Table 2

Synthesis of studies included in the review

Study, year, countryStudy typeParticipant characteristics, n (male:female)Flat:national huntData collection toolSummary of main findings
Caulfield and Karageorghis, 2008, UK10Experimental design41 (41:0)Not specifiedEAT-26
Jockeys’ mood profiles lower when making minimal weight in comparison with optimal or relaxed weight (p<0.05). Significant difference in attitudes to eating when making minimal weight than at optimal weight or relaxed weight. Depression, fatigue and confusion scores greater on BRUMS when making minimal weight (p<0.05).
Cotugna et al, 2011, USA50Mixed-methods20 (19:1)20:0Diet assessment tool and interviewsJockeys reported a variety of disordered eating practices to make weight which included fluid restriction, food restriction and flipping (throwing up).
Dolan et al, 2011, Ireland15Cross-sectional27
17:1059-item nutrition, lifestyle and health questionnaireWeight loss strategies—sauna (86%), exercise to sweat (81%), restrict food intake (71%), not eating between meals (67%), exercise to use up calories (48%), excessive exercise (38%), vomit after meals (14%). Negative impact of weight loss—reduced mood (33%), decreased libido (24%), tension (19%) and irritation (14%).
Labadarios et al, 1993, South Africa18Cross-sectional93
(gender not stated)
Not statedHealth and nutrition questionnaireRapid weight loss strategies reported by jockeys included the use of saunas (70%) and hot baths (27%). Drug use via diuretics (70%), laxatives (27%) and appetite suppressants (48%) reported.
Leydon and Wall, 2002, New Zealand17Cross-sectional20 (6:14)
Senior (4:5)
Apprentice (2:9)
20:0EAT-26Mean scores for all jockeys was 13.5 (9.3). 20% of jockeys reported scores of 20 or greater on EAT, indicative of an eating disorder. Mean scores greater for male (M=16, SD=7.3) than female jockeys (M=12.4, SD=10.3) (p>0.05).
King et al, 2020, Ireland6Cross-sectional84
Greenhaus Scale
Prevalence of jockeys meeting the threshold for adverse alcohol use (61%), depression (35%), generalised anxiety (27%) and distress (19%) reported. Statistically significant risk factors for generalised anxiety were athlete burnout (EE OR=4.7; D OR=3.0; PA OR=2.9), career dissatisfaction (OR=0.9, 95% CI 0.8 to 1.0) and contemplating retirement (OR=0.24, 95% CI 0.1 to 0.7). Associations were reported between distress and athlete burnout (EE OR=5.3; D=7.9; PA OR=8.0) (p<0.05), career dissatisfaction (OR=0.8, 95% CI 0.7 to 0.9) (p<0.05) and contemplating retirement (OR=0.13, 95% CI 0.04 to 0.4) (p<0.05).
Losty et al, 2019, Ireland8Cross-sectional42
Jockeys reported symptoms of MHDs: depressive symptoms (57%), stress symptoms (52%), social phobia symptoms (38%), self-esteem symptoms (31%), distress symptoms (36%) and generalised anxiety symptoms (21%). Injured jockeys were 46 times more likely to meet the criteria for depression than those without a current injury. Being at or above the established threshold score for social phobia resulted in 6.82 times increase in the likelihood of reporting depression (95% CI=1.491 to 31.191), and exceeding the threshold score for stress resulted in a 14.44 times increase in the likelihood of reporting depression (95% CI=0.694 to 17.610).
Martin et al, 2017, UK16Qualitative10
Not statedSemistructured interviewDisordered eating pathology discussed by jockeys, often used to make weight. One jockey referred to using laxatives on a daily basis. Other jockeys discussed induced vomiting (known as ‘flipping’ within the racing industry) as a last resort to make weight. Food restriction was popular to make weight.
McConn-Palfreyman and Littlewood, 2019, UK12Cross-sectional15
(not stated)
Not statedSelf-made questionnaire examining prevalence of MHDs over the past year and barriers to help-seekingOver the past 12 months, 87% of jockeys reported experiencing stress, anxiety or depression, 13% reported problems due to alcohol use and 5% stated problems due to illegal drug use. Most significant barriers to help-seeking included the need to appear ‘strong’ in front of colleagues (55%), social stigma of being viewed negatively for accessing mental health services (41%) and limited time to engage in services (34%).
McGuane et al, 2019, Ireland11Qualitative6
Not statedSemistructured interviewsWasting (rapid weight loss) was routine for jockeys with negative implications for physical and mental health. Self-induced vomiting and the use of diuretics were also reported as methods of losing weight for competition.
Mezey and King, 1987, UK51Mixed-methods10
Clinical interview schedule
Symptom rating test
EAT scores (14.9) reported greater than other male groups. Weights reported 21% lower than anticipated for age group. One jockey met ICD (version not stated) criteria for phobic anxiety state. No jockeys met the criteria for a mental health disorder on clinical interview. Sig increase in irritability when wasting.
Moore et al, 2002, Australia19Cross-sectional116
Not statedQuestionnaire related to weight loss attitudes, weight loss strategies and weight maintenance strategiesWeight loss strategies: all jockeys—skip meals (75%), sauna use—race-day only (28%), daily (11%), 2–3 times per week (15%), weekly (5%), never (41%). Laxatives—all jockeys—race-day only (12%), daily (5%), weekly (4%), monthly (2%), never (77%). Diuretics—race-day only (21%), daily (4%), weekly (3%), monthly (9%), never (63%). Induced vomiting—9%.
Wilson et al, 2012, UK13Case study1
0:1BRUMSDiet and exercise intervention strategy developed for one professional jockey with an emphasis on diet and exercise. Pre-intervention, the jockey displayed above average levels of anger, depression and fatigue, with lower than average vigour. Post-intervention, increases in vigour and a reduction of fatigue were observed.
Wilson et al, UK, 201324Cross-sectional37
19:18BRUMSBoth flat and national hunt jockeys reported impaired mood profiles, with flat jockeys reporting significantly greater scores for anger and fatigue.
Wilson et al, UK, 201452Experimental design8
2:6Questionnaire related to weight-making methodsJockeys reported a variety of weight-making methods. This included: exercising in a sweat suit (100%), gradual dieting (100%), sauna use (75%), fluid restriction (62%), food restriction (62%), other methods such as exercising in a bin liner and extra clothes, laxative tablets, and drinking Epsom salts in water (50%), salt bath (37%), hot bath (37%), and fasting (25%).
Wilson et al, 2015, UK14Experimental design10
9:0GHQ (GHQ-12)
Six-week exercise and diet programme. Pre-intervention mean GHQ-12 was 10.3 (SD=4.3), which reduced post-intervention to 8.9 (SD=3.8) (p>0.05). Findings indicated that 29% of jockeys met the threshold indicative of an eating disorder. The mean EAT-26 score pre-intervention was 14.8 (SD=9.6), which decreased post-intervention to 11.0 (SD=5.6) (p>0.05).
  • ABQ, Athlete Burnout Questionnaire; AUDIT-C, Alcohol Use Disorders Identification Test; BRUMS, Brunel Mood Scale; CES-D, Center for Epidemiologic Studies Depression Scale; D, devaluation; EAT-26, Eating Attitudes Test; EE, emotional exhaustion; GAD-7, Generalised Anxiety Disorder Scale; GHQ-12, General Health Questionnaire; ICD, International Classification of Diseases; K10, Kessler Psychological Distress Scale; MHDs, mental health difficulties; PA, reduced sense of personal accomplishment; PSS, Perceived Stress Scale; RSES, Rosenberg’s Self-Esteem Scale; SPIN, Social Phobia Inventory.