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Li T, Liu Y. Evaluation and test of the reliability and validity of the Chinese defeat scale in the elite athletes of Chinese universities. Sci Rep 2024; 14:21347. [PMID: 39284866 PMCID: PMC11405387 DOI: 10.1038/s41598-024-69952-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 08/12/2024] [Indexed: 09/22/2024] Open
Abstract
To test the reliability and validity of the "Defeat Scale" and explore whether the scale is suitable for use in surveys of college athletes. A total of 226 athletes from five universities in China were selected for evaluation using the defeat scale. Factor analysis and correlation analysis were used to explore the reliability and validity of the defeat scale. Exploratory factor analysis showed that two factors could be extracted from this scale, namely a sense of decadence and a sense of low achievement. Confirmatory factor analysis showed that the model fit of the two factors was excellent (X2/DF = 2.809, RMSEA = 0.092, SRMR = 0.054, NFI = 0.891, IFI = 0.927, CFI = 0.926, GFI = 0.919, TLI = 0.910) . The convergent validity AVE values are 0.579 and 0.505 respectively, AVE > 0.5, and the combined reliability is 0.946 and 0.746 respectively. Both > 0.7 indicate good convergence effect. The arithmetic square roots of AVE, 0.760 and 0.710, are both higher than the absolute value of the correlation coefficient between the two dimensions, 0.30, indicating good discriminant validity; and the Cronbach's alpha coefficient of defeat is 0.931, and the Spearman-Brown coefficient is 0.888. The defeat scale has good reliability and validity among college athletes.
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Affiliation(s)
- Tao Li
- Physical Education Teaching and Research Section, Cangzhou Jiaotong College, Hebei, China
| | - Yameng Liu
- Physical Education Teaching and Research Section, Cangzhou Jiaotong College, Hebei, China.
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2
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Gill VS, Sullivan G, Stearns H, Tummala SV, Haglin JM, Economopoulos KJ, Marks L, Chauhan M. Mental Health in Elite Athletes: A Systematic Review of Suicidal Behaviour as Compared to the General Population. Sports Med 2024; 54:1-18. [PMID: 38407749 DOI: 10.1007/s40279-024-01998-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Previous systematic reviews on mental health in athletes have found athletes to be at a potentially increased risk for mental health diagnoses compared to the public. Multiple cross-sectional studies have examined suicide behaviour within different athlete populations, but there is a need for a comprehensive review to synthesize and identify risk factors and epidemiology regarding suicide behaviour in the elite athlete population, especially as it compares to the general population. METHODS A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science from 1990 to January 2023. Inclusion criteria included original peer-reviewed research articles examining suicidal ideation, suicide attempt, or suicide completion within elite athlete populations. Exclusion criteria included athletes participating in high-school or Paralympic level sports, studies that did not report results regarding elite athletes and non-athletes separately, and non-peer reviewed work. All studies were screened for inclusion by two independent reviewers. The primary outcome variables extracted from included studies included rates, risk factors, and protective factors for suicide behaviour. The study quality and risk of bias was evaluated for each study using the Joanna-Briggs Institute (JBI) critical appraisal tools. RESULTS Of the 875 unique studies identified, 22 studies, all of which were cross-sectional in nature, met the inclusion criteria. Seven studies evaluated previous athletes, 13 studies evaluated current athletes, and two studies included a combination of previous and current athletes. Seven studies involved varsity college athletes, nine involved professional athletes of various sports, and six focused on international or Olympic level athletes. The rate of suicidal ideation in professional athletes ranged from 6.9 to 18% across four studies, while the rate in collegiate athletes ranged from 3.7 to 6.5% across three studies. Ten studies compared athletes to the general population, the majority of which found athletes to be at reduced risk of suicidal ideation, suicide attempt, and suicide completion. Only one study found athletes to have increased rates of suicide compared to matched non-athletes. Risk factors for suicide behaviour identified across multiple studies included male sex, non-white race, older age, and depression. Player position, athletic level, sport played, and injuries showed trends of having limited effect on suicide behaviour risk. CONCLUSION This review suggests that elite athletes generally demonstrate reduced risk of suicidal ideation, suicide attempt, and suicide completion compared to the general population. Coaches should remain aware of specific factors, such as male sex, non-white race, and higher athletic level, in order to better identify at-risk athletes. Limitations of this review include the heterogeneity in the methodology and athlete populations across the included studies. Therefore, future targeted research is essential to compare suicide behaviour between sports and identify sport-specific suicide risk factors. TRIAL REGISTRATION PROSPERO Registration: CRD42023395990.
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Affiliation(s)
- Vikram S Gill
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA.
- Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | | | - Hunter Stearns
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | - Jack M Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Lisa Marks
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Mohit Chauhan
- Department of Psychiatry, Mayo Clinic, Jacksonville, FL, USA
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3
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Montero A, Baranoff J, Adams R, Drummond M. Athletic retirement: factors contributing to sleep and mental health problems. Front Psychol 2024; 15:1350925. [PMID: 38558779 PMCID: PMC10978592 DOI: 10.3389/fpsyg.2024.1350925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The aim of this investigation was to determine which factors were associated with symptoms of sleep and mental health disorders in former athletes. Methods Former athletes (N = 173, 50% women) who retired from any competition level within the last 20 years participated in an online survey. The survey consisted of the Athlete Sleep Screening Questionnaire (ASSQ), Personal Wellbeing Index-Adult (PWI-A), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R), and Generalised Anxiety Disorder Assessment (GAD-7). Results Binary logistic regressions revealed that both age (OR = 0.95 [95% CI:0.92, 0.99], p = 0.007) and gender (OR = 2.28 [95% CI:1.09, 4.79], p = 0.029) were associated with anxiety, with women and younger ex-athletes presenting greater risk of anxiety symptoms. Higher body mass was associated with an increased risk for sleep difficulty (OR = 1.13 [95% CI:1.03, 1.23], p = 0.008), sleep disordered breathing (OR = 1.20 [95% CI:1.10, 1.30], p < 0.001), and compromised wellbeing (OR = 0.89 [95% CI:0.83, 0.96], p = 0.001). Athletes who subjectively placed a lower priority on sport while competing presented greater risk of sleep disordered breathing (OR = 2.00[95% CI:1.05, 3.80], p = 0.035). No associations between recency retirement and any outcome measures were observed. Discussion Findings suggest potential predictive factors for difficulty transitioning out of sport. Future longitudinal research should consider the interplay between sport re-engagement and the incidence and chronicity of sleep and mental health disorders.
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Affiliation(s)
- Ashley Montero
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Bedford Park, SA, Australia
- Flinders Health and Medical Research Institute (FHMRI) Sleep Health, Bedford Park, SA, Australia
| | - John Baranoff
- School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute (FHMRI) Sleep Health, Bedford Park, SA, Australia
| | - Murray Drummond
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Bedford Park, SA, Australia
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Smoliga JM, Wilber ZT, Robinson BT. Premature Death in Bodybuilders: What Do We Know? Sports Med 2023; 53:933-948. [PMID: 36715876 PMCID: PMC9885939 DOI: 10.1007/s40279-022-01801-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/31/2023]
Abstract
Premature deaths in bodybuilders regularly make headlines and are cited as evidence that bodybuilding is a dangerous activity. A wealth of research has revealed elite athletes typically enjoy lower mortality rates than non-athletes, but research on bodybuilder lifespan is surprisingly limited. Anabolic androgenic steroid (AAS) use is commonly cited as a key contributor to morbidity and premature mortality in bodybuilders, but this area of research is highly nuanced and influenced by numerous confounders unique to bodybuilding. It is quite possible that bodybuilders are at elevated risk and that AAS use is the primary reason for this, but there remains much unknown in this realm. As global participation in bodybuilding increases, and healthcare providers play a more active role in monitoring bodybuilder health, there is a need to identify how numerous factors associated with bodybuilding ultimately influence short- and long-term health and mortality rate. In this Current Opinion, we discuss what is currently known about the bodybuilder lifespan, identify the nuances of the literature regarding bodybuilder health and AAS use, and provide recommendations for future research on this topic.
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Affiliation(s)
- James M. Smoliga
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC 27268 USA
| | - Z. Taggart Wilber
- Department of Physical Therapy, One University Parkway, High Point University, High Point, NC 27268 USA ,Helix Performance Recovery, Wellington, FL USA
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Pichler EM, Ewers S, Ajdacic-Gross V, Deutschmann M, Exner J, Kawohl W, Seifritz E, Claussen MC. Athletes are not at greater risk for death by suicide: A review. Scand J Med Sci Sports 2023; 33:569-585. [PMID: 36648386 DOI: 10.1111/sms.14316] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/21/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Suicide represents a major mental and public health issue. Elite athletes share certain individual and environmental characteristics that may increase their risk for mental illnesses, ultimately leading to suicide. This notion conflicts with the general perception of athletes, being the healthiest representatives of society. METHODS A comprehensive literature search was carried out through PubMed and Embase databases for relevant publications. RESULTS Recent calls for investigating suicidality among athletes resulted in a considerable amount of literature providing some evidence regarding lower rates of suicide among professional and high-performance athletes as well as similar incidence and prevalence of mental conditions, which are known as risk factors for suicide. Nevertheless, special attention is required in this population as predisposing and precipitating factors might differ from classical features of suicidality in the general population. Sports physicians, sports psychiatrists, and other mental health professionals in elite sports should be aware of early signs of affective disorders, risk of recreational drug abuse, misuse of performance-enhancing medications, sport-specific environmental stressors, serious physical injuries, and presence of physical or mental illness, all of which may increase suicidality. Traumatic brain injury (TBI) is with suicide with higher severity correlated with increased risk. Compared to active athletes, former athletes may have higher rates of suicide due to common life stressors occurring after sports retirement. CONCLUSIONS The findings suggest a multidisciplinary approach to suicidality in elite athletes, the main goal of which should be the reduction of suicide-related morbidity and mortality. Further research is required to clarify the existing gaps in the current knowledge of the issue. While having lower rates of suicide, athletes share some similar (affective disorders, drug abuse, mental and physical illness) and unique factors (misuse of performance-enhancing substances, sports-related stressors, sports injuries, TBI) putting them at risk of suicide during active career and retirement.
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Affiliation(s)
- Eva-Maria Pichler
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
| | - Simon Ewers
- Klinikum Fünfseenland, Fachklinik für Psychiatrie und Psychotherapie, Wallerfangen, Germany
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Markus Deutschmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Jan Exner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Clienia Schlössli AG, Oetwil am See, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Malte Christian Claussen
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Private Clinic Wyss AG, Münchenbuchsee, Switzerland.,Psychiatric Services Grisons, Chur, Switzerland
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6
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Neumann DL, Piatkowski TM, Moffitt RL, Minahan CL. The mental health of elite athletes in developing nations of the greater Oceania region. AUSTRALIAN PSYCHOLOGIST 2022. [DOI: 10.1080/00050067.2022.2130027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- David L. Neumann
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Timothy M. Piatkowski
- School of Applied Psychology, Griffith University, Gold Coast, Australia
- College of Health & Human Sciences, Charles Darwin University, Darwin, Australia
| | | | - Clare L. Minahan
- School of Health Sciences & Social Work, Griffith University, Gold Coast, Australia
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7
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Montero A, Stevens D, Adams R, Drummond M. Sleep and Mental Health Issues in Current and Former Athletes: A Mini Review. Front Psychol 2022; 13:868614. [PMID: 35465516 PMCID: PMC9023010 DOI: 10.3389/fpsyg.2022.868614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep and mental health are important aspects of human health that work concurrently. However, sleep and mental health disorders are often overlooked and undiagnosed in sport due to the negative stigma associated with them. Evidence suggests that athletes are disproportionately affected by mental health issues and sleep problems. Internal and external pressures contribute to psychological distress. Variable competition times, travel and stress are detrimental to sleep quality. Retirement from sport can deteriorate sleep and psychological wellbeing, particularly for those who retired involuntarily and identify strongly with their athletic role. When untreated, these issues can manifest into a range of clinical disorders. This is concerning, not only for compromised athletic performance, but for general health and wellbeing beyond sport. Previous research has focussed on sleep and health independently among currently competing, or former, athletes. To date, no research has comprehensively assessed and compared sleep complaints and mental health issues between these two cohorts. Moreover, research has failed to obtain data across a variety of different competition levels, sports, and genders, leaving the current scope of the literature narrow. Comorbid conditions (e.g., concussion history, obesity), ex-college athletes, and mental health has been the focus of existing literature post-retirement. Future research would benefit from employing both quantitative and qualitative methodologies to comprehensively assess the prevalence and severity of sleep and mental health disorders across current and retired athletes. Research outcomes would inform education strategies, safeguarding athletes from these issues by reducing negative stigmas associated with help-seeking in sport and ultimately increase self-guided treatment.
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Affiliation(s)
- Ashley Montero
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Bedford Park, SA, Australia
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - David Stevens
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Robert Adams
- Adelaide Institute for Sleep Health, Flinders University, Bedford Park, SA, Australia
| | - Murray Drummond
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
- Sport, Health, Activity, Performance and Exercise (SHAPE) Research Centre, Flinders University, Bedford Park, SA, Australia
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8
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Gestsdottir S, Kristjansdottir H, Sigurdsson H, Sigfusdottir ID. Prevalence, mental health and substance use of anabolic steroid users: a population-based study on young individuals. Scand J Public Health 2020; 49:555-562. [PMID: 33280527 DOI: 10.1177/1403494820973096] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: The use of anabolic androgen steroids to enhance performance is not a modern phenomenon. However, the majority of today's anabolic androgen steroid users are not competitive athletes, but individuals who want to look leaner and muscular. This study aimed to examine the prevalence of anabolic androgen steroid use among young individuals and assess whether their mental health, lifestyle and substance use differ from non-anabolic androgen steroid users. Methods: A population-based study conducted in secondary schools, mean age was 17.3 years. A total of 10,259 participants (50% young women, 1% reported gender as 'other', 49% young men) answered questions on mental health, anabolic androgen steroid use, substance use and sports participation. Statistical analysis included descriptive statistics, t-test, χ2 and logistic regression. Results: The prevalence of anabolic androgen steroid use was 1.6%, and 78% of users were young men. Anabolic androgen steroid users had more anger issues, anxiety, depression, and their self-esteem was lower than among non-anabolic androgen steroid users (P<0.05). A larger proportion of anabolic androgen steroid users, 30%, had attempted suicide compared to 10% of non-users (χ2 (1, 9580) = 57.5, P<0.001). Proportionally, anabolic androgen steroid users were more likely to take medicine for mental health problems and misuse substances than non-users. Participation in non-organised sports, increased anger and body image were associated with increased odds of using anabolic androgen steroids. Conclusions: Anabolic androgen steroid use is a public health threat. It had an alarming effect on the life of individuals who report having used anabolic androgen steroids. Authorities, healthcare workers, parents and others working with young people need to be informed of the signs and risks of anabolic androgen steroid use to reduce future negative implications.
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Affiliation(s)
- Sunna Gestsdottir
- Centre of Sport and Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Hafrun Kristjansdottir
- Physical Activity, Physical Education, Health and Sport Research Centre (PAPESH), Reykjavik University, Reykjavik, Iceland
| | - Hedinn Sigurdsson
- Reykjavik Capital Area Primary Health Care Centre, Glaesibaer Centre, Reykjavik, Iceland
| | - Inga Dora Sigfusdottir
- Icelandic Centre for Social Research and Analysis, Reykjavik, Iceland.,Teachers College, Columbia University, New York, USA
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9
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Russell ER, McCabe T, Mackay DF, Stewart K, MacLean JA, Pell JP, Stewart W. Mental health and suicide in former professional soccer players. J Neurol Neurosurg Psychiatry 2020; 91:1256-1260. [PMID: 32694163 PMCID: PMC8747033 DOI: 10.1136/jnnp-2020-323315] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/06/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION There is growing recognition of an association between contact sports participation and increased risk of neurodegenerative disease, including Alzheimer's disease and chronic traumatic encephalopathy. In addition to cognitive impairment, a range of mental health disorders and suicidality are proposed as diagnostic features of traumatic encephalopathy syndrome, the putative clinical syndrome associated with chronic traumatic encephalopathy. However, to date, epidemiological data on contact sport participation and mental health outcomes are limited. METHODS For a cohort of former professional soccer players (n=7676) with known high neurodegenerative mortality and their matched general population controls (n=23 028), data on mental health outcomes were obtained by individual-level record linkage to national electronic records of hospital admissions and death certification. RESULTS Compared with matched population controls, former professional soccer players showed lower risk of hospital admission for anxiety and stress related disorders, depression, drug use disorders, alcohol use disorders and bipolar and affective mood disorders. Among soccer players, there was no significant difference in risk of hospitalisation for mental health disorders between outfield players and goalkeepers. There was no significant difference in rate of death by suicide between soccer players and controls. CONCLUSIONS Among a population of former professional soccer players with known high neurodegenerative disease mortality, hospital admissions for common mental health disorders were lower than population controls, with no difference in suicide. Our data provide support for the reappraisal of currently proposed diagnostic clinical criteria for traumatic encephalopathy syndrome, in particular the inclusion of mental health outcomes.
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Affiliation(s)
- Emma R Russell
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Thomas McCabe
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Katy Stewart
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Hampden Park, Glasgow, UK
| | - John A MacLean
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,Hampden Sports Clinic, Hampden Park, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - William Stewart
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK .,Department of Neuropathology, NHS Greater Glasgow and Clyde, Glasgow, UK
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10
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Duncombe SL, Tanaka H, De Larochelambert Q, Schipman J, Toussaint JF, Antero J. High hopes: lower risk of death due to mental disorders and self-harm in a century-long US Olympian cohort compared with the general population. Br J Sports Med 2020; 55:900-905. [PMID: 33214139 DOI: 10.1136/bjsports-2020-102624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the risk of death due to prominent mental disorders, substance abuse, and self-harm among US Olympians compared with the general population. METHODS All female (n=2301) and male (n=5823) US Olympians who participated in the summer or winter Games between 1912 and 2012 were followed until 2016. The National Death Index certified their vital statuses and causes of death. We performed a Standard Mortality Ratio (SMR) analysis for all causes studied and applied the years-saved (YS) method to quantify differences in the risk of death for (1) anxiety, depression and self-harm and (2) substance abuse and eating disorders. Additionally, we examined the YS across sports with greater than 100 total deaths and between medalists and non-medalists. RESULTS US Olympians had a 32% (SMR=0.68, 95% CI 0.49 to 0.91) lower risk of death compared with the general population, resulting in a longevity advantage of 0.21 YS (95% CI 0.14 to 0.29) for deaths by depression, anxiety and self-harm and 0.12 years (95% CI 0.08 to 0.15) for substance abuse and eating disorders. There were no significant differences between medalists and non-medalists, but findings varied by sports. Most sports (eg, athletics, swimming, rowing) had significantly lower risks of deaths than the general population with the exceptions of fencing and shooting. Shooting showed a trend towards a higher risk through suicide by firearm. CONCLUSION Olympians have a lower risk of death, favouring an increased longevity compared with the general population for mental disorders, substance abuse and suicides.
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Affiliation(s)
- Stephanie L Duncombe
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | - Hirofumi Tanaka
- Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, USA
| | | | - Julien Schipman
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
| | - Jean-François Toussaint
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France.,Centre d'Investigation en Médecine du Sport (CIMS), AP-HP, Paris, France
| | - Juliana Antero
- Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
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11
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Kujala UM. Fitter, healthier and stronger? Many factors influence elite athletes' long-term health. Br J Sports Med 2020; 55:77-78. [PMID: 33168579 DOI: 10.1136/bjsports-2020-102239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Urho M Kujala
- Faculty of Sport and Health Sciences, University of Jyväskylä, 40014 Jyväskylän, Finland
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12
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Smit DL, Buijs MM, de Hon O, den Heijer M, de Ronde W. Positive and negative side effects of androgen abuse. The HAARLEM study: A one-year prospective cohort study in 100 men. Scand J Med Sci Sports 2020; 31:427-438. [PMID: 33038020 DOI: 10.1111/sms.13843] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/25/2020] [Indexed: 01/04/2023]
Abstract
An estimated 4-6% of fitness center visitors uses anabolic-androgenic steroids (AAS). Reliable data about adverse reactions of AAS are scarce. The HAARLEM study aimed to provide insight into the positive and negative effects of AAS use. One hundred men (≥18 years) who intended to start an AAS cycle on short notice were included for follow-up. Clinic visits took place before (T0 ), at the end (T1 ), and three months after the end of the AAS cycle (T2 ), and one year after the start of the cycle (T3 ), and comprised a medical history, physical examination, laboratory analysis, and psychological questionnaires. During the follow-up period, four subjects reported a serious adverse event, that is, congestive heart failure, acute pancreatitis, suicidal ideation, and exacerbation of ulcerative colitis. All subjects reported positive side effects during AAS use, mainly increased strength (100%), and every subject reported at least one negative health effect. Most common were fluid retention (56%) and agitation (36%) during the cycle, and decreased libido (58%) after the cycle. Acne and gynecomastia were observed in 28% and 19%. Mean alanine transaminase (ALT) and creatinine increased 18.7 U/l and 4.7 µmol/L, respectively. AAS dose and cycle duration were not associated with the type and severity of side effects. After one-year follow-up (T3 ), the prevalence of observed effects had returned to baseline. There was no significant change in total scores of questionnaires investigating wellbeing, quality of life, and depression. In conclusion, all subjects experienced positive effects during AAS use. Four subjects experienced a serious adverse event. Other side effects were mostly anticipated, mild, and transient.
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Affiliation(s)
- Diederik L Smit
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands
| | - Madelon M Buijs
- Atalmedial Diagnostics Centre, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | - Olivier de Hon
- Doping Authority Netherlands, Capelle aan den IJssel, the Netherlands
| | - Martin den Heijer
- Department of Internal Medicine, Section of Endocrinology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Willem de Ronde
- Department of Internal Medicine, Spaarne Gasthuis, Haarlem, the Netherlands
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13
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Nicholls AR, Fairs LRW, Plata-Andrés M, Bailey R, Cope E, Madigan D, Koenen K, Glibo I, Theodorou NC, Laurent JF, Garcia G, Chanal B. Feasibility randomised controlled trial examining the effects of the Anti-Doping Values in Coach Education (ADVICE) mobile application on doping knowledge and attitudes towards doping among grassroots coaches. BMJ Open Sport Exerc Med 2020; 6:e000800. [PMID: 33088583 PMCID: PMC7547541 DOI: 10.1136/bmjsem-2020-000800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives Sports coaches are influential in whether athletes dope, but receive very little antidoping education, particularly within entry-level coaching qualifications. We tested the feasibility of an antidoping intervention, delivered via a mobile application, which was designed to increase coaches’ knowledge of doping and to reduce favourable doping attitudes. Methods A two-arm randomised controlled trial, with grassroots coaches who coach young amateur athletes aged between 14 and 18 years of age, was conducted. The Anti-Doping Values in Coach Education (ADVICE) mobile application included modules on fair play, substances, nutritional supplements, rules and leadership. The primary outcome was the change in doping knowledge, 6 weeks after receiving the mobile application. The secondary outcome was changes in doping attitudes. Results Grassroots coaches (n=200; aged between 18 and 71 years, with between 1 and 42 years of coaching experience) from 29 different countries completed baseline assessments, and 85 completed follow-up assessments, and were included in mixed analysis of variance analyses. The intervention increased coaches’ knowledge about doping and also reduced favourable doping attitudes in the experimental arm. Conclusion The ADVICE mobile application is a feasible method for delivering and increasing grassroots coaches’ knowledge of banned substances and the potential side effects of doping. Mobile application-based resources could facilitate a much wider dissemination of antidoping education.
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Affiliation(s)
| | - Lucas R W Fairs
- Department of Sport, Health, and Exercise Science, University of Hull, Hull, UK
| | - Mar Plata-Andrés
- Agencia Española de Protección de la Salud en el Deporte, Madrid, Spain
| | | | - Edward Cope
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Katrin Koenen
- School of Sport, Exercise and Health Sciences, Senate of Berlin, Berlin, UK
| | - Iva Glibo
- Department of Sport and Health Sciences, Technical University of Munich, Munchen, Germany
| | | | | | - Gaetan Garcia
- The Association for International Sport for All, Frankfurt, Germany
| | - Benoit Chanal
- Agence Française de Lutte Contre le Dopage, Paris, France
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14
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Nicholls AR, Levy AR, Meir R, Sanctuary C, Jones L, Baghurst T, Thompson MA, Perry JL. The Susceptibles, Chancers, Pragmatists, and Fair Players: An Examination of the Sport Drug Control Model for Adolescent Athletes, Cluster Effects, and Norm Values Among Adolescent Athletes. Front Psychol 2020; 11:1564. [PMID: 32754092 PMCID: PMC7366030 DOI: 10.3389/fpsyg.2020.01564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022] Open
Abstract
Although there are few high-profile cases of adolescent athletes being caught doping, up to a third of young athletes may dope. In order to generate a more accurate understanding of why adolescent athletes dope, it is important to validate models that help to explain this behavior. The aims of this study were 3-fold: firstly, to test the Sport Drug Control Model for Adolescent Athletes (SDCM-AA); secondly, to generate athlete profiles that would help quantify the proportion of athletes who are at risk of doping; and thirdly, to create norm values for the Adolescent Sport Doping Inventory (ASDI), which would allow national doping organizations, sporting organizations, and clubs to benchmark the scores of their athletes for key psycho-social variables linked to doping. A total of 2208 adolescent athletes from the United Kingdom, Australia, Hong Kong, and the United States completed the ASDI. The data presented an appropriate fit to the SDCM-AA model, in which 54% of the variance in susceptibility to doping was explained in the model, and 44.8% of attitudes toward doping was accounted for. Four distinct clusters of athletes emerged: the Susceptibles (i.e., identified with the benefits of doping, were willing to cheat, and viewed little threat), the Chancers (i.e., identified with the benefits of doping, scored high on willingness to cheat, and were highly influenced by their reference group, but had an average score for threat, self-esteem, and legitimacy), the Pragmatists (i.e., did not engage with any aspects of doping, but were more susceptible than the fair players), and Fair Players (i.e., high levels of sportspersonship, unwilling to cheat, and viewed doping as a threat). The revised SDCM-AA appears a valid model that helps explain the factors associated with doping attitudes and doping susceptibility. Adolescent athletes can be classified into one of four clusters, in relation to doping. Their cluster group could influence the content of the anti-doping education they receive.
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Affiliation(s)
- Adam R. Nicholls
- Department of Sport, Health and Exercise Science, University of Hull, Hull, United Kingdom
| | - Andrew R. Levy
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Rudi Meir
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Colin Sanctuary
- School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia
| | - Leigh Jones
- Hong Kong Rugby Foot-Ball Union, Hong Kong, Hong Kong
| | - Timothy Baghurst
- College of Education, Florida State University, Tallahassee, FL, United States
| | - Mark A. Thompson
- Department of Sport, Health and Exercise Science, University of Hull, Hull, United Kingdom
| | - John L. Perry
- Department of Psychology, Mary Immaculate College, Limerick, Ireland
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15
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Börjesson A, Möller C, Hagelin A, Vicente V, Rane A, Lehtihet M, Dahl ML, Gårevik N, Ekström L. Male Anabolic Androgenic Steroid Users with Personality Disorders Report More Aggressive Feelings, Suicidal Thoughts, and Criminality. ACTA ACUST UNITED AC 2020; 56:medicina56060265. [PMID: 32481676 PMCID: PMC7353874 DOI: 10.3390/medicina56060265] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: Anabolic androgenic steroids (AAS) are mainly used for aesthetic and performance-enhancing reasons. Their use is a growing public health problem and concern for society because of their adverse effects. The primary aim of this study was to identify psychiatric and personality disorders and to measure anxiety and depression in AAS users. Materials and Methods: Fifty-six males who actively contacted the Anti-Doping Hot-Line and wished to stop using AAS were included. Structured Clinical Interviews Diagnosis-I and -II were used to diagnose psychiatric and personality disorders. The Brief Scale for Anxiety and Montgomery Asberg Depression Rating Scale (subscales from the Comprehensive Psychopathological Rating Scale) were used to measure changes in anxiety and depression. Structured Clinical Interviews Diagnosis-I and -II were performed at one time point. Anxiety and depression were measured at inclusion and after six months. Urine samples were collected for an analysis of AAS and drugs of abuse. Results: All participants reported some adverse effects that they associated with AAS use. In total, 56% and 52% of the cohort fulfilled the criteria for Structured Clinical Interviews Diagnosis-I and -II diagnoses, respectively. A significantly increased risk of reporting aggressive feelings/behaviors (Odds Ratio (OR) = 4.9; Confidence Interval (CI) 0.99-25, p = 0.04), suicidal thoughts/attempts (OR = 4.6, CI 95; 0.99-21, p = 0.04) and criminality (OR = 6.5, CI 1-39, p = 0.03) was found among individuals with AAS use fulfilling the criteria for personality disorders compared with those without such AAS use. The Brief Scale for Anxiety score decreased from the median of 15 at inclusion to 10 at the follow-up visit six months later (p = 0.01, n = 19). Conclusions: Our findings indicate that among individuals with AAS use, those with a personality disorder report more aggressive behaviors, suicidal thoughts/suicidal attempts, and criminality than those without a personality disorder.
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Affiliation(s)
- Annica Börjesson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
- Correspondence: ; Tel.: +46-8-585-811-92
| | - Christian Möller
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Psychiatric Clinic, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, 422 49 Gothenburg, Sweden
| | - Anders Hagelin
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
| | - Veronica Vicente
- The Ambulance Medical Service in Stockholm (AISAB), Academic EMS, 121 63 Stockholm, Sweden;
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anders Rane
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
| | - Mikael Lehtihet
- Department of Medicine, Karolinska Institutet, S:t Görans Hospital, 122 19 Stockholm, Sweden;
| | - Marja-Liisa Dahl
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
| | - Nina Gårevik
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
- Department of Neurobiology Care Sciences and Society, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Lena Ekström
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden; (A.H.); (A.R.); (M.-L.D.); (N.G.); (L.E.)
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16
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Abstract
ZusammenfassungWährend moderate sportliche Bewegung die Überlebenswahrscheinlichkeit einer Risikogruppe positiv beeinflusst, sind die Befunde im Leistungssport international gemischt. Für Deutschland liegt dazu nur eine Studie zu Fußball-Nationalspielern vor. Daher wurden mit Hilfe der Daten der Mitglieder der deutschen Olympiamannschaften 1956 bis 2016 (n = 6066) Hypothesen zu Effekten im Vergleich zur Gesamtbevölkerung, zum metabolischen Stoffwechsel, zu Einzel‑, Mix- und Mannschaftssportarten, zu Doping, zum olympischen Erfolg und zum Geschlecht getestet und dabei auch die Mitgliedschaft in den Olympiamannschaften der Bundesrepublik, der DDR sowie dem wiedervereinigten Deutschland berücksichtigt. Es zeigt sich, dass die Mitglieder der deutschen Olympiamannschaften bislang eine im Vergleich mit der Gesamtbevölkerung höhere Mortalitätsrate aufweisen, es keine höheren Überlebensraten für die Mitglieder der Olympiamannschaften der alten Bundesrepublik gibt, sich keine Differenzen zwischen Sportarten finden lassen, aber steigende olympische Erfolge zu höheren Mortalitätsraten führen.
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17
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Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention: American Medical Society for Sports Medicine Position Statement. Clin J Sport Med 2020; 30:e61-e87. [PMID: 32000169 DOI: 10.1097/jsm.0000000000000817] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment, and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers, and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct, and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders, and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance, and prevention. This document uses the Strength of Recommendation Taxonomy (SORT) to grade level of evidence.
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18
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Madigan DJ, Mallinson-Howard SH, Grugan MC, Hill AP. Perfectionism and attitudes towards doping in athletes: A continuously cumulating meta-analysis and test of the 2 × 2 model. Eur J Sport Sci 2019; 20:1245-1254. [DOI: 10.1080/17461391.2019.1698660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Takeuchi T, Kitamura Y, Sado J, Hattori S, Kanemura Y, Naito Y, Nakajima K, Okuwaki T, Nakata K, Kawahara T, Sobue T. Mortality of Japanese Olympic athletes: 1952-2017 cohort study. BMJ Open Sport Exerc Med 2019; 5:e000653. [PMID: 32206340 PMCID: PMC7078660 DOI: 10.1136/bmjsem-2019-000653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/15/2022] Open
Abstract
Aim To evaluate mortality among Japanese Olympic athletes compared with the general population and also evaluate their mortality based on total number of Olympics participation and intensity of sports disciplines. Methods Information on biography, vital status, date of birth, date of death and latest follow-up date on Japanese Olympians was retrieved from six online databases and compared. Standardised mortality ratio (SMR) was estimated according to observation periods and years from last participation in the Olympics. To further evaluate the association between mortality and total number of Olympics participation/intensity of sports disciplines within the study population, rate ratios (RRs) adjusted by sex, observation period and attained age group were estimated by a Poisson regression model. Results A total of 3381 Olympians were included in the analysis. The total person years was 94 076.82. The deaths of 153 (4.53%) Olympians were confirmed, and the overall SMR was 0.29 (95% CI, 0.25 to 0.34). SMRs categorised by years from last participation did not differ significantly. Higher mortality was observed among those who participated in the Olympics twice (RR: 1.52; 95% CI, 1.04 to 2.23) and three times or more (RR: 1.87; 95% CI, 1.08 to 3.25) compared with those who participated just once. Compared with combination of low static and low dynamic intensity category, higher mortality was observed in most combinations of middle-intensity or high-intensity categories. Conclusion Japanese Olympians lived longer than the general population. More frequent participation in the Olympics and higher intensity of sports disciplines were associated with higher mortality.
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Affiliation(s)
- Taro Takeuchi
- Department of Social Medicine, Osaka University, Suita, Japan
| | - Yuri Kitamura
- Department of Social Medicine, Osaka University, Suita, Japan
| | - Junya Sado
- Department of Health and Sports Sciences, Osaka University, Suita, Japan
| | - Satoshi Hattori
- Department of Integrated Medicine, Osaka University, Suita, Japan
| | - Yumiko Kanemura
- Department of Food Science and Nutrition, Mukogawa Women's University, Nishinomiya, Japan
| | - Yoshihiko Naito
- Department of Food Science and Nutrition, Mukogawa Women's University, Nishinomiya, Japan
| | - Kohei Nakajima
- Japan Institute of Sports Sciences, Kita-ku, Japan
- Japanese Olympic Committee, Tokyo, Japan
| | - Toru Okuwaki
- Japan Institute of Sports Sciences, Kita-ku, Japan
| | - Ken Nakata
- Department of Health and Sports Sciences, Osaka University, Suita, Japan
| | - Takashi Kawahara
- Japan Institute of Sports Sciences, Kita-ku, Japan
- Japanese Olympic Committee, Tokyo, Japan
| | - Tomotaka Sobue
- Department of Social Medicine, Osaka University, Suita, Japan
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20
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Currie A, McDuff D, Johnston A, Hopley P, Hitchcock ME, Reardon CL, Hainline B. Management of mental health emergencies in elite athletes: a narrative review. Br J Sports Med 2019; 53:772-778. [PMID: 31097462 DOI: 10.1136/bjsports-2019-100691] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 01/19/2023]
Abstract
Mental health emergencies require a rapid, effective response. We searched the literature on mental health emergencies in athletes and found five papers. None of these addressed elite athletes. Nonetheless, common mental health emergencies may present in the sports environment and may place the athlete and others at risk. Sports teams and organisations should anticipate which emergencies are likely and how medical and support staff can best respond. Responses should be based on general non-sporting guidelines. We stress the importance of clinicians following standard procedures.
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Affiliation(s)
- Alan Currie
- Regional Affective Disorders Service, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - David McDuff
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Allan Johnston
- Mental Health Expert Panel, English Institute of Sport, Sheffield, UK
| | | | - Mary E Hitchcock
- Ebling Library for the Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Claudia L Reardon
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
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21
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Havnes IA, Jørstad ML, Wisløff C. Anabolic-androgenic steroid users receiving health-related information; health problems, motivations to quit and treatment desires. Subst Abuse Treat Prev Policy 2019; 14:20. [PMID: 31096999 PMCID: PMC6524231 DOI: 10.1186/s13011-019-0206-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/15/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anabolic-androgenic steroids (AAS) are used to increase muscle strength and improve appearance, but users also carry the risk of developing physical and mental health problems. In Norway, the substance use disorder treatment system provides health care to this patient group, but few AAS users have sought such treatment. Therefore, a service was created to inform AAS users and next of kin of potential negative consequences and their treatment options. This study describes health problems, motivations for AAS cessation, and treatment desires among AAS users. METHODS Over four years, 232 AAS users and 60 next of kin contacted the information service and received an hour-long information session with healthcare personnel. Information about AAS use, physical and mental health problems, substance use, motivation for cessation, and whether the information seeker desired treatment were registered. Qualitative interviews were conducted among seven individuals and analyzed thematically to explore information service experiences. RESULTS Of the 232 AAS users, 179 (77.2%) desired treatment after completing the information session and 53 (22.9%) were unsure or did not want treatment. Those who desired treatment were significantly older, had used AAS longer, reported more physical and mental health side effects, and a higher proportion reported having children than those who did not desire treatment. Although 181 (78.0%) reported co-occuring physical and mental health problems, mental health problems were the most common motivation for AAS cessation (n = 108, 47.8%), followed by a combination of mental and physical health problems (52, 23.0%). Findings from qualitative interviews suggest that barriers to treatment may be overcome with an easily accessible service that informs about addiction treatment and facilitates the treatment entry process. CONCLUSIONS Healthcare professionals who encounter users of AAS should have knowledge about AAS use and adverse effects. The desire for health care reveals extensive health problems and the user group is so non-homogeneous that examination and treatment must be adapted individually with focus on physical, mental and social factors as well as possible dependence of AAS and/or psychoactive substances.
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Affiliation(s)
- Ingrid Amalia Havnes
- National Advisory Unit on Substance Use Disorder Treatment, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen, 0424 Oslo, Norway
| | - Marie Lindvik Jørstad
- National Advisory Unit on Substance Use Disorder Treatment, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen, 0424 Oslo, Norway
| | - Christine Wisløff
- National Advisory Unit on Substance Use Disorder Treatment, Division of Mental Health and Addiction, Oslo University Hospital, PO Box 4959, Nydalen, 0424 Oslo, Norway
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22
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Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med 2019; 53:667-699. [DOI: 10.1136/bjsports-2019-100715] [Citation(s) in RCA: 349] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/03/2022]
Abstract
Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.
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23
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Lenz B, Röther M, Bouna-Pyrrou P, Mühle C, Tektas OY, Kornhuber J. The androgen model of suicide completion. Prog Neurobiol 2018; 172:84-103. [PMID: 29886148 DOI: 10.1016/j.pneurobio.2018.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 09/02/2017] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
Suicide is a devastating public health issue that imposes severe psychological, social, and economic burdens not only for the individuals but also for their relatives, friends, clinicians, and the general public. Among the different suicidal behaviors, suicide completion is the worst and the most relevant outcome. The knowledge of biological etiopathological mechanisms involved in suicide completion is limited. Hitherto, no objective markers, either alone or in combination, can reliably predict who will complete a suicide. However, such parameters are strongly needed to establish and optimize prediction and prevention. We introduce here a novel ideation-to-completion framework in suicide research and discuss the problems of studies aiming at identifying and validating clinically useful markers. The male gender is a specific risk factor for suicide, which suggests that androgen effects are implicated in the transition from suicidal ideation to suicide completion. We present multiple lines of direct and indirect evidence showing that both an increased prenatal androgen load (with subsequent permanent neuroadaptations) and increased adult androgen activity are involved in suicide completion. We also review data arguing that modifiable maternal behavioral traits during pregnancy contribute to the offspring's prenatal androgen load and increase the risk for suicide completion later in life. We conclude that in utero androgen exposure and adult androgen levels facilitate suicide completion in an synergistic manner. The androgen model of suicide completion provides the basis for the development of novel predictive and preventive strategies in the future.
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Affiliation(s)
- Bernd Lenz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
| | - Mareike Röther
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Polyxeni Bouna-Pyrrou
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Christiane Mühle
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Ozan Y Tektas
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany
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24
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Lemez S, Wattie N, Baker J. The end game: Mortality outcomes in North American professional athletes. Scand J Med Sci Sports 2018; 28:1722-1730. [PMID: 29394512 DOI: 10.1111/sms.13066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 01/18/2023]
Abstract
Comprehensive investigations into the mortality outcomes of elite athletes can assist in decoding risk factors for premature mortality and provide avenues for exploring human health through engagement in sport. As such, the purpose of this study was to comprehensively examine lifespan trends of athletes from the 4 major sports in North America: Major League Baseball (MLB), National Basketball Association (NBA), National Football League (NFL), and National Hockey League (NHL). We hypothesized that proportional death rates would be similar across the 4 sports, when standardizing the data by debut years. Overall, 17 523 of 50 515 (34.7%) athletes were deceased as of the respective data collection cutoff date for their sport, with MLB players having the highest risk of imminent mortality. Professional basketball players generally had the highest relative proportion of death when standardizing data by debut year, although NHL and NFL players who debuted after 2005 had the highest proportion of death. In addition, a 1-year increase in career length significantly decreased the risk of death (HR: 0.982, 95% CI: 0.978-0.985), even after adjusting for sport type (HR: 0.977, 95% CI: 0.974-0.980). Meaningful significance should be considered given the historical and unique nature of the sample. Nevertheless, investigating risk of death differences through different occupational and biological variables can help highlight aversive trends to lifespan that permeate throughout high-performance athlete populations.
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Affiliation(s)
- S Lemez
- School of Kinesiology and Nutritional Science, California State University, Los Angeles, CA, USA
| | - N Wattie
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - J Baker
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
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25
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Lindqvist Bagge A, Rosén T, Fahlke C, Ehrnborg C, Eriksson B, Moberg T, Thiblin I. Somatic effects of AAS abuse: A 30-years follow-up study of male former power sports athletes. J Sci Med Sport 2017; 20:814-818. [DOI: 10.1016/j.jsams.2017.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 02/13/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
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26
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Nicholls AR, Madigan DJ, Backhouse SH, Levy AR. Personality traits and performance enhancing drugs: The Dark Triad and doping attitudes among competitive athletes. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2017.02.062] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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27
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Nicholls AR, Cope E, Bailey R, Koenen K, Dumon D, Theodorou NC, Chanal B, Saint Laurent D, Müller D, Andrés MP, Kristensen AH, Thompson MA, Baumann W, Laurent JF. Children's First Experience of Taking Anabolic-Androgenic Steroids can Occur before Their 10th Birthday: A Systematic Review Identifying 9 Factors That Predicted Doping among Young People. Front Psychol 2017; 8:1015. [PMID: 28676778 PMCID: PMC5476735 DOI: 10.3389/fpsyg.2017.01015] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/01/2017] [Indexed: 01/27/2023] Open
Abstract
Taking performance-enhancing drugs (PEDs) can cause serious and irreversible health consequences, which can ultimately lead to premature death. Some young people may take PEDs without fully understanding the ramifications of their actions or based on the advice from others. The purpose of this systematic review was to identify the main factors that predicted doping among young people. The literature was systematically reviewed using search engines, manually searching specialist journals, and pearl growing. Fifty-two studies, which included 187,288 young people aged between 10 and 21 years of age, 883 parents of adolescent athletes, and 11 adult coaches, who were interviewed regarding young athletes, were included in this review. Nine factors predicted doping among young people: gender; age; sports participation; sport type; psychological variables; entourage; ethnicity; nutritional supplements; and health harming behaviors. In regards to psychological variables, 22 different constructs were associated with doping among young people. Some psychological constructs were negatively associated with doping (e.g., self-esteem, resisting social pressure, and perfectionist strivings), whereas other were positively associated with doping (e.g., suicide risk, anticipated regret, and aggression). Policy makers and National Anti-Doping Organizations could use these findings to help identify athletes who are more at risk of doping and then expose these individuals to anti-doping education. Based on the current findings, it also appears that education programs should commence at the onset of adolescence or even late childhood, due to the young age in which some individuals start doping.
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Affiliation(s)
| | - Ed Cope
- School of Life Sciences, University of HullHull, United Kingdom
| | - Richard Bailey
- International Council of Sport Science and Physical EducationBerlin, Germany
| | - Katrin Koenen
- International Council of Sport Science and Physical EducationBerlin, Germany
| | - Detlef Dumon
- International Council of Sport Science and Physical EducationBerlin, Germany
| | | | - Benoit Chanal
- Agence Française de Lutte Contre le DopageParis, France
| | | | - David Müller
- Nationale Anti-Doping Agentur Austria GmbHWien, Austria
| | - Mar P. Andrés
- Agencia Española de Protección de la Salud en el DeporteMadrid, Spain
| | | | | | - Wolfgang Baumann
- The Association for International Sport for AllFrankfurt, Germany
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Lee-Heidenreich J, Lee-Heidenreich D, Myers J. Differences in life expectancy between olympic high jumpers, discus throwers, marathon and 100 meter runners. BMC Sports Sci Med Rehabil 2017; 9:3. [PMID: 28149523 PMCID: PMC5267370 DOI: 10.1186/s13102-017-0067-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/09/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several studies have demonstrated that body habitus is associated with survival (life expectancy) time. We sought to determine if survival differed between elite athletes with a range of body types. We hypothesized that the survival would differ between athlete types and that ectomorph athletes would have longer survival than heavier athletes. METHODS For each Olympics between 1928 and 1948 we identified the top (up to 20) Olympic male and female finishers in the high jump (HJ), discus throw, marathon, and 100-m run. We determined date of death using internet searches and calculated age-specific expected survival using published US life tables. We adjusted life expectancy for country of origin based on Global Burden of Disease data. RESULTS We identified a death date for 336 of 429 (78%) Olympic athletes including 229 males (55 marathon, 56 100-m 58 high jump, 60 discus), and 107 females (54 100-m, 25 high jump, 28 discus). Discus throwers were heaviest and marathon runners the lightest and oldest athletes (p < 0.01). Observed-expected survival was highest for high jumpers (7.1 years for women, 3.7 years for men) and marathon runners (4.7 years for men) and lowest for sprinters (-1.6 years for women and -0.9 years for men). In multivariate analysis controlling for age and gender, type of sport remained significantly associated with mortality with greatest survival for high jumpers and marathon runners compared to discus throwers and sprinters (p = 0.005). Controlling for weight, reduced the survival benefit of high jumpers over discus throwers, but had little effect on the survival benefit of marathon runners vs. sprinters. CONCLUSION Significant differences in long term survival exist for different types of track and field Olympic athletes that were explained in part by weight.
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Affiliation(s)
| | | | - Jonathan Myers
- VA Palo Alto Health Care System, Palo Alto, CA USA
- Department of Medicine, Stanford University, Stanford, CA USA
- Mail Code 111C, 3801 Miranda Avenue, Palo Alto, CA USA 94304
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29
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Abstract
The focus of this paper is to provide an update on the use of psychotherapy as a treatment in sport psychiatry, and the use of this approach to address common psychiatric issues encountered with this population. Specifically, family therapy, individual therapy, and group psychotherapy prescribed alone, or in combination with medication, will be examined as methods to manage issues/disorders often associated with athletes. These include obsessive-compulsive rituals and perfectionism, and aggressive and risky behaviours, such as gambling, infidelity, substance use, and suicidal ideation, narcissism, and aggression in the context of individual and team competitive sports.
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Affiliation(s)
- Mark A Stillman
- a Department of Clinical Medical Pschology , Mercer University, Health Sciences Center , Atlanta , GA , USA
| | - Tyler Brown
- b Mercer University, Health Sciences Center , Atlanta GA , USA
| | | | - Ira D Glick
- d Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , CA , USA
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30
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Putukian M. The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med 2015; 50:145-8. [PMID: 26719498 DOI: 10.1136/bjsports-2015-095586] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Injury is a major stressor for athletes and one that can pose significant challenges. Student athletes must handle rigorous academic as well as athletic demands that require time as well as significant physical requirements. Trying to perform and succeed in the classroom and on the playing field has become more difficult as the demands and expectations have increased. If an athlete is injured, these stressors increase. MAIN THESIS Stress is an important antecedent to injuries and can play a role in the response to, rehabilitation and return to play after injury. The psychological response to injury can trigger and/or unmask mental health issues including depression and suicidal ideation, anxiety, disordered eating, and substance use/abuse. There are barriers to mental health treatment in athletes. They often consider seeking help as a sign of weakness, feeling that they should be able to 'push through' psychological obstacles as they do physical ones. Athletes may not have developed healthy coping behaviours making response to injury especially challenging. PURPOSE I discuss the current state of knowledge regarding the psychological response to injury and delineate resources necessary to direct the injured athlete to a mental health care provider if appropriate.
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Affiliation(s)
- Margot Putukian
- Department of Athletic Medicine, University Health Services, Princeton University, Princeton, New Jersey, USA Rutgers-Robert Wood Johnson Medical School, University Health Services, Princeton University, Princeton, New Jersey, USA
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Bird SR, Goebel C, Burke LM, Greaves RF. Doping in sport and exercise: anabolic, ergogenic, health and clinical issues. Ann Clin Biochem 2015; 53:196-221. [DOI: 10.1177/0004563215609952] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2015] [Indexed: 12/11/2022]
Abstract
The use of doping agents is evident within competitive sport in senior and junior age groups, where they are taken by non-elite as well as elite participants. They are also taken in non-sporting contexts by individuals seeking to ‘improve’ their physique through an increase in muscle and/or decrease in fat mass. While attaining accurate data on the prevalence of their use has limitations, studies suggest the illicit use of doping agents by athletes and non-athletes may be 1–5% in the population and greater than 50% in some groups; with the prevalence being higher in males. There is conclusive evidence that some doping agents are anabolic and ergogenic. There is also evidence that the use of doping agents such as anabolic androgenic steroids, growth hormone and other anabolic agents, erythropoietin and stimulants conveys considerable health risks that include, but are not limited to: cardiovascular disease, diabetes, cancer, mental health issues, virilisation in females and the suppression of naturally produced androgens in males. This review will outline the anabolic, ergogenic and health impacts of selected doping agents and methods that may be used in both the sporting and physique development contexts. It also provides a brief tabulated overview of the history of doping and how doping agents may impact upon the analyses of clinical samples.
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Affiliation(s)
- Stephen R Bird
- School of Medical Sciences, RMIT University, Victoria, Australia
| | - Catrin Goebel
- Australian Sports Drug Testing Laboratory, Sydney, Australia
| | | | - Ronda F Greaves
- School of Medical Sciences, RMIT University, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
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Lemez S, Baker J. Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes. SPORTS MEDICINE - OPEN 2015; 1:16. [PMID: 26301178 PMCID: PMC4534511 DOI: 10.1186/s40798-015-0024-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 06/16/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Understanding of an athlete's lifespan is limited with a much more sophisticated knowledge of their competitive careers and little knowledge of post-career outcomes. In this review, we consider the relationship between participation at elite levels of sport and mortality risk relative to other athletes and age- and sex-matched controls from the general population. Our objective was to identify, collate, and disseminate a comprehensive list of risk factors associated with longevity and trends and causes of mortality among elite athletes. METHODS English language articles were searched using the Web of Science database. Keywords athletes, death, elite, "high performance" life expect*, longevity, mortality, players, professional, and sport were used to locate research articles. Seventeen additional articles were retrieved from reference lists found in these papers and a general web search. The inclusion criteria were the following: (1) publication year 1980 or later; (2) the study examined elite-level athletes; and (3) outcome data measured mortality/longevity trends and/or causes. RESULTS Fifty-four peer-reviewed publications and three articles from online sources met the criteria for inclusion. Baseball, football, soccer, basketball, and cycling had the most reported data on elite athletes' lifespan longevities. A variety of mechanisms have attempted to explain mortality risk (e.g., handedness, playing position, achievement, etc.). Considerable support was found for superior longevity outcomes for elite athletes, particularly those in endurance and mixed sports. CONCLUSIONS Future research into the mechanisms that may affect mortality risk is important for a better understanding of life expectancies in both eminent and non-eminent populations. Participation in elite sport is generally favorable to lifespan longevity. KEY POINTS A majority of studies included in this review reported superior lifespan longevity outcomes for elite athletes compared to age- and sex-matched controls from the general population and other athletes.Several mechanisms within and between sports may have powerful effects on the overall lifespan longevities of players (e.g., type of sport, playing position, race, and energy system).Future research on mortality in elite athletes would benefit from more comprehensive statistical measures and reliable databases to determine potential mechanisms that may influence mortality trends and causes in both athlete and non-athlete samples.
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Affiliation(s)
- Srdjan Lemez
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, M3J 1P3 ON Canada
| | - Joseph Baker
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, M3J 1P3 ON Canada
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Iverson GL, Gardner AJ, McCrory P, Zafonte R, Castellani RJ. A critical review of chronic traumatic encephalopathy. Neurosci Biobehav Rev 2015; 56:276-93. [PMID: 26183075 DOI: 10.1016/j.neubiorev.2015.05.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/14/2015] [Accepted: 05/08/2015] [Indexed: 12/14/2022]
Abstract
Chronic traumatic encephalopathy (CTE) has been described in the literature as a neurodegenerative disease with: (i) localized neuronal and glial accumulations of phosphorylated tau (p-tau) involving perivascular areas of the cerebral cortex, sulcal depths, and with a preference for neurons within superficial cortical laminae; (ii) multifocal axonal varicosities and axonal loss involving deep cortex and subcortical white matter; (iii) relative absence of beta-amyloid deposits; (iv) TDP-43 immunoreactive inclusions and neurites; and (v) broad and diverse clinical features. Some of the pathological findings reported in the literature may be encountered with age and other neurodegenerative diseases. However, the focality of the p-tau cortical findings in particular, and the regional distribution, are believed to be unique to CTE. The described clinical features in recent cases are very similar to how depression manifests in middle-aged men and with frontotemporal dementia as the disease progresses. It has not been established that the described tau pathology, especially in small amounts, can cause complex changes in behavior such as depression, substance abuse, suicidality, personality changes, or cognitive impairment. Future studies will help determine the extent to which the neuropathology is causally related to the diverse clinical features.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, MassGeneral Hospital for Children Sports Concussion Program, & Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA.
| | - Andrew J Gardner
- Hunter New England Local Health District Sports Concussion Program; & Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre - Austin Campus, Heidelberg, Victoria, Australia
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Brigham and Women's Hospital; & Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, MA, USA
| | - Rudy J Castellani
- Division of Neuropathology, University of Maryland School of Medicine, USA
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Antero-Jacquemin J, Rey G, Marc A, Dor F, Haïda A, Marck A, Berthelot G, Calmat A, Latouche A, Toussaint JF. Mortality in female and male French Olympians: a 1948-2013 cohort study. Am J Sports Med 2015; 43:1505-12. [PMID: 25813868 DOI: 10.1177/0363546515574691] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Whereas intense physical activity has been associated with deleterious effects on elite athletes' health, in particular due to cardiovascular anomalies, long-term follow-ups have suggested lower mortality rates among elite athletes. Causes of death for French Olympic athletes and female elite athletes have not been studied. HYPOTHESIS/PURPOSE We aimed to measure overall and disease-specific mortality of French female and male Olympians compared with the French general population. We hypothesize that Olympians, both women and men, have lower mortality rates. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS French elite athletes (601 women and 1802 men) participating in summer or winter Olympic Games from 1948 to 2010 had their vital status verified by national sources and were followed until 2013. Causes of death were obtained via the National Death registry from 1968 to 2012. Overall and disease-specific mortalities of Olympians were compared with those of the French general population through standardized mortality ratios (SMRs) and 95% CIs. Olympians' observed and expected survivals were illustrated by Kaplan-Meier curves. RESULTS At the endpoint of the study, 13 women and 222 men had died. Overall mortality in Olympians compared with that of their compatriots was 51% lower (SMR, 0.49; 95% CI, 0.26-0.85) among women and 49% lower (SMR, 0.51; 95% CI, 0.45-0.59) among men. Olympic athletes' survival is significantly superior to that of the French general population (women, P = .03; men, P < .001). According to the total deaths occurring from 1968 to 2012 (12 among women, 202 among men), female Olympians died from neoplasm (50.0%), external causes (33.3%), and cardiovascular diseases (16.6%). The main causes of death among men were related to neoplasms (36.1%), cardiovascular diseases (24.3%), and external causes (14.4%). Regarding the main causes of mortality among male Olympic athletes, the SMRs were as follows: 0.55 for neoplasms (95% CI, 0.43-0.69), 0.55 for cardiovascular diseases (95% CI, 0.41-0.73), and 0.66 for external causes (95% CI, 0.44-0.94). CONCLUSION French Olympians live longer than their compatriots: A lower overall mortality of similar magnitude is observed among male and female athletes compared with the general population. The main causes of death in French Olympians are neoplasms, cardiovascular diseases, and external causes.
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Affiliation(s)
- Juliana Antero-Jacquemin
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France Université Paris Descartes, Paris, France
| | - Grégoire Rey
- INSERM, Centre for Epidemiology on Medical Causes of Death (CépiDc), Le Kremlin-Bicêtre, France
| | - Andy Marc
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France
| | - Frédéric Dor
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France
| | - Amal Haïda
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France Université de Rouen, Rouen, France
| | - Adrien Marck
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France
| | - Geoffroy Berthelot
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France Université Paris Descartes, Paris, France
| | - Alain Calmat
- Comité National Olympique Sportif Français (CNOSF), Paris, France
| | | | - Jean-François Toussaint
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France Université Paris Descartes, Paris, France Centre d'investigations en médécine du sport (CIMS), Paris, France
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Piacentino D, Kotzalidis GD, Del Casale A, Aromatario MR, Pomara C, Girardi P, Sani G. Anabolic-androgenic steroid use and psychopathology in athletes. A systematic review. Curr Neuropharmacol 2015; 13:101-21. [PMID: 26074746 PMCID: PMC4462035 DOI: 10.2174/1570159x13666141210222725] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 07/31/2014] [Accepted: 10/25/2014] [Indexed: 12/19/2022] Open
Abstract
The use of anabolic-androgenic steroids (AASs) by professional and recreational athletes is increasing worldwide. The underlying motivations are mainly performance enhancement and body image improvement. AAS abuse and dependence, which are specifically classified and coded by the DSM-5, are not uncommon. AAS-using athletes are frequently present with psychiatric symptoms and disorders, mainly somatoform and eating, but also mood, and schizophrenia-related disorders. Some psychiatric disorders are typical of athletes, like muscle dysmorphia. This raises the issue of whether AAS use causes these disorders in athletes, by determining neuroadaptive changes in the reward neural circuit or by exacerbating stress vulnerability, or rather these are athletes with premorbid abnormal personalities or a history of psychiatric disorders who are attracted to AAS use, prompted by the desire to improve their appearance and control their weights. This may predispose to eating disorders, but AASs also show mood destabilizing effects, with longterm use inducing depression and short-term hypomania; withdrawal/discontinuation may be accompanied by depression. The effects of AASs on anxiety behavior are unclear and studies are inconsistent. AASs are also linked to psychotic behavior. The psychological characteristics that could prompt athletes to use AASs have not been elucidated.
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Affiliation(s)
- Daria Piacentino
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy
| | - Antonio Del Casale
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy; ; Department of Psychiatric Rehabilitation, P. Alberto Mileno Onlus Foundation, San Francesco Institute, Vasto, Italy
| | - Maria Rosaria Aromatario
- Department of Anatomical, Histological, Forensic Medicine, And Orthopedic Sciences. Sapienza University-Rome, Italy
| | - Cristoforo Pomara
- Department of Forensic Pathology, University of Foggia; Ospedale Colonnello D'Avanzo, Foggia, Italy
| | - Paolo Girardi
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy; ; Centro Lucio Bini, Rome, Italy
| | - Gabriele Sani
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University-Rome, Italy; UOC Psychiatry, Sant'Andrea Hospital, Rome, Italy; ; Centro Lucio Bini, Rome, Italy; ; IRCCS Santa Lucia Foundation, Department of Clinical and Behavioral Neurology, Neuropsychiatry Laboratory, Rome, Italy
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