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

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.

Characteristics of mental skills interventions in dance: a mixed methods systematic review protocol

INTRODUCTION

Dancers are expected to navigate major challenges in their careers that might take a toll on their physical and mental health. To address underlying factors that might increase dancers' mental and physical health difficulties, research suggests the systematic use of techniques to build mental skills that can reduce risk factors and enhance protective factors against the challenges dancers encounter. However, existing mental skills training interventions in dance present a lack of consistency in design, content and duration, making it difficult to provide evidence-based recommendations. Hence, dance researchers and practitioners would benefit from a mixed methods systematic review (MMSR) of the why, what and how of these interventions. Adopting tools such as the Template for Intervention Description and Replication (TIDieR) can aid this endeavour by describing replicable aspects of interventions, thus offering dance researchers suggestions on how to understand, appraise and report intervention characteristics and processes in dance. Therefore, this protocol outlines a MMSR that will employ TIDieR to identify and assess characteristics of mental skills interventions in dance.

METHODS AND ANALYSIS

A systematic search will be undertaken in Psycinfo, Medline, Embase, Sportdiscus, Web of Science and the first 30 pages of GoogleScholar. Following the search, two reviewers will independently screen identified studies in Covidence. One reviewer will extract data using the TIDieR framework and the Mixed Methods Appraisal Tool (MMAT) for quality appraisal, while a second reviewer will check a sample of extracted studies for accuracy. A convergent integrated synthesis will be conducted where quantitative and qualitative evidence will be integrated by qualitising the quantitative data into textual descriptions.

ETHICS AND DISSEMINATION

There is no requirement for ethical approval for this systematic review as no empirical data will be collected. The findings will be disseminated through a peer-reviewed publication in a scientific journal and presentations in several different forums (eg, a dance psychology network, at scientific and applied conferences).

PROSPERO REGISTRATION NUMBER

CRD42024537249.

Health Problems of Professional Ballet Dancers: an Analysis of 1627 Weekly Self-Reports on Injuries, Illnesses and Mental Health Problems During One Season

BACKGROUND

Several studies have investigated injuries of (pre-)professional ballet dancers, however most used a medical-attention and/or time-loss definition and did not analyse the prevalence of all health problems. The aim was to analyse the frequency and characteristics of all self-reported physical and mental health complaints (i.e. injuries, illnesses and mental health problems) of professional ballet dancers during one season.

METHODS

Three professional ballet companies were prospectively monitored weekly during one season with the Performing artist and Athlete Health Monitor (PAHM). Numerical rating scales (ranging 0-10) were used for severity of musculoskeletal pain, all health problems and impairment of the ability to dance at full potential in the previous seven days. If dancers rated the severity of their health problems or their impairment greater than 0, they were asked to answer specific questions on the characteristics of each health problem.

RESULTS

Over a period of 44 weeks, 57 dancers (57.9% female) filled in 1627 weekly reports (response rate of 64.9%), in which 1020 (62.7%) health problem were registered. The dancers reported musculoskeletal pain in 82.2% of the weeks. They felt that their ability to dance at their full potential was affected due to a health problem in about every second week (52.6%) or on at least 29.1% of the days documented in the weekly reports. Almost all dancers (96.5%) reported at least one injury, almost two thirds (64.9%) an illness and more than a quarter (28.1%) a mental health problem. On average, every dancer reported 5.6 health problems during the season. Most of the 320 health problems were injuries (73.1%), 16.9% illnesses and 10.0% mental health problems. Injuries affected mainly ankle, thigh, foot, and lower back and were mostly incurred during rehearsal (41.6%) or training (26.1%). The most frequent subjective reasons of injury were "too much workload" (35.3%), "tiredness/exhaustion" (n = 22.4%) and "stress/overload/insufficient regeneration" (n = 21.6%).

CONCLUSION

Preventive interventions are urgently required to reduce the prevalence of health problems and especially injuries of professional dancers. Injury prevention measures should regard the balance of the load capacity of professional dancers and the workload in training, rehearsals and performances.

A systematic review, meta-analysis, and meta-regression of the prevalence of self-reported disordered eating and associated factors among athletes worldwide

BACKGROUND

The purpose of this meta-analysis was to provide a pooled prevalence estimate of self-reported disordered eating (SRDE) in athletes based on the available literature, and to identify risk factors for their occurrence.

METHODS

Across ten academic databases, an electronic search was conducted from inception to 7th January 2024. The proportion of athletes scoring at or above predetermined cutoffs on validated self-reporting screening measures was used to identify disordered eating (DE). Subgroup analysis per country, per culture, and per research measure were also conducted. Age, body mass index (BMI), and sex were considered as associated/correlated factors.

RESULTS

The mean prevalence of SRDE among 70,957 athletes in 177 studies (132 publications) was 19.23% (17.04%; 21.62%), I2 = 97.4%, τ2 = 0.8990, Cochran's Q p value = 0. Australia had the highest percentage of SRDE athletes with a mean of 57.1% (36.0%-75.8%), while Iceland had the lowest, with a mean of 4.9% (1.2%-17.7%). The SRDE prevalence in Eastern countries was higher than in Western countries with 29.1% versus 18.5%. Anaerobic sports had almost double the prevalence of SRDE 37.9% (27.0%-50.2%) compared to aerobic sports 19.6% (15.2%-25%). Gymnastics sports had the highest SRDE prevalence rate, with 41.5% (30.4%-53.6%) while outdoor sports showed the lowest at 15.4% (11.6%-20.2%). Among various tools used to assess SRDE, the three-factor eating questionnaire yielded the highest SRDE rate 73.0% (60.1%-82.8%). Meta-regression analyses showed that female sex, older age, and higher BMI (all p < 0.01) are associated with higher prevalence rates of SRDE.

CONCLUSION

The outcome of this review suggests that factors specific to the sport affect eating behaviors throughout an athlete's life. As a result, one in five athletes run the risk of developing an eating disorder. Culture-specific and sport-specific diagnostic tools need to be developed and increased attention paid to nutritional deficiencies in athletes.