Background Scientific studies on the prevalence of mental health problems in elite athletes are rare, and most have had considerable methodological limitations, such as low response rate and heterogeneous samples.

Aims To evaluate the prevalence of depression and anxiety in top-level football players in comparison to the general population, and to analyse potential risk factors.

Methods Players of all first league (FL) and of four U-21 football teams in Switzerland were asked to answer a questionnaire on player's characteristics, the Centre of Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder (GAD-7) scale.

Results All 10 women's FL teams, 9 of 10 men's FL teams and 4 male U-21 teams (n=471 football players) took part in the study. The CES-D score indicated a mild to moderate depression in 33 (7.6%) players and a major depression in 13 (3.0%) players. The GAD-7 score indicated an at least moderate anxiety disorder in 6 (1.4%) players. Compared to the general population, the prevalence of depression was similar and the prevalence of anxiety disorders was significantly (χ²=16.7; p<0.001) lower in football players. Significant differences were observed with regard to player characteristics, such as age, gender, player position, level of play and current injury.

Conclusions Swiss FL football players had the same prevalence of depression as the general population, while male U-21 players had a higher prevalence of depression. It is important to raise awareness and knowledge of athletes’ mental health problems in coaches and team physicians, and to provide adequate treatment to athletes.