Tell us more about yourself and the author team.
I am a doctor who finished his study in medicine one year ago. Since then, I have been working as a resident, not in training at the Department of Orthopaedic Surgery. In my youth, I’ve been practising Taekwondo on a national and international level. Due to an ankle injury, I was forced to quit. However, I was and am still fascinated by sports. During my study, I found Orthopaedic surgery and specifically sport injuries/trauma extremely interesting. Consequently, I already started doing research during my bachelor years with prof. Vincent Gouttebarge. This resulted in a PhD trajectory, which I combined with my masters. In the past years, I have published multiple studies about mental health symptoms among athletes (and the influence of injuries on the mental health of athletes) together with prof. Gino Kerkhoffs and prof. Vincent Gouttebarge.
Prof. Gouttebarge is an ex-professional football player being a professor at the University of Pretoria, and the Chief Medical Officer at FIFPRO (representing hundreds of thousands of football players worldwide). Vincent works toward developing and implementing scientific knowledge to protect and promote the physical and mental health of professional athletes (especially footballers). Vincent is also Chair of the International Olympic Committee (IOC) Mental Health Working Group.
Gino Kerkhoffs is professor and head of the Department of Orthopedic Surgery of the Amsterdam University Medical Centers; chair of the Academic Center of Evidence-based Sports medicine (ACES), and co-chair of the Amsterdam Collaboration on Health and Safety in Sports (ACHSS), one of the 11 IOC Centers of Research Excellence for the Prevention of Injury and Promotion of Health in Athletes. His clinical work focuses on sports injuries of the lower extremity. He has been honorarily recognized as Team NL Preferred Physician for providing excellent orthopaedic medical care to elite athletes by the Dutch National Olympic Committee. One of his main research topics is Mental Health issues in (elite) athletes.
What is the story behind your study?
Mental health symptoms in elite sports have been increasingly examined in the past decade. A recent meta-analysis showed that the prevalence of mental health symptoms ranged from 19% for alcohol misuse to 34% for anxiety/depression in active elite athletes and between 16% for psychological distress to 26% for anxiety/depression in former elite athletes. This amount is higher than that is seen among the normal population. Several stressors (such as injuries) contribute to the occurrence of mental health symptoms in elite athletes. Earlier studies have shown that mental health symptoms among professional footballers occur subsequently after musculoskeletal injuries. Also, mental health topics are often seen a taboo topic. We are glad to see that the interest in mental health symptoms and disorders in the context of elite sport is increasing over the past few years, resulting in the development of an IOC consensus statement about mental health in elite athletes. Also, it is seen that in the majority of the published articles, only male populations are included. We also wanted to focus on the female population with this study, which should be done more often in future research.
In your own words, what did you find?
We found that mental health symptoms are common among elite and former athletes, with rates up to 63% for sport-related psychological distress and 69% for alcohol misuse respectively. Also, we found that several topics within mental health symptoms (e.g. global psychological distress, sleep disturbance, alcohol misuse and substance misuse) were lower among active athletes than former athletes. Also, the results showed that increased psychological resilience among active male footballers was associated with a decrease in mental health symptoms among female and male active football players. Furthermore, problem gambling and sleep disturbance were associated with injury among active male and female footballers, respectively.
What was the main challenge you faced in your study?
The main challenge with the study was that a topic such as mental health is sensitive a sensitive subject. As mental health symptoms are a taboo subject in professional sports such as football, our study was done through anonymous recruitment. It validated scales to improve the objectivity of the participants towards their own mental health. Another challenge was the limited number of former female athlete participants. We are happy that women’s football has gained more attention during the past years as the participation of active female athletes was sufficient.
If there is one take-home message from your study, what would that be?
I like to say that one’s physical condition goes hand in hand with a psychological condition. Our study showed that an increase in psychological resilience was protective against mental health symptoms. Early recognition and detection of mental health symptoms with the available tools can make an early multi-disciplinary approach possible, improving the psychological resilience and the well-being and performance of athletes. Also, mental health symptoms are common among retired athletes. By acknowledging this and after career consultation could help enable a smooth transition into retirement.