Depression and anxiety symptoms in 17 teams of female football players including 10 German first league teams

Prevalence of Mental Health Problems and their Potential Association with Sleep Disturbance, Coping Skills and Social Support in Professional Ballet Dancers

Introduction: While several studies have analyzed the characteristics and burden of injuries and physical complaints in (pre-)professional dancers, mental health problems, other than eating disorders, have rarely been studied in professional ballet dancers. The aims were to (a) investigate the prevalence of self-reported mental health problems, and (b) analyze their potential associations with sleep disturbance, coping skills and social support in professional ballet dancers. Methods: During a pre-season health screening, professional ballet dancers of three companies were asked to answer questions on personal characteristics, current need and attempt to lose weight, chronic/recurrent mental health problems, and need of support from a psychotherapist as well as established questionnaires on depression (PHQ-9), generalized anxiety (GAD-7), eating disorders (EDE-QS), sleep disturbance (ASSQ), athletic coping skills (ACSI-28) and perceived social support (F-SozU-K6). Results: All 96 dancers (average age 27.3 years, 51.0% male) who participated in the screening answered the questionnaire. In the PHQ-9, 19 (19.8%) dancers reported mild, and 4 (4.2%) moderate to severe symptoms. In the GAD-7, 19 (19.8%) dancers reported mild, 11 (11.5%) moderate and three (3.1%) severe symptoms. Ten (10.4%) dancers were screened positive for an eating disorder in the EDE-QS. Almost two thirds of the dancers reported sleep problems of mild (n = 39; 40.6%), moderate (n = 19; 19.8%) or severe extent (n = 3; 3.1%) in the ASSQ. One in five dancers (n = 19; 19.8%) wanted or needed support from a psychotherapist at the time of the screening. The mean score of ASSQ correlated significantly with PHQ-9 (r = .34; P = .001) and GAD-7 (r = .27; P = .008). Correlations of mental health problems with athletic coping skills and social support were generally low. Conclusion: The prevalence of mental health problems, especially anxiety and eating disorders, was high in professional ballet dancers. Routine screening of mental health and sleep problems as well as interventions to improve mental health and sleep quality are strongly recommended. Level of Evidence: 2b cross-sectional study.

Mental Health in Elite Athletes: A Systematic Review of Suicidal Behaviour as Compared to the General Population

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.

Unmasking mental health symptoms in female professional football players: a 12-month follow-up study

Objective

To calculate the prevalence rates of mental health symptoms among female professional football players over a 12-month period and to explore the associations of severe injury and related surgery with mental health symptoms among female professional footballers.

Methods

An observational prospective cohort study was conducted over a 12-month follow-up period by distributing an electronic questionnaire three times. The questionnaire was based on validated screening tools for assessing mental health symptoms.

Results

A total of 74 female professional football players participated in this study. Mental health symptoms ranged from 1% for substance misuse to 65% for sport-psychological distress at baseline, from 6% for anxiety to 53% for sport-psychological distress 6 months postbaseline and from 3% for substance misuse to 55% for sport-psychological distress 12 months postbaseline. The prevalence of disordered eating remained between 15% and 20% over the 12-month period. Only one of the associations was statistically significant. Female professional football players were nearly twice as likely to report sport-related psychological distress following every surgery.

Conclusions

The substantial prevalence of mental health symptoms among female professional football players emphasises the need for increased attention, awareness and interventions. Additionally, female professional football players are nearly twice as likely to report sport-related psychological distress after each surgery. Sports medicine physicians and mental health professionals working in female football should provide standard care, which involves identifying, monitoring and implementing tailored interventions for mental health symptoms.

Athlete mental health help-seeking: A systematic review and meta-analysis of rates, barriers and facilitators

Athletes are vulnerable to a range of mental health symptoms, in part due to stressors within the sport environment. An early intervention framework suggests the benefits of routine screening and referral for mental health, however, greater understanding around athlete help-seeking is needed to support referral uptake. This review examined rates of formal help-seeking behaviour as well as barriers and facilitators to help-seeking in sport settings. Relevant studies were retrieved from SportDiscus, PubMed and PsycInfo, with unpublished studies identified through contacting authors. Help-seeking rates were meta-analysed and barriers and facilitators were meta-synthesised. Twenty-two studies were included. Help-seeking rates were reported in 11 studies (N = 3415) and the pooled proportion of help-seeking was 22.4 % (95 % CI 16.2-30.2, I2 = 95.7 %). Barriers were reported in 13 studies and facilitators in six, highlighting a range of sporting-specific factors, such as stigma in relation to athlete identity and sport culture, fear of deselection, and concerns around confidentiality in sport settings, in addition to lack of awareness, low mental health literacy, and negative attitudes to services. Normalising experiences of mental health in sport settings, including through role models, was a key facilitator to help-seeking. Results provide implications for sport organisations to promote help-seeking and athlete mental health, such as through the use of role models, ensuring clarity around confidentiality, stigma reduction interventions, and fostering team cultures that promote mental health. Findings also support the value of sport staff in facilitating help-seeking, and organisational culture changes to foster wellbeing.

Behind the Curtain: Prevalence of Symptoms of Depression, Generalised Anxiety and Eating Disorders in 147 Professional Dancers from Six Opera Houses or State Theatres

BACKGROUND

Mental health problems cover a wide spectrum. Depression and anxiety disorders are the most frequent mental health problem in the general population and in elite athletes. The aim of the present study was to assess the prevalence of symptoms of depression, generalised anxiety disorder and eating disorders in professional dancers, to compare the results between genders and to the general population and to analyse potential determinants.

METHODS

During a pre-season health screening, professional dancers of six German companies answered a comprehensive questionnaire on personal and dancer-specific characteristics, medical history and the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Questionnaire (GAD-7) and Eating-Disorder-Examination-Questionnaire (EDE-QS).

RESULTS

A total of 82 (55.8%) female and 65 (44.2%) male dancers answered the questionnaire. One in five (20.8%) dancers had at least moderate symptoms of either depression, generalised anxiety disorder or eating disorders. The prevalence of at least moderate symptoms of depression was 11.1% in female and 6.4% in male dancers, of generalised anxiety disorder 16.0% in female and 6.4% in male dancers and of eating disorders 14.8% in female and 6.1% in male dancers. Compared to the general population of the same gender and similar age, the prevalence of at least moderate symptoms of generalised anxiety disorder was significantly higher in both genders. About one in four dancers (26.9%) reported a subjective need for support from a psychotherapist at the time of the screening. The PHQ-9, GAD-7 and EDE-QS sum scores were not related to the size or type of the companies, the age or rank of the dancers, but the PHQ-9 and GAD-7 sum score were significantly related to severity of musculoskeletal pain in the past seven days and to chronic or recurrent symptoms of low mood and generalised anxiety.

CONCLUSION

The prevalence of symptoms of depression, generalised anxiety and eating disorders was high in professional dancers. Routine screening and low-threshold interventions to improve mental health of professional dancers are recommended.

Prevalence of symptoms of depression and generalized anxiety disorder in field hockey players of German first and lower leagues

BACKGROUND

While several studies on mental health of elite athletes were published in recent years, few compared the prevalence with the general population and none included field hockey players.

AIMS

To analyze the prevalence of symptoms of depression and generalized anxiety disorder in field hockey players of different skill levels and to compare it to the general population.

METHODS

Male and female hockey players from different leagues were asked to answer questions on player characteristics, the Centre of Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder-7 (GAD-7).

RESULTS

One hundred and eighty-seven players (incl. 54 first and 28 second league players) participated in the study (response rate 97.4%). More than a third (n = 64; 35.0%) reported to be affected by an injury/health complaint, but 157 (86.3%) were able to train and play without limitations. The CES-D score indicated depression symptoms in more female (n = 15; 18.3%) than male (n = 5; 4.8%) players (χ2=8.8; p < 0.01). No male and one female player had symptoms of generalized anxiety disorder. Players who played 60 or more matches in the previous 12 months had on average significantly higher depression (t = 2.3; p < 0.05) and generalized anxiety scores (t = 4.2; p < 0.001) than players who played fewer matches. The prevalence of depression and of generalized anxiety symptoms was similar to or lower than in the general population. Although 20 (10.7%) players had depression symptoms, only 4 (2.2%) received psychological counseling or psychotherapy.

CONCLUSION

It is recommended to provide routine screening of mental health problems and low-threshold access to adequate treatment for elite athletes.

Athletes are not at greater risk for death by suicide: A review

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.

Beyond the medals: a cross-sectional study exploring retired elite female athletes' health

Objectives

Little is known about the impact of elite sport participation on long-term athlete health. We aimed to: (1) describe musculoskeletal, mental health, reproductive/endocrine and cardiovascular characteristics in retired elite female athletes and compare to the general population and (2) explore athletes' perceptions of their elite sport participation and its impact on health.

Methods

A 136-item online questionnaire was disseminated to Canadian elite female rowing and rugby athletes >18 years old, >2 years retired from elite competition. Matched general population data were obtained from Statistics Canada when available.

Results

Seventy-four (24% response rate) athletes (average age 45 (±9) years; retired 15 (±9) years) completed the questionnaire (30 rowing, 44 rugby athletes). During their career, 63 athletes (85%) experienced a hip/groin, knee, foot/ankle injury, or low back pain, with 42 (67%) reporting ongoing symptoms. Athletes 35-54 years reported worse knee symptoms and quality of life compared with the general population (symptom: p=0.197; d=1.15 [0.66, 1.63]; quality of life: p=0.312 d=1.03 [0.54, 1.51]) while other hip, knee and foot/ankle outcome scores were similar. Retired athletes had lower odds of anxiety (OR=0.155 [95% CI0.062 to 0.384]), greater lifetime/ever odds of amenorrhea (OR=6.10 [95%CI 2.67 to 13.96]) and gave birth when older (p<0.05). Fifty-nine (79%) recalled witnessing or experiencing at least one form of harassment/abuse during their career. Sixty athletes (81%) rated their current health as above average or excellent and 61 (82%) would compete at the same level again if given the choice.

Conclusion

These novel insights can inform future preventative efforts to promote positive elite sport-related outcomes for current, former and future female athletes.

EVALUATION OF ANXIETY AND DEPRESSION SYMPTOMS AMONG U-20 SOCCER ATHLETES IN RECIFE-PE: A CROSS-SECTIONAL STUDY

ABSTRACT Introduction Being a soccer player is one of the dreams most present in the popular imagination of Brazilian children. However, the path to professionalization is arduous and several reasons can be pointed out for this difficulty: a very competitive environment, few chances, and poor career counseling, among others. In competitive soccer, the athlete must be ready for all the demands that will be made, as well as accept the demand for the best possible performance. Furthermore, athletes from the youth system are still adolescents and youths in development, usually up to 21 years of age, who are often forced to choose soccer and its demands, at the expense of their studies and family lives, to become professional players. In this scenario, a still little-debated topic is mental health among soccer players. Objectives To verify the frequency of anxiety and depression symptoms among soccer players of the under-20 youth categories of Pernambuco clubs and to assess its association with sociodemographic, athletic, and health data. Methods The Hospital Anxiety and Depression Scale (HADS) was applied and socio-demographic, athletic, and health data were collected. A marginal descriptive analysis was conducted, as well as categorical and numerical assessments of anxiety- and depression-related variables. Finally, a linear regression study of the anxiety and depression scores was conducted. Results A statistically significant association was found between income received and an increase in anxiety symptoms. An increase in depressive symptoms as income decreased was also identified. Conclusion Further research with larger numbers of participants is needed, as well as with a greater variety of clubs, to better understand the relationship observed. Level of Evidence II; Prognostic study – Investigation of the effect of a patient characteristic on the outcome of their illness.

Elite female footballers in England: an exploration of mental ill-health and help-seeking intentions

OBJECTIVES

Mental health research in sport is almost entirely focused on elite male athletes. However, recent research suggests that elite female athletes are at higher risk for mental ill-health when compared to their male counterparts. Given the recent growth of women's football in England and lack of research surrounding mental health in this population, this study sought to explore the prevalence of, and factors associated with depression, anxiety, and eating disorder symptoms in females competing in the top two tiers of English football.

METHODS

An anonymous online questionnaire pack, which measured personal and player characteristics and included the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder scale (GAD-7), Brief Eating Disorder Questionnaire (BEDA-Q), and General Help-Seeking Questionnaire (GHSQ), was completed between November 2020 and March 2021 by elite female footballers competing in the Women's Super League (WSL) and Women's Championship.

RESULTS

A total of 115 players completed the questionnaire (63 from the WSL; 52 from the Women's Championship). 36% displayed eating disorder symptoms (BEDAQ) 11% displayed moderate to severe anxiety symptoms (GAD-7), and 11% displayed moderate to severe depression symptoms (PHQ-9). Significant associations emerged between starting status, want for psychological support, student-athlete status, help-seeking intentions score, and mental ill-health symptoms.

CONCLUSION

In summary, elite female footballers in England reported significant mental health symptoms, particularly disordered eating symptoms. Further research should explore the experiences of mental ill-health in this population, focusing on the factors that were important in this study.

National vs. Non-National Soccer Referee: Physiological, Physical, and Psychological Characteristics

Purpose: The objectives of the present study were to analyze the relationship between psychological variables (self-esteem, anxiety and self-confidence) assessed before the competition and physical and physiological responses demonstrated during the competition in soccer referees and to compare these psychophysical and physiological responses by category (CAT; national and non-national). Method: A total of 153 soccer referees participated (age Mage = 23.2; SD = 4.8 years; experience Mage = 6.0; SD = 4.5 years) in the study. The CSAI-2 and Rosenberg questionnaires were conducted before the match, and match performance data were collected using GPS devices. Results: The results showed significant differences in self-esteem and self-confidence across CATs (p < .001; d > .84). The national referees had higher psychological and physical-physiological responses (mean and maximum heart rate) Some correlations were observed among the psychophysical and physiological responses, CAT and age, demonstrating that the age could explain up to 48.4% of the variance the referee CAT (p < .001) and this CAT could explain self-esteem, anxiety and self-confidence by up to 20% of the variance. Conclusions: national referees presented better psychological responses prior to the competition, and also obtained greater physical and physiological records, which could be translated into a better position on the pitch in conflicting plays in order to make a right and just decision.

The effects of injury, contextual match factors and training load upon psychological wellbeing in English Premier League soccer players via season-long tracking

The study aimed to track psychological wellbeing (PWB) across two consecutive soccer seasons examining the effects of injury, illness, training load (TL) and contextual match factors (playing status, match selection and individual win rate). Furthermore, examine PWB prior to injury or illness event. Thirty-two English Premier League (EPL) soccer players completed the "Warwick-Edinburgh Mental Wellbeing Scale" every two weeks. No differences were found for group averaged PWB across the seasons (52.2 ± 0.3 vs. 51.8 ± 1.1) (p > 0.05). Previous 7-day TL measured using GPS (session duration, total distance, explosive distance, low-intensity distance, high-speed distance (HSD) and sprint distance (SD)) were not related to current PWB (p > 0.05). Yet, previous 14-day HSD (r (385) = -0.095) and 21-day SD (r (385) = 0.100) were related to current PWB (p < 0.05). Only 100% (vs. 0%) win rate in the previous 14-days to the questionnaire revealed a higher current PWB score (52.7 ± 4.7 vs. 50.9 ± 5.6 (p < 0.05)). PWB did not differ prior to an injury or illness event, when players were injured or had low contextual match factors at time of questionnaire or previous match, and the previous 7-days (p > 0.05). In conclusion, PWB fluctuations across the season are associated with prior TL and multiple negative results. But prior PWB was not linked to injury or illness events. Implications for prioritising interventions to improve PWB during periods of chronic high intensity TLs and losing streaks, monitoring PWB, and use in injury and illness prediction are discussed.HighlightsPsychological wellbeing responses, as measured by the "Warwick-Edinburgh Mental Wellbeing Scale" did not change significantly at a group level between the phases of the two seasons.Prior training load was associated with wellbeing scores, specifically previous 14-day high-speed distance and 21-day sprint distance.Psychological wellbeing scores were only affected by win/loss rate in the previous 14-days.These findings highlight the importance of timely interventions to improve wellbeing in periods of negative results, and the recommendation of longitudinally monitoring wellbeing.

Association of Preexisting Mental Health Conditions With Increased Initial Symptom Count and Severity Score on SCAT5 When Assessing Concussion

Background:

Mental health conditions, such as depression, anxiety, and learning disabilities, are associated with symptoms that can overlap with those seen in persons with concussion. While concussion screening tools such as the Sport Concussion Assessment Tool–5th Edition (SCAT5) quantify the number of symptoms and symptom severity, it is not known whether these outcomes differ among individuals with concurrent mental health conditions compared with those without them.

Purpose:

To determine whether, during initial concussion assessment, individuals with a self-reported mental health condition have a significantly different number of self-reported concussion symptoms or symptom severity compared with those without a self-reported mental health condition (controls).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective chart review was performed on consecutive patients aged ≥13 years who underwent post-concussion assessment at the Fowler Kennedy Sport Medicine Clinic between May 2018 and March 2020 (N = 765). Most participants did not self-report a mental health condition (n = 606; 79.2%). Participants with a self-reported mental health condition (n = 159) were classified as having a learning disability (n = 14; 8.8%), anxiety (n = 62; 39.0%), depression (n = 20; 12.6%), or multiple conditions (≥2 conditions: n = 63; 39.6%). Each participant with a mental health condition was matched with 2 control participants (overall pool, n = 318) based on age, sex, student status, and sport-related risk. Mann-Whitney U tests were used to determine the statistical significance of differences between each subgroup and their matched controls for the self-reported number of concussion symptoms and symptom severity as measured using the SCAT5.

Results:

The anxiety and multiple-conditions subgroups had a significantly greater number of reported symptoms than their corresponding control subgroups (median, 17 vs 15 [P = .004] and 18 vs 14.5 [P < .001], respectively). Additionally, the SCAT5 symptom severity score was significantly greater in the anxiety and multiple-conditions subgroups than their corresponding controls (median, 49 vs 34.5 [P = .018] and 62 vs 32 [P < .001], respectively).

Conclusion:

During initial concussion assessment, both the number of concussion-related symptoms and the symptom severity were greater in study participants with anxiety and multiple mental health conditions than participants without these conditions.

The effects of home confinement on physical activity level and mental status in professional football players during COVID-19 outbreak

OBJECTIVES

The coronavirus outbreak caused significant changes in football around the world, such as the suspension of leagues and home isolation of players, etc. The main purpose of the present study was to assess the psychological impacts of lockdown and similar restrictions on professional football players during the coronavirus pandemic.

MATERIALS AND METHODS

The players from 36 professional football teams (n = 977) among Turkish Super League and First League teams were invited to complete a questionnaire including the Center for Epidemiologic Studies Depression Scale (CES-D), Impact of Event Scale-Revised Scores (IES-R) and short form of International Physical Activity Questionnaire (IPAQ).

RESULTS

The online survey was completed by 237 players (24.3%). The mean number of self-quarantine day of participants was 26.9 ± 6.2 days. The median CES-D Scale and IES-R scores were 6.0 (min:0, max:42) and 23.0 (min:0, max:59), respectively. IPAQ scores of the players showed that four-fifths of the players still maintain high physical activity levels. There were negative, very weak and significant correlations between CES-D score and being married (r = -0.146, p = 0.024), as well as between CES-D score and IPAQ-Walking (r = -0.189, p = 0.004). A significant positive very weak correlation was observed between CES-D score and self-quarantine days (r = 0.148, p = 0.024). IPAQ-Walking was an independent predictor of CES-D.

CONCLUSION

These findings support that maintaining regular physical activity and routinely exercising in a safe home environment is one of the most important strategies to ensure healthy mental state.

PHYSICAL ACTIVITY IN THE TREATMENT OF DEPRESSION IN COLLEGE STUDENTS

ABSTRACT Introduction: The mental health of college students is getting more and more attention from society. Physical exercise as a means of psychotherapy and mental health has become common at home and abroad. Objective: We explore the effect of prescribing physical exercise in the treatment of depression in college students. Methods: College students who had been diagnosed with depression were randomly divided into an observation group and a control group, each with 18 patients. The control group received drug treatment. The observation group received sports therapy in addition to drug therapy. Results: There was a statistically significant difference in HAMD scores between the observation and control groups in the first week (P<0.01). Conclusions: Exercise can play a role in treating depression patients rapidly, safely, and efficiently. Level of evidence II; Therapeutic studies - investigation of treatment results.

Beneath the Surface: Mental Health and Harassment and Abuse of Athletes Participating in the FINA (Aquatics) World Championships, 2019

OBJECTIVE

To assess the mental health and experience of sport-related harassment and abuse of elite aquatic athletes and to analyze it in relation to gender and discipline.

DESIGN

Cross-sectional study using an anonymous survey.

SETTING

The FINA World Championships 2019.

PARTICIPANTS

Registered athletes in the disciplines of swimming, diving, high diving, water polo, artistic swimming, and open water swimming.

INTERVENTIONS

Athletes completed an online or paper-based questionnaire.

MAIN OUTCOME MEASURES

The main outcome measures included screening for depression (10-item version of the Center for Epidemiological Studies Depression Scale revised), eating disorders (Brief Eating Disorders in Athletes Questionnaire), the subjective need for psychotherapeutic support, and the experience of sport-related harassment and/or abuse.

RESULTS

A quarter (24.6%) of the 377 responding athletes were classified as depressed and 2.5% as having an eating disorder. More than 40% of the athletes stated that they wanted or needed psychotherapeutic support. Fifty-one athletes (14.9%) had experienced harassment/abuse in sport themselves, and 31 (9%) had witnessed it in another athlete. The experiences of harassment and abuse ranged from unwanted comments about body or appearance (40.2%) to rewards in sport for sexual favors (2.5%) and rape (0.3%). Athletes who had experienced harassment/abuse in sport themselves had higher average scores for depression and eating disorders, and more of them felt they needed psychotherapeutic support. Up to a third would not talk or report to anybody if they saw or experienced harassment/abuse, and less than 20% would talk to an official for help.

CONCLUSION

Targeted initiatives are required to address mental health issues and harassment and abuse in sport in the FINA aquatic disciplines.

Elite Sport and Sustainable Psychological Well-Being

There is conflicting evidence that sport plays a protective role in the development of psychopathological disorders and contributes to the sustainability of mental health. The aim of the present study was to determine the prevalence of mental disorders among elite Slovenian athletes. We were interested in the prevalence of depression, anxiety, suicide risk, substance abuse, and eating disorders among athletes of both sexes and among athletes of individual and team sports aged 18 years or older. A total of 97 elite athletes participated in the study. We used PAI and EDI-3 questionnaires, and the study also included a control group of 90 non-athletes, matched in gender and age to the target group of elite athletes. Testing was conducted in 2020 and 2021. The comparison between elite athletes and the normative group showed a similar expression of depressive and anxious symptomatology. The athletes have a more pronounced drive for thinness and are more expansive, self-confident, and confident of their abilities compared to the control group. A total of 14% of the athletes show self-confidence to the point of self-grandiosity. Male athletes are more likely to use alcohol and other psychoactive substances and are also more impulsive and risk-taking, while female athletes are at higher risk of developing eating disorders. The study suggests that the prevalence of mental disorders in elite athletes is as high as in the general population. There is an urgent need to sustainably ensure the psychological well-being of athletes.

Depressive Symptoms and Burnout in Football Players: A Systematic Review

The purpose of this article was to systematically review and organise the available literature devoted to the topic of depressive symptoms and burnout in football players. A systematic search was conducted in Web of Science, Scopus, SPORTdiscus, PubMed, and Psychinfo for articles published up to June 2020. The searches yielded 1589 articles, and after the screening process, a total of 18 studies met the eligibility criteria and were included for review. Playing position and conflicts with coach/management seems to have a direct influence on the prevalence of depressive symptoms in current players as do the injuries and life events of former players. During the pre-competition phase, most of the athletes displayed reduced rates, indicating burnout. An exploration of the mental health of football players will help to create models of care and guide professionals so that they may help players achieve better performance while also having better wellbeing. Understanding how to prevent and cope with the emotional wellbeing of football players will be possible to guide players and coaches.

What Lies Beneath: Exploring Different Depressive Symptoms Across Selected Risk Factors in Icelandic Team Sport Athletes

The aim of the study was to explore the prevalence of specific symptoms of depression in athletes and to test differences in the likelihood of athletes exhibiting these symptoms across age, sex, type of team sport, and level of competition. A sample of Icelandic male and female team sport athletes (N = 894, 18–42 years) was included in the study. Of the athletes exhibiting clinically significant depressive symptoms on the Patient Health Questionnaire-9, 37.5% did not exhibit core symptoms of depression. Compared with males, females were significantly more likely to exhibit depressed mood, feelings of worthlessness/guilt, and problems with sleep, fatigue, appetite, and concentration. Within males, differences were mostly related to neurovegetative aspects of depression (sleep and appetite), whereas in females, differences were related to cognitive/emotional aspects (e.g., depressed mood, guilt/worthlessness). The findings underline the importance of exploring specific symptoms of depression to provide a richer understanding of depressive symptomology in athletes.

Can psychological characteristics, football experience, and player status predict state anxiety before important matches in Danish elite-level female football players?

Elite football can make players feel nervous, and personality characteristics, as well as experience, affect how well pressure is handled before important games. Studying the psychological characteristics of female football players can provide information on how well psychological pressure is handled and generate knowledge on how to support players in order to improve performance. Based on a sample of 128 female elite football players from 8 top-level teams, the present study investigates whether psychological characteristics and football experience/player stus in elite female football players can predict state anxiety before important matches. Our results outline that high age and national team experience negatively predicted most of the trait anxiety subscales. In line with previous research, no psychological differences were found between goalkeepers, defenders, midfielders, and strikers while starting players revealed to have significantly lower trait anxiety. When measuring before important matches, we found that somatic state anxiety was negatively associated with senior national team experience and positively associated with worry trait anxiety and fear of failure. Cognitive state anxiety was negatively associated with hope for success and positively associated with somatic and worry trait anxiety. Self-confidence was positively associated with youth national team experience and negatively associated with worry trait anxiety. It can be concluded that psychological characteristics and national team experience are both important for optimal state anxiety before important matches in elite-level women's football. Implications for practice and future research are discussed.

Psychological Distress and Problem Gambling in Elite Athletes during COVID-19 Restrictions-A Web Survey in Top Leagues of Three Sports during the Pandemic

COVID-19 and lockdown strategies may affect mental health and addictive behavior differently in the population, and elite athletes are among the professions clearly affected by the pandemic. This study in top elite athletes aimed to study current perceived psychological influence from COVID-19 and symptoms of depression, anxiety and changes in alcohol drinking, gambling behavior and problem gambling in the midst of the COVID-19 lockdown. This web survey included athletes in top leagues of soccer, ice hockey and handball in Sweden (N = 327, 62% men). A total of 66% and 51% were worried about the future of their sport or about their own future in sports, respectively. Feeling worse psychologically during the pandemic was common (72% of women, 40% of men, p < 0.001); depression criteria were endorsed by 19% of women and three percent of men (p < 0.001); anxiety criteria by 20% of women and five percent of men (p < 0.001). Reporting increased gambling during the pandemic was associated with gambling problem severity. Moderate-risk or problem gambling was seen in 10% of men and none of the women (p < 0.001). Depression and anxiety were associated with feeling worse during the COVID-19 pandemic and with concern over one's own sports future. In conclusion, COVID-19-related distress is common in elite athletes and associated with mental health symptoms. Gambling increase during the pandemic was rare, but related to gambling problems, which were common in male athletes. The calls for increased focus on COVID-19-related concerns in athletes and on problem gambling in male athletes.

Me, Myself, and My Thoughts: The Influence of Brooding and Reflective Rumination on Depressive Symptoms in Athletes in the United Kingdom

Individual differences in vulnerability to depression are still underexplored in athletes. We tested the influence of different brooding and reflective rumination profiles (i.e., repetitive thought processes in response to low/depressed mood) on the odds of experiencing clinically relevant depressive symptoms in competitive athletes (N = 286). The Patient Health Questionnaire–9 and the Ruminative Responses Scale–short form were utilized to measure depression and rumination, respectively. Compared to athletes with a low brooding/reflection profile, athletes with a high brooding/reflection profile had significantly higher odds of experiencing clinical levels of depressive symptoms (OR = 13.40, 95% CI = 3.81–47.11). A high reflection/low brooding profile was not, however, related to increased odds of depressive symptoms. Future research could extend our findings by exploring determinants of ruminative tendencies, especially brooding, in athletes. Furthermore, psychological interventions targeting rumination could be examined as a potential prevention and treatment approach to tackling depressive symptoms in athletes.

The prevalence of depressive symptoms in high-performance athletes: a systematic review

Objective: To provide an up-to-date overview of the prevalence of depressive symptoms in high-performance athletes and describe the tools used to assess for these in order to identify knowledge gaps and potential future research priorities. Data sources: PubMed, EMBASE, SPORTDiscus, PsychINFO, and Cochrane were systematically searched from December 1993 to December 2018. Peer-reviewed original research articles reporting the prevalence of depression among high-performance athletes aged ≥ 17 years were included. Study selection: Sixteen studies satisfied the inclusion criteria, and seven had a low risk of bias. Data extraction: The Center for Epidemiologic Studies Depression Scale (CES-D) was the most commonly used tool to assess for depressive symptoms. The prevalence of those with high depression symptom cutoff scores ranged from 6.7% to 34.0%. Data synthesis: Higher levels of competition, injuries, > 3 concussions, and female sex were identified as potential risk factors for depression. Female athletes and athletes playing individual sports had high risk of having elevated depression symptom scores. Conclusions: Prevention of mental illness in high-performance sports is a novel and emerging field of research interest. This review highlights the prevalence of high depression symptom scores among high-performance athletes. The data collection methods, sample size, sport and athlete population, and tools used to assess depression vary across studies; thus, findings cannot be generalized. This review establishes the need for data collection enhancements with robust longitudinal study designs and standardized depression assessment tools to guide the development of evidence-based mental wellbeing interventions.

Determinants of anxiety in elite athletes: a systematic review and meta-analysis

Objective

To identify and quantify determinants of anxiety symptoms and disorders experienced by elite athletes.

Design

Systematic review and meta-analysis.

Data sources

Five online databases (PubMed, SportDiscus, PsycINFO, Scopus and Cochrane) were searched up to November 2018 to identify eligible citations.

Eligibility criteria for selecting studies

Articles were included if they were published in English, were quantitative studies and measured a symptom-level anxiety outcome in competing or retired athletes at the professional (including professional youth), Olympic or collegiate/university levels.

Results and summary

We screened 1163 articles; 61 studies were included in the systematic review and 27 of them were suitable for meta-analysis. Overall risk of bias for included studies was low. Athletes and non-athletes had no differences in anxiety profiles (d=−0.11, p=0.28). Pooled effect sizes, demonstrating moderate effects, were identified for (1) career dissatisfaction (d=0.45; higher anxiety in dissatisfied athletes), (2) gender (d=0.38; higher anxiety in female athletes), (3) age (d=−0.34; higher anxiety for younger athletes) and (4) musculoskeletal injury (d=0.31; higher anxiety for injured athletes). A small pooled effect was found for recent adverse life events (d=0.26)—higher anxiety in athletes who had experienced one or more recent adverse life events.

Conclusion

Determinants of anxiety in elite populations broadly reflect those experienced by the general population. Clinicians should be aware of these general and athlete-specific determinants of anxiety among elite athletes.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

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.

A season long investigation into the effects of injury, match selection and training load on mental wellbeing in professional under 23 soccer players: A team case study

Abstract This study examined the influence of injury, match selection and training load on mental wellbeing (MW) in a squad of professional soccer players. Using a longitudinal design, twenty-five male soccer players (age, 20 ± 1 years, height, 1.80 ± 5.79 m, body mass 76.33 ± 7.52 kg) from the under 23 squad playing in the Premier League 2 division in the UK completed the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) each week of the 2017/2018 season (37 weeks in total). Injury and non-selection for the match squad were the only significant predictors of MW (P < 0.05). Injury had the biggest influence on MW that was lower when injured vs. not injured (43.6 ± 5.0 vs. 49.9 ± 3.5, respectively, P = 0.001, ES = 1.48), accounting for 40% of the variation in MW. This increased to 50% when not being selected to play games was also considered. Weekly training loads measured by GPS (total distance, sprint distance and total duration) and individual player win rate did not influence MW (P > 0.05). These findings highlight the importance of monitoring MW in professional soccer players and suggest that injured players and those rarely selected for the match squad should be educated on the strategies available for managing their mental health and wellbeing.