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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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McCabe, T., Peirce, N. S., Gorczynski, P. F., & Heron, N. (2021) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2020-000910 · Cited by 17
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“In elite athletes, anxiety and depression are also the most common mental health disorders, with a joint prevalence of 34% [2].”
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“Researchers suggest 34% of elite athletes report symptoms of anxiety and/or depression (Gouttebarge et al., 2019).”
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Jasser, J., Patel, D. R., & Beenen, K. T. (2022) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2022.05.010 · Cited by 13
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On the Frontline of Athlete Mental Health: The Mental Health Literacy of NCAA Coaches
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“For instance, among elite-level athletes, a meta-analysis indicated that the prevalence of anxiety and depression ranged from 26% among former elite athletes to 34% among current elite athletes (Gouttebarge et al., 2019).”
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“Athlete-specific factors may cause or exacerbate anxiety and depression disorders (Du Preez et al., 2017; Gorczynski et al., 2017; Gouttebarge et al., 2019; Rice et al., 2019).”
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“, 2015), pursuing excellence in high-performance sports is associated with various factors that may pose threats to the holistic wellbeing of athletes (MacAuley, 2012; Gouttebarge et al., 2019; Giles et al., 2020).”
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“…outcomes among elite athletes and sports staff is comparable to the general population (~12 %; GBD 2019 Mental Disorders Collabo-rators, 2022; Gouttebarge et al., 2017; Åkesdotter et al., 2020), though some may be over-or underrepresented (Gouttebarge et al., 2019; Åkesdotter et al., 2020, 2022).”
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Lefebvre, J. S., Henderson, S., Salomie, A., Heath, N. L., & Bloom, G. A. (2022) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2022.2066705 · Cited by 11
“Therefore, participant receptivity to participating in this type of program is important given their vulnerability for experiencing psychological distress due to the pressures and expectations of the sport and its culture (Gouttebarge et al., 2019; Nixdorf et al., 2016).”
BackgroundInfluentialMental health help-seeking preferences and behaviour in elite male rugby players
Oguro, S., Ojio, Y., Matsunaga, A., Shiozawa, T., Kawamura, S., Yoshitani, G., Horiguchi, M., & Fujii, C. (2023) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2023-001586 · Cited by 12
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Self-citationDepressive Disorders in Athletes
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Batting against mental health in elite cricket
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“Furthermore, we limited outcomes to three mental health symptoms (i.e., GAD, depression, and athlete burnout) given their high prevalence rates and close associations with sport performance in elite youth athletes (Gouttebarge et al., 2019; Gustafsson et al., 2007; Sanhueza et al., 2016).”
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“Despite any perceived inconvenience, MHL and cultural competence are important in elite sporting environments, where athletes might be at risk for compromised mental health or mental illness (Champ et al., 2018; Gouttebarge et al., 2019).”
Beebe, K. E., Petrie, T. A., Kiefer, H. R., Slavin, L. E., & Arnold, M. L. (2023) · Journal of Clinical Sport Psychology · doi:10.1123/jcsp.2022-0047 · Cited by 12
Bidirectional relationship between mental health and sport injuries: a review of reviews
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“Commonly, anxiety, distress, sleep disturbance, depression and alcohol misuse are MHS encountered in elite athletes [7].”
BackgroundSelf-citationAthlete career transitions: a systematic review and future directions for sport management research
Fleischman, D., Mulcahy, R. F., English, P., Kirby, K., Stevenson, T., & Sotiriadou, P. (2024) · European Sport Management Quarterly · doi:10.1080/16184742.2024.2437793 · Cited by 10
“More recently, Gouttebarge et al.’s (2019) systematic review and meta-analysis of 15 studies discusses mental health symptoms in current and former elite athletes.”
Lopes, C. P., Allado, E., Poussel, M., Essadek, A., Hamroun, A., & Chenuel, B. J. (2022) · Healthcare · doi:10.3390/healthcare10030511 · Cited by 10
Depressive symptoms among male professional soccer players in Japan
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“Most studies on mental health issues among sports players have been conducted in Western countries ( Gouttebarge et al., 2019 ).”
BackgroundGorczynski, P. F., Aron, C. M., Moore, M. A., & Reardon, C. L. (2023) · Clinics in Sports Medicine · doi:10.1016/j.csm.2023.06.001 · Cited by 15
Self-citationGouttebarge, V., Andersen, T. E., Cowie, C., Goedhart, E. A., Jorstad, H. T., Kemp, S. P. T., Königs, M., Maas, M. M., Orhant, E., Rantanen, J., et al. (2019) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2019-000680 · Cited by 10
Self-citationGrimson, S., Brickley, G., Smeeton, N. J., Abbott, W., & Brett, A. (2021) · European Journal of Sport Science · doi:10.1080/17461391.2021.1976841 · Cited by 15
“In 607 male soccer players, 9% reported adverse alcohol, 38% anxiety and depression and 58% adverse nutrition (Gouttebarge et al., 2019).”
BackgroundPressure is not a privilege: what we can learn from Simone Biles
Tardelli, V. S., Parmigiano, T. R., Castaldelli-Maia, J. M., & Fidalgo, T. M. (2021) · Brazilian Journal of Psychiatry · doi:10.1590/1516-4446-2021-0036 · Cited by 11
Self-citationLundqvist, C., Jederström, M., Korhonen, L., & Timpka, T. (2022) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2022-001414 · Cited by 10
Junge, A., Wellmann, K., & Zech, A. (2023) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14426 · Cited by 15
Mental ill-health in semi-elite women’s soccer in England: a mixed-methods approach
Bramley, O., Healy, L. C., & Sarkar, M. (2024) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2024.2311752 · Cited by 9
Ruggiero, M., FERRANTE, L., Tafuri, D., Meccariello, R., & Mazzeo, F. (2025) · Sports · doi:10.3390/sports13070233 · Cited by 11
“The latest available data, also cited in the latest 2024 Paris Olympics, report that 33.6 percent of elite athletes suffer from depression or anxiety [17,18].”
InfluentialThe Mental Health Status of Esports Athletes
Kegelaers, J. J., Maîresse, O., Ruysevelt, L. V., Trotter, M. G., Watson, M., Pedraza-Ramirez, I., Bonilla, I., Davis, P., Ragnarsson, J., & Heel, M. V. (2025) · Journal of Electronic Gaming and Esports · doi:10.1123/jege.2025-0017 · Cited by 9
Mental health and well‐being in esports: A scoping review
Poulus, D., Nicholson, M., Obine, E. A. C., Drew, M., FISHER, K., Vella, S. A., Seidler, Z. E., & Sharpe, B. T. (2026) · Applied Psychology · doi:10.1111/apps.70055 · Cited by 18
Imboden, C., Claussen, M. C., Iff, S., Quednow, B. B., Seifritz, E., Spörri, J., Scherr, J., & Fröhlich, S. (2021) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2021.759335 · Cited by 10
McLoughlin, E., Arnold, R., Cavallerio, F., Fletcher, D. F., & Moore, L. J. (2023) · Sport Exercise and Performance Psychology · doi:10.1037/spy0000319 · Cited by 12
Aguiar, A. S. (2023) · Cannabis and Cannabinoid Research · doi:10.1089/can.2023.0012 · Cited by 9
“Moreover, elite athletes are vulnerable to mental health problems, with significant anxiety/depression 52,53 and precompetition poor sleep.”
Sustaining the unsustainable: meaningful longevity and the doing of coaching
Jones, R. L., Corsby, C. L. T., & Lane, A. P. (2023) · Sport in Society · doi:10.1080/17430437.2023.2253754 · Cited by 10
“…vulnerability during the course of their work (features found to be associated with increased symptoms of mental health disorders, for example see Gouttebarge et al. 2019; Reardon et al. 2019 for discussion) concluded that the intense hyper-busyness claimed ‘to do’ the job, where work-related…”
BackgroundAlcohol related disorders among elite male football players in Sweden: nationwide cohort study
Ueda, P., Pasternak, B., Svanström, H., Lim, C.-E., Neovius, M., Forssblad, M. L., Ludvigsson, J. F., & Kader, M. (2022) · BMJ · doi:10.1136/bmj-2022-074093 · Cited by 9
“Studies have indicated that elite athletes could be at increased risk of alcohol related disorders after retirement from their elite careers 14 15 22 owing to changes in life circumstances associated with retirement.”
BackgroundUpdate on integrative treatment of psychiatric symptoms and disorders in athletes
Glick, I. D., Stillman, M. A., & Mcduff, D. R. (2020) · The Physician and Sportsmedicine · doi:10.1080/00913847.2020.1757370 · Cited by 10
Seshadri, D. R., Harlow, E. R., Thom, M. L., Emery, M. S., Phelan, D. M. J., Hsu, J. J., Düking, P., Mey, K. D., Sheehan, J., Geletka, B. J., et al. (2023) · Digital Health · doi:10.1177/20552076231177498 · Cited by 10
Chrétien, A., d’Arripe-Longueville, F., Haffner, K., Hayotte, M., Bernier, M., & Vuillemin, A. (2023) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2023.2251235 · Cited by 15
“Moreover, elite athletes are subjected to a set of constraints that lead to specific risks such as injury (Sghir et al., 2021) anxiety, or burnout (Lin et al., 2022; Gouttebarge et al., 2019).”
BackgroundMesagno, C., Hammond, A. A., & Goodyear, M. A. (2024) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2024.102663 · Cited by 8
Hu, S., Li, W., Chen, Y., Li, N., Lou, S., Shao, Y., Guo, Y., Sun, Q., Ni, Z., Dong, L., et al. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06839-8 · Cited by 9
“The prevalence of mental health symptoms ranges from 19 to 34% in current elite athletes, and the most common one is anxiety/depression [7], causing increased injury vulnerability, prolonged injury recovery [8], and poor athletic performance [9].”
Bürger, L., Reis, D., Spielmann, J., Mayer, J., & Steindorf, L. (2025) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2025.102868 · Cited by 8
Ronkainen, H., Lundgren, T., Kenttä, G., Ihalainen, J. K., Kalaja, S., Valtonen, M., & Lappalainen, R. I. (2025) · Journal of Applied Sport Psychology · doi:10.1080/10413200.2025.2521267 · Cited by 11
“General risk factors comprise normal age-related risk indicators such as adverse life events (Gouttebarge et al., 2019; Nixdorf et al., 2016), physical and psychological changes ( € Ozdemir et al., 2016), and financial uncertainty and inadequate social support (Purcell et al., 2022; Walton et al.,…”
Tao, Y., & Lv, X. (2023) · Medicine · doi:10.1097/md.0000000000035254 · Cited by 8
“[34,35] For this reason, occasionally, the loss of this equilibrium could lead individuals to seek solace in sleeping pills.”
InfluentialFuture of Mental Health in Sport: CBT and Athletes
Werner, C., Parrish, D. E., & McIngvale, E. (2023) · Sport Social Work Journal · doi:10.33043/sswj.4.1.81-94 · Cited by 11
Sport Psychiatry and Its Research Agenda
Currie, A., & Purcell, R. (2021) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2021.04.007 · Cited by 8
Weber, B., Bos, J., Clancy, E. M., Menon, R., Cross, T., & Hall, K. (2021) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-104388 · Cited by 10
Reimagining Sport Management Programs Within Kinesiology and Public Health
George, T. R., Marquez, A. A., Coble, C. J., & Williams, A. S. (2022) · Kinesiology Review · doi:10.1123/kr.2022-0026 · Cited by 8
Clinical Commentary: Depression and Anxiety in Adolescent and Young Adult Athletes
Putukian, M., & Yeates, K. O. (2023) · Journal of Athletic Training · doi:10.4085/1062-6050-0658.22 · Cited by 9
Translation and Validation of the Arabic Version of the Athlete Psychological Strain Questionnaire
Alhowimel, A., Alenazi, A. M., Alshehri, M. M., Alqahtani, B. A., Aljamaan, A., Alzahrani, H. A., Alodaibi, F., & Rice, S. (2023) · Journal of Sport Rehabilitation · doi:10.1123/jsr.2022-0311 · Cited by 8
Self-citationA balancing act: Sport psychologist insights into supporting athlete mental health in elite sport
Prior, E., Papathomas, A., & Rhind, D. J. A. (2025) · Journal of Applied Sport Psychology · doi:10.1080/10413200.2025.2462551 · Cited by 7
“The prevalence of mental health concerns amongst athletes is well-documented, with athletes as likely—and sometimes more likely—than the general population to experience symptoms of mental illness (see Åkesdotter et al., 2020; Gouttebarge et al., 2019; Poucher et al., 2021).”
Stavitz, J., Porcelli, R., Block‐Lerner, J., Marks, D. R., & Katzman, H. (2025) · Sports · doi:10.3390/sports13040116 · Cited by 13
Effects of group mindfulness intervention on high-level distance runners: a quasi-experimental study
Kelemen, B., Tóth, R., Benczenleitner, O., & Tóth, L. (2025) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2025.1556404 · Cited by 15
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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