korea showed better preventive practice than local Korean students, while the proportion of moderate to severe depression of Chinese international students was relatively higher (28.07%) than that of local Korean students (22.38%). Determinants of depression of Chinese international students in South Korea were information satisfaction, likelihood of survival after infection, symptoms of a cough and feelings of discrimination, while for local Korean students were gender, educational level, family, suspected symptoms, self-assessed physical health status, COVID-19 detection, population contact history and online sources of information. These results could be used as a reference for decreasing the depressive symptoms among the university students.

Mental Health Symptoms of Amateur Association Football Referees: A Cross-Sectional Study

Although referees who officiate in the amateur football leagues are exposed to various stressors that can negatively affect their mental health (MH), little is known about their MH symptoms. The purpose of the study was to evaluate MH symptoms of referees who officiate in the Turkish amateur football leagues. An online survey was sent to all referees in the Turkish amateur football leagues (n = 4,900) incorporating standardized scales assessing depression, anxiety, and stress. A total of 1,279 referees participated in the study. Female referees reported higher depression (p < .01) and anxiety (p = .02) scores than males. Younger referees (23–27 years) reported higher depression (p = .01) and anxiety (p < .01) scores than older (>38 years) referees. Results showed that symptoms of depression, anxiety, and stress scores were associated with marital status (being single), lower incomes, severe sports injury history, and inadequate social support. In light of these results, MH assessments should be undertaken to detect which referees are at greater risk of MH problems and facilitate appropriate and timely MH interventions. Further study is needed to inform MH risk reduction strategies and/or programming.