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Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis
Open accessAbstract
Objectives: To present an overview of the existing epidemiological evidence regarding the occurrence of mental health symptoms and disorders among current and former elite athletes. Design: Systematic review and meta-analysis. Data sources: Five electronic databases were searched from inception to November 2018: PubMed (MEDLINE), SportDiscus via EBSCO, PSycINFO via ProQuest, Scopus and Cochrane. Eligibility criteria for selecting studies: We included original quantitative studies that were written in English, were conducted exclusively among current or former elite athletes, and presented incidence or prevalence rates of symptoms of mental disorders. Results: Twenty-two relevant original studies about mental health symptoms and disorders among current elite athletes were included: they presented data especially on symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 2895 to 5555 current elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression. Fifteen relevant original studies about mental health symptoms and disorders among former elite athletes were included: they similarly presented data especially about symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 1579 to 1686 former elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 16% for distress to 26% for anxiety/depression. Conclusions: Our meta-analyses showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression for current elite athletes, and from 16% for distress to 26% for anxiety/depression for former elite athletes.
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“To date, research has primarily examined the mental health outcomes of elite athletes [15–18], with comparatively less research focusing on understanding these psychological experiences among coaches [19].”
From The Mental Health of Elite-Level Coaches: A Systematic Scoping Review (2024) · cites this paper as [15]
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“Among individuals participating in professional sports or performing arts, the prevalence of anxiety-related disorders varies between 19.5% [2] and 34% [3].”
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BackgroundLi, C., Fan, R., Sun, J. M., & Li, G. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.607800 · Cited by 35
Mood Responses and Regulation Strategies Used During COVID-19 Among Boxers and Coaches
Roberts, R. J., & Lane, A. M. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.624119 · Cited by 28
Posttraumatic Stress Disorder in Elite Athletes
Lynch, J. H. (2021) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000918 · Cited by 30
Gaining perspectives: A scoping review of research assessing depressive symptoms in athletes
Tahtinen, R. E., Shelley, J., & Morris, R. (2021) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2021.101905 · Cited by 35
Mental health symptoms in German elite athletes: a network analysis
Geiger, S., Jahre, L. M., Aufderlandwehr, J., Krakowczyk, J. B., Esser, A. J., Mühlbauer, T., Skoda, E., Teufel, M., & Bäuerle, A. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1243804 · Cited by 31
The Mental Health of Athletes: Recreational to Elite
Reardon, C. L. (2021) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000000916 · Cited by 30
Self-citationBeyond the medals: a cross-sectional study exploring retired elite female athletes’ health
Thornton, J. S., Rosen, C., Davenport, M. H., Mountjoy, M. L., Dorian, P., Gouttebarge, V., Breau, B., Pila, E., Reilly, K. C., Yuan, J., et al. (2023) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2022-001479 · Cited by 32
“By doing so, athletes can make informed decisions about their reproductive health.”
Self-citationRisk and protective factors for mental ill-health in elite para- and non-para athletes
Olive, L. S., Rice, S. M., Gao, C., Pilkington, V., Walton, C. C., Butterworth, M., Abbott, L., Cross, G., Clements, M., & Purcell, R. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.939087 · Cited by 26
“A recent systematic review suggested that approximately one third of currently competing athletes report experiencing symptoms of the common mental health disorders (e.g., depression and anxiety; Gouttebarge et al., 2019), a rate that is comparable (or elevated for general distress) to the general population (Purcell…”
BackgroundSelf-citationPrevalence of anxiety and depression in former elite athletes: a systematic review and meta-analysis
Runacres, A., & Marshall, Z. A. (2024) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2023-001867 · Cited by 36
Interventions for improving mental health in athletes: a scoping review
Ekelund, R., Holmström, S., Gustafsson, H., Ivarsson, A., Lundqvist, C., & Stenling, A. (2023) · International Review of Sport and Exercise Psychology · doi:10.1080/1750984x.2023.2258383 · Cited by 33
“Moreover, the results of prevalence studies on mental health, mental health problems, and mental disorders in athlete populations in the past decade (e.g. Gouttebarge et al., 2019), have highlighted athletes ’ need for e ff ective mental health interventions.”
Lundqvist, C. (2020) · The Sport Psychologist · doi:10.1123/tsp.2019-0152 · Cited by 24
Psychological readiness to return to sports practice and risk of recurrence: Case studies
Gómez-Espejo, V., Zafra, A. O., Abenza‐Cano, L., García‐Mas, A., & Ortega, E. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.905816 · Cited by 24
“However, knowledge about the relationship between psychological factors and sports injuries is still limited (Olmedilla et al., 2018b; Gouttebarge et al., 2019; Rice et al., 2019).”
BackgroundWang, L., Yang, M., & Meng, W. (2023) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000006452 · Cited by 24
Measuring Psychological Load in Sport
Mellalieu, S. D., Jones, C., Wagstaff, C. R. D., Kemp, S. P. T., & Cross, M. J. (2021) · International Journal of Sports Medicine · doi:10.1055/a-1446-9642 · Cited by 23
“, retirement) of elite sports and those athletes classified as long-term injured [30, 39].”
BackgroundUrinary Incontinence in Elite Female Athletes
Gan, Z. S., & Smith, A. L. (2022) · Current Urology Reports · doi:10.1007/s11934-022-01133-6 · Cited by 23
Supporting The Mental Health Of Elite‐Level Coaches Through Early Intervention
Frost, J., Walton, C. C., Purcell, R., & Rice, S. (2023) · Arthroscopy Sports Medicine and Rehabilitation · doi:10.1016/j.asmr.2023.04.017 · Cited by 28
“, n >100),(26) these initial findings suggest that high-performance coaches may be at a greater risk of developing mental disorders when compared with elite athletes.(27)”
BackgroundSelf-citationBentzen, M., Kenttä, G., Karls, T., & Fagher, K. (2022) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2022.945073 · Cited by 28
“4% for sleep disturbance, and 34% for anxiety/depression (8).”
BackgroundBiró, A., Cuesta‐Vargas, A., & Szilágyi, L. S. (2023) · Acta Universitatis Sapientiae Informatica · doi:10.2478/ausi-2023-0022 · Cited by 22
Lundqvist, C., Schary, D. P., Jacobsson, J., Korhonen, L., & Timpka, T. (2024) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2024.05.001 · Cited by 27
Rice, S., Butterworth, M., Clements, M., Josifovski, D., Arnold, S., Schwab, C., Pennell, K., & Purcell, R. (2020) · Case Studies in Sport and Exercise Psychology · doi:10.1123/cssep.2019-0016 · Cited by 26
Self-citationOltmans, E., Confectioner, K., Jonkers, R., Kerkhoffs, G. M. M. J., Moen, M. H., Verhagen, E. A. L. M., Wylleman, P., & Gouttebarge, V. (2020) · The Physician and Sportsmedicine · doi:10.1080/00913847.2020.1868276 · Cited by 26
“disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression [4].”
BackgroundSelf-citationWalton, C. C., Purcell, R., & Rice, S. (2019) · Early Intervention in Psychiatry · doi:10.1111/eip.12857 · Cited by 25
“…schedules, public scrutiny and post-career transition (especially when non-voluntary) to a non-athletic identity (Gorczynski, Coyle, & Gibson, 2017; Gouttebarge et al., 2019; Gouttebarge, FringsDresen, & Sluiter, 2015; Gulliver, Griffiths, Mackinnon, Batterham, & Stanimirovic, 2015; Henriksen et…”
Self-citationCall-to-action: the need for a mental health research agenda for sports match officials
Gorczynski, P. F., & Webb, T. (2020) · Managing Sport and Leisure · doi:10.1080/23750472.2020.1792803 · Cited by 22
“…prevalence rates for distress (6%), anxiety/ depression (undifferentiated) (12%), sleep disturbance (9%), and alcohol misuse (17%), were all lower than those reported in a recent metaanalysis that examined the same symptoms for elite athletes (Gouttebarge et al., 2017; Gouttebarge et al., 2019).”
ResultSelf-citationUnmasking mental health symptoms in female professional football players: a 12-month follow-up study
Bilgoe, S. C., van Rensburg, D. C. J., Goedhart, E. A., Orhant, E., Kerkhoffs, G. M. M. J., & Gouttebarge, V. (2024) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2024-001922 · Cited by 23
“Therefore, 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.”
BackgroundSelf-citationWaleriańczyk, W., Krzywański, J., Gorgol, J., Konopka, K., Kuśmierczyk, A., Lisek, G., Maleszka, P., Sławińska, M., Surała, O., Więcław, G., et al. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2024-108919 · Cited by 25
Şenel, E., Küttel, A., Adiloğulları, İ., & Jowett, S. (2025) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2025.102850 · Cited by 27
Grasdalsmoen, M., Clarsen, B. M., & Sivertsen, B. (2022) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2022.817757 · Cited by 22
Validity and reliability of the Turkish version of Athlete Psychological Strain Questionnaire (APSQ)
Lima, Y., ÖZ, N. D., Denerel, N., Özkaya, Ö., Şenışık, S., & Rice, S. (2022) · Turkish Journal of Sports Medicine · doi:10.47447/tjsm.0637 · Cited by 21
Self-citationHilpisch, C., Krüger, K., Raab, M., Wiese, L., Zentgraf, K., & Mutz, M. (2024) · International Review for the Sociology of Sport · doi:10.1177/10126902241248767 · Cited by 31
“…is limited and previous fi ndings have been mixed, recent evidence has suggested that athletes are at comparable or even higher risk of mental health problems than the general population (Frank et al., 2013; Gouttebarge et al., 2019; Reardon et al., 2019; Rice et al., 2016; Wolanin et al., 2015).”
Kelly, N., Stafford, J., Craig, C., Herring, M. P., & Campbell, M. J. (2022) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2022.102244 · Cited by 19
Anonymous vs. non-anonymous administration of depression scales in elite athletes: a meta-analysis
Harenberg, S., Ouellet-Pizer, C. M., Nieto, M., Kuo, L., Vosloo, J., Keenan, L., & Wilson, S. E. (2022) · International Review of Sport and Exercise Psychology · doi:10.1080/1750984x.2022.2095658 · Cited by 19
“%) in depressive symptoms (Gouttebarge et al., 2019).”
Athletes are not at greater risk for death by suicide: A review
Pichler, E. M., Ewers, S. M., Ajdacic‐Gross, V., Deutschmann, M., Exner, J., Kawohl, W., Seifritz, E., & Claussen, M. C. (2023) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14316 · Cited by 23
Mental Health Symptoms Related to Body Shape Idealization in Female Fitness Physique Athletes
Mathisen, T. F., & Sundgot-Borgen, J. K. (2019) · Sports · doi:10.3390/sports7110236 · Cited by 27
“A recent meta-analysis identified mental health symptoms and disorders as highly prevalent among elite athletes (34%) [6] and slightly higher compared to the frequency of mental health disorders in the general population (~20%) [11].”
BackgroundReaching out: help-seeking among professional male ice hockey athletes
Crawford, K. L., Wilson, B., Clarke, L. H., & Beauchamp, M. R. (2022) · Qualitative Research in Sport Exercise and Health · doi:10.1080/2159676x.2022.2111458 · Cited by 19
“Despite the prevalence of mental health concerns among elite athletes (Gouttebarge et al. 2019), when compared to their non-athlete counterparts, athletes are less likely to engage in help-seeking behaviours (Watson 2005).”
BackgroundOjio, Y., Kawamura, S., Horiguchi, M., & Gouttebarge, V. (2023) · Sports Psychiatry · doi:10.1024/2674-0052/a000059 · Cited by 20
Self-citation
Metadata
- Authors
- Gouttebarge, V., Castaldelli-Maia, J. M., Gorczynski, P., Hainline, B., Hitchcock, M. E., Kerkhoffs, G. M., Rice, S. M., & Reardon, C. L.
- Affiliations
- Amsterdam University Medical Centers (NL)
- University of Portsmouth (GB)
- National Collegiate Athletic Association (US)
- University of Wisconsin–Madison (US)
- Amsterdam UMC Location University of Amsterdam (NL)
- The University of Melbourne (AU)
- University of Wisconsin System (US)
- Corresponding author
- Gouttebarge, Vincent
- ORCID
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2019-05-16
- Volume
- 53
- Issue
- 11
- Pages
- 700-706
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- PMC
- PMC6579497
- OpenAlex
- W2944177380
- Cited by
- 604
- References
- 68
- Citations by year
- 2026: 119 · 2025: 107 · 2024: 111 · 2023: 77 · 2022: 80 · 2021: 58 · 2020: 44 · 2019: 7
- FWCI
- 10.09
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- British Journal of Sports Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, cc-by)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- HighWire Press Open Archive (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc)
- Funders
- International Olympic Committee
- Topics
- Social Sciences › Psychology › Developmental and Educational Psychology › Sport Psychology and Performance
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- mental health, elite athletes, former athletes, anxiety, depression, alcohol abuse, sleep disorders, psychological distress, prevalence, mental illness
- MeSH terms
- Anxiety, Mental Disorders, Depression, Humans, Sleep Wake Disorders, Incidence, Prevalence, Alcohol-Related Disorders, Athletes
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