Introduction
Despite some prominent cases (eg, Reng and Enke,1 Biermann and Schäfer,2 Rafati3), mental health problems are rarely reported in football and other sports. It is possible that the physical activity,4 ,5 the team support or the ‘privileged’ life (eg, financial security, access to various resources, admiration from the public) associated with professional football protects these players from getting mental disorders, or that people with a predisposition for mental disorders do not become high-level athletes. But it is also possible that the stigma attached to mental health issues makes it an under-investigated and under-reported area in top-level football and other elite sport.6–8
Scientific studies on the mental health of athletes are rare,9–11 and their results are inconsistent. Many studies focused on college athletes in the USA,12–18 and few investigated the top-level national athletes.19–21 Many studies included athletes from various sports without providing prevalence data for specific types of sport.12 ,13 ,17–20 ,22 Up to now, only one study reported mental health problems of active high-level male football players.23 A further study analysed career-time mental health problems of female elite football players (Prinz and Junge, submitted). Some studies had a low response rate (eg, 25.1%19; 29%23), and others did not even report it.12 ,15 ,18 ,20 ,24 This is a serious methodological limitation, since potential selection effects might have biased the reported prevalence.
Most studies on mental health of active athletes have investigated depression, and few have looked into anxiety, eating disorders, abuse of alcohol or unspecific mental health problems such as distress and burnout. Depression was most frequently measured using the Centre of Epidemiologic Studies Depression Scale (CES-D25) (table 1). For other mental health problems, various measurements were used, which makes a comparison of results and, consequently, a conclusion on the prevalence, almost impossible.
The percentage of athletes classified as depressed varied from 3.6%21 to 37%24; if results solely based on the CES-D were regarded, the range was still 16%15 to 36%.12 In most studies, a higher prevalence of depression in female rather than in male players was reported.12 ,13 ,18–20 Nixdorf et al20 found different prevalence rates of depression in professionals (15%), and junior (20%) and amateur athletes (29%), however, the means of these groups were similar. Further, significantly higher average depression scores were observed in individual rather than in team sport athletes.20 Thus, differences in the athletes’ characteristics may have contributed to the heterogeneous results in addition to the methodological problems mentioned above.
Very little information about the prevalence of anxiety in active athletes was found in the literature.13 ,14 ,18 ,19 ,21 In studies using different self-report questionnaires, the reported prevalence of anxiety symptoms varied between 3.8%19 and 22.2%18 in male and 10.2%19–37.318 in female athletes. Schaal et al21 found 6-month prevalence rates for general anxiety disorders of 5.2% in male and 7.5% in female athletes, analysing their medical records.
Therefore, the aim of the present study was to evaluate the depression and anxiety, in a homogenous and representative group of top-level male and female athletes. The prevalence of depression and anxiety will be assessed in all players of all Swiss first league (FL) football teams and compared to data of the general population. In addition, effects of player characteristics on depression and anxiety will be analysed.
How might it impact on clinical practice in the near future?
Awareness and knowledge of athletes’ mental health problems need to be raised in coaches and team physicians.
Adequate psychotherapeutic and/or pharmacological treatment should be provided to athletes in need.