Mental health conditions in former professional football players: data extraction from included studies
| Article details (Author(s), year of publication, reference number, country of origin) | Study population | Study design and purpose | Health condition(s) | Assessment method(s) | Outcome (prevalence, incidence) |
| Fernandes et al, 201910 (UK) | N=572 G=male A=60.11 (SD 10.77) C=not provided R=not provided | Case-control study To determine the prevalence of depressive symptoms and general health of male ex-professional footballers compared with general population controls. | Depression, anxiety, sleep issues | Questionnaire using HADS, SF-36, sleep scale from MOS, PANAS, comorbidities, body pain mannequin, self-reported analgesic medication | 5.7% probable depression (controls: 5.8%) 12.0% probable anxiety (controls: 10.3%) |
| Gouttebarge et al, 201751 (The Netherlands—Global) | N=220 G=male A=35 (SD 6) C=12 (SD 5) R=4 (SD 3) | Cross-sectional study To explore the relationship between sports career-related concussions and the subsequent occurrence of symptoms of common mental disorders among former male professional athletes. | Distress, anxiety/depression, sleep disturbance, adverse alcohol use, ≥2 CMD symptoms. | Questionnaire using distress screener (based on 4DSQ), GHQ-12, PROMIS, AUDIT-C and total number of confirmed concussions during professional career | 18% distress 26% anxiety/depression 28% sleep disturbance 25% adverse alcohol use 25%≥2 CMD symptoms |
| Gouttebarge et al, 201650 (The Netherlands—Global) | N=219 G=male A=35 (SD 6.4) C=16.6 (SD 5.0) R=4.4 (SD 3.6) | Case-control study To explore the relationship of level of education, employment status and working hours with symptoms of common mental disorders (distress, anxiety/depression, sleep disturbance, adverse alcohol behaviour, smoking, adverse nutritional behaviour) among current and retired professional footballers. | Smoking, adverse alcohol use, adverse nutrition behaviour, distress, anxiety/depression | Questionnaire using distress screening tool (based on 4DSq), PROMIS, the 3-item AUDIT-C and additional questions for smoking and eating habits | 11.4% adverse smoking behaviour (current players: 3.8%) 24.6% adverse alcohol behaviour (current players: 9.4%) 18.4% distress (current players: 14.8%) 35.3% anxiety/depression (current players: 37.9%) 64.5% adverse nutritional behaviours (current players: 58.1%) |
| Gouttebarge et al, 20159 (The Netherlands—Global) | N=104 G=male A=36 (SD 5) C=12 (SD 5) R=5 (SD 3) | Case-control study To determine the prevalence of mental health problems and psychosocial difficulties in current and former professional footballers. | Distress, burnout, anxiety/depression, low self-esteem, adverse alcohol use, smoking, adverse nutrition behaviour | Questionnaire using The Distress Screener, The Utrecht Burn-Out Scale, the 12-item General Health Questionnaire, Rosenberg’s Self-Esteem Scale, the 3-item AUDIT-C and additional questions for smoking and eating habits | 15% distress (current players: 10%) 16% burnout (current players: 5%) 39% anxiety/depression (current players: 26%) 5% Low self-esteem (current players: 3%) 32% adverse alcohol behaviour (current players: 19%) 12% smoking (current players: 7%) 42% adverse nutrition behaviour (current players: 26%) |
| Kilic et al, 201713 (Denmark) | N=345 G=male (79%), female (21%) A=34.0 (SD 4.9) C=9.8 (SD 4.9) R=6.0 (SD 4.4) | Case-control study To determine the prevalence of symptoms of common mental disorders among current and retired professional football and handball players. | Distress, anxiety/depression, sleep disturbance, adverse alcohol use | Questionnaire using a distress screening tool, GHQ-12, PROMIS, the 3-item AUDIT-C | 8.7% distress (current players: 14.7%) 18.7% anxiety/depression (current players: 18.1%) 11.0% sleeping disturbance (current players: 15.8%) 8.4% adverse alcohol use (current players: 2.9%) |
| Prinz et al, 201652 (Germany) | N=157 G=female A=33.0 (SD 6.25) C=8.65 (SD 5.13) R=6.48 (SD 3.56) | Cross-sectional study To evaluate depression symptoms during and after the career in former female football players of the German First League. | Depression, symptoms related to depression | Questionnaire using CES-D, PHQ-2 and questions on mood, reason for ending career, future life plans, problems in first 2 years after end of football career, need and use for psychotherapeutic support during/after career. | 27.3% were bothered by injuries or physical symptoms in the first 2 years after retirement 20.7% were feeling low in the first 2 years after retirement 8.5% classified as depressed in the first 2 years after retirement 20.0% had counselling or treatment by a psychologist |
| Russell et al, 202012 (UK) | N=7676 G=male A=not provided C=not provided R=not provided | Case-control study To investigate whether former professional soccer players with known high neurodegenerative mortality are at higher risk of common mental health disorders and have higher rates of suicide than the general population. | Admission to hospital for mental disorders, suicide. | Records from prewar Scottish league players and records of postwar Scottish league players. | 5.1% admitted to hospital for management of mental health disorder (controls: 6.1%) 93 (0.40%) suicides as cause of death (controls: 19 (0.25%)) 27 (0.35%) admission to hospital due to anxiety and stress related disorder (controls: 222 (0.96%)) 0.50% admission to hospital due to depression (controls: 0.73%) 0.31% admission to hospital due to drug use disorders (controls: 0.82%) 1.52% admission to hospital due to alcohol use disorder (controls: 2.43%) 0.27% admission to hospital due to bipolar and affective mood disorders (controls: 0.49%) |
| Sanders and Stevinson, 201770 (UK) | N=307 G=male A=46.8 (SD 15.7) C=6.7 (SD 3.7) R=21.2 (SD 14.6) | Cross-sectional study To examine associations between career-ending injury, chronic pain, athletic identity and depressive symptomology in retired professional footballers. | Depressive symptoms | Questionnaire using the SDHS, PI-NRS, AIMS, question for reason of retirement | 15.6% depressive symptoms |
| Van Ramele et al, 201711 (The Netherlands) | N=212 G=male A=35 (SD 6) C=12 (SD 5) R=4 (SD 3) | Cross-sectional study To prospectively explore the incidence of symptoms of CMD (distress, sleep disturbance, anxiety/depression, adverse alcohol use) in retired professional football players. | Distress, sleep disturbance, anxiety/depression, adverse alcohol use (12-month incidence) | Questionnaire using the Distress Screener, PROMIS, CHQ-12, AUDIT-C, SARRS, 5 questions on needs for medical support related to symptoms of CMD | 11% distress 28% sleep disturbance 29% anxiety/depression 15% adverse alcohol use |
A, age; AIMS, Athletic Identity Measurement Scale; AUDIT-C, Alcohol Use Disorders Identification Test; C, duration of career; CES-D, Centre for Epidemiologic Studies Depression Scale; CHQ-12, 12-item General Health Questionnaire; CMD, common mental disorder; 4DSq, Four-Dimensional Symptom Questionnaire; G, gender; HADS, Hospital Anxiety and Depression Scale; MOS, Medical Outcome Survey; N/n, number of participants; PANAS, Positive and Negative Affect Scale; PHQ-2, Patient Health Questionnaire-2; PI-NRS, pain intensity numerical rating scale; PROMIS, Patient-Reported Outcome Measurement Information System; R, duration of retirement; RSES, Rosenberg Self-Esteem Scale; SARRS, Social Athletic Readjustment Rating Scale; SDHS, Short Depression-Happiness Scale; SF-36, 36-item short form; SIP, Sleep Problem Index.