Sleep and Mental Health Issues in Current and Former Athletes: A Mini Notably, studies evidencing null-relationships between examined risk factors and psychological outcomes are less likely to be published, leading to publication bias. Longitudinal studies would also help elucidate whether career termination and the factors associated with psychological distress presented in this review caused psychological distress in adulthood, or whether this distress is more likely attributable to predisposition to mental health conditions preceding a career in elite sports. Thousands more are now suing the NFL for doing too. Several studies showed that concussion history was not associated with psychological distress. Additionally, adjustment disorder is characterized as a group of symptoms such as stress, feeling sad or hopeless, and physical symptoms that can occur after an individual experiences a stressful event (American Psychiatric Association, 2013). This review found evidence for this pattern and identified a multitude of other factors associated with psychological distress. These injured athletes are eight times more likely to feel sad and are twice as likely to have a . Collision Athletes: T 48 Contact Athletes: T 51 Limited Contact Athletes T 57, Collision athletes: 52.29 (7.36) Contact athletes: 52.92 (7.37) Limited-contact athletes: 51.79 (7.83), Competed for four years: 75% Competed for 2, 3, or 5 years: <10% Competed between 1 and 10 years: 30%. 1Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, 2Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, 3Health Science Center, University of Florida, Gainesville, FL, Linda B. Cottler, Ph.D., M.P.H., Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, Florida 32610-0165, ude.lfu.phhp@relttocbl, Phone: (352)-273-5468, William M. Perlstein, Ph.D., Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Depression. The prevalence of anxiety was lowest among former Finnish athletes aged 6069 (8.4%) and highest among former Division 1 collegiate athletes, with 16.2% reporting anxiety based on responses from the Veterans Rand 12-Item Health Survey (Bckmand et al., 2009; Kerr, DeFreese, & Marshall, 2014). Neuroimaging of cognitive distress and depression in aging retired National Football League players: a cross-sectional study. In regard to analytical approach, 60% (n=24) of studies utilized univariate or bivariate analyses. Exercise has been shown to have therapeutic effects cognitively and emotionally, of which former players experiencing high levels of pain may not be able to achieve due to their difficulty with mobility (Ang & Gomez-Pinilla, 2007; Schwenk et al., 2007). Improved subjective well-being was also reported eighteen months after retiring (Douglas & Carless, 2009; McKenna & Thomas, 2007), indicating the negative effects of retirement may not persist indefinitely in all retirees. Retirement transition types have been previously grouped into two clusters, normative and non-normative (Schlossberg, 1995). Terry was 22 years old and 6 feet 2 inches, with the kind of wavy hair sweatbands were made for. Concussions, pain, injury, osteoarthritis, physical inactivity, and psychosocial factors were associated with psychological distress among retired elite athletes. However, more recent investigations have identified influential predictors and modifiers of psychological functioning among retired elite athletes. Additionally, Schwenk and colleagues (2007) noted that retired professional football players experienced depression severity comparable to that of the general population, but more severe self-reported pain exacerbated symptoms of depression. Mainwaring LM, Hutchison M, Bisschop SM, Comper P, & Richards DW (2010). Please refer to Table 1 for additional information regarding utilized measures, as well as pertinent demographic and psychosocial information. The combination of depression and pain was significantly associated with difficulties with sleep, finances, social relationships, exercise, and fitness. Additionally, Wippert and Wippert (2008) found that approximately 20% of the former German National Ski Team reported clinical traumatic stress at 3 and 8 months retirement. Voluntary retirement: Depression/Anxiety: 26.1% Adverse Alcohol Use: 21.9% Forced retirement: Depression/Anxiety: 32.7% Adverse Alcohol Use: 34.5%, Voluntary retirement: 39.0 (5.0) Forced retirement: 37.0 (5.0), Voluntary retirement: 9.2 (3.8) Forced retirement: 8.4 (3.7), Voluntary retirement: 7.6 (4.5) Forced retirement: 7.2 (4.3), Ireland, France, & South Africa; Rugby Union. Of the 19 studies reporting depression symptoms as an outcome, almost half (47.4%, n = 9) involved samples of retired In the one study that assessed for symptoms via structured interview, 31.5% of retired hockey athletes reported previously meeting criteria for alcohol dependence (Esopenko et al., 2017). Schwenk TL, Gorenflo DW, Dopp RR, & Hipple E (2007). Depressive Symptoms and Concussions in Aging Retired NFL Players First, the considerable diversity across study populations and measures made it difficult to use meta-analytic methods to aggregate data. Inclusion in an NLM database does not imply endorsement of, or agreement with, Many athletes are at risk for the development of depression due to high pressure sporting events, personal and team expectations, and even individual disposition. Continued physical activity into later adulthood may protect against psychological distress. Record lows 'Was I depressed at my. Why did Junior Seau kill himself? Exploring athletes and depression Psychological distress was associated with greater negative life events and a higher level of Rugby Union career dissatisfaction. PROFESSIONAL ATHLETES FACE A HIGH RISK OF EXPERIENCING MENTAL HEALTH ISSUES INCLUDING DEPRESSION, ANXIETY, AND SUBSTANCE ABUSE AFTER THEY RETIRE. The findings for depression symptoms are organised below according to (a) studies reporting on retired athlete populations, followed by (b) studies reporting on currently competing athletes. Of the 40 studies included in this review, sample size ranged from 26 2675 participants, with epidemiological studies comprising larger samples and studies utilizing neurocognitive testing and brain imaging including smaller numbers of participants (Bckmand et al., 2001; Strain et al., 2013). In instances of non-agreement, the two authors discussed the article and either delivered a mutually agreed-upon decision or sought out a third author to break the tie. Unanticipated severe orthopedic injuries also frequently reduce career longevity or lead to premature, unplanned retirement. The Mental Health of Elite Athletes: A Narrative Systematic Review Athletic trainers, team psychologists, and team physicians should continue to support, educate, and treat symptoms of psychological distress among players exhibiting such symptoms during their career. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL 32610-0165, ude.lfu.phhp@1nosugrefe, Phone: (352)-273-6617, Mary E. Edwards, M.L.I.S, Ed.D., University Librarian, University of Florida, P.O. Depression and pain in retired professional football players, Current health-related quality of life is lower in former Division I collegiate athletes than in noncollegiate athletes, Current Health-Related Quality of Life in Former National Collegiate Athletic Association Division I Collision Athletes Compared With Contact and Limited-Contact Athletes. Over half (62%) of the included studies did not include information related to age, average years of play, or average years of retirement, all factors that can influence the trajectory and prevalence of psychological distress. These findings lend credence to the need of additional research examining retired women, as they may be more likely than their male counterparts to experience psychological distress in retirement. Forty articles were selected and included. Depression (Clinically Diagnosed): Steroid Users: 21.0% Non Users: 10.3%. However, subgroups reporting medical comorbidities, significant pain, a greater number of concussions, less social support, and adverse psychosocial factors were at greater risk for psychological distress. government site. Lindqvist AS, Moberg T, Eriksson BO, Ehrnborg C, Rosn T, & Fahlke C (2013). Moher D, Liberati A, Tetzlaff J, Altman DG, & Prisma Group. National Discharge Register based on hospital admittance and corresponding ICD-8, ICD-9, and ICD-10 codes, Alcohol-related disease, Retired athletes: 6.2% Controls: 7.1%, Finland; Olympians, European or World champions, or international contestants in track and field, weightlifting, combat sports, team sports, & shooting. Participants described both sport and non-sport related triggers in regard to their depression (e.g., institutional mistreatment and bullying, injuries, previous MHI, and miscarriage), as well as a range of behaviour, performance (e.g., decline), and personality changes compared to their normal functioning. However, when collision athletes were compared to that of the general population, composite mental health scores did not differ significantly. Greater physical activity decreased the risk of depression by 8.0% and acted as a protective factor against anxiety onset, while less physical activity led to a threefold increase in the odds of being classified as depressed at ten-year follow-up (Bckmand et al., 2003; Bckmand et al., 2009). Anabolic Androgenic steroid use (AAS), Lifetime illicit drug use, & Lifetime treatment seeking for psychological distress (i.e., depression & anxiety), Depression: Former AAS Users: 13.0% Lifetime Nonusers: 5.0% Anxiety: Former AAS Users: 13.0% Lifetime Nonusers: 6.0% Lifetime Illicit Drug Use: Former AAS Users: 18.0% Lifetime Nonusers: 4.0%, Sweden; Wrestlers, Olympic lifters, Powerlifters, and the throwers in track and field top 10 national ranking lists. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. King T, Rosenberg M, Braham R, Ferguson R, & Dawson B (2013). Turner AP, Barlow JH, & Heathcote-Elliott C (2000). Data sources: Ten electronic databases. Results indicate that the prevalence of psychological distress ranged from 4.8% (depression) to 39.0% (depression/anxiety), with prevalence rates generally higher among athletes assessed by a study psychologist or other mental health professional. Some psychological traits of Slovenian Olympians (Beijing . Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL 32610-0165, ude.lfu.phhp@pmw, Phone: (352)-273-6617, Larry E. Burrell II, M.S., Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Current athletes reported a higher prevalence of depression/anxiety compared to retired athletes while retired athletes reported a higher prevalence of adverse alcohol use. Depression in Retired Athletes | Behavioral Health Of The Palm Beaches Article PubMed Google Scholar Kotnik B, Tuak M, Topi MD, et al. Methodological quality score for each study are included in Table 1. In a study examining gender differences in a sample of current elite French athletes, Schaal and colleagues (2011) found that women were more likely to have at least one psychopathology, including higher prevalence of depression, anxiety, eating disorders, and sleep difficulties. Utilizing these specific criteria may have inhibited our ability to identify studies with mixed samples of current and retired athletes. Less social support, being unmarried, financial instability, and a difficult retirement transition were associated with greater depressive distress (Bckmand et al., 2003; Guskiewicz et al., 2007; Prinz et al., 2016; Schwenk et al., 2007). Retired rugby players also scored higher than controls on the AUDIT, with ten retired athletes and only two controls reporting at least hazardous drinking behavior (Gardner et al., 2017). Are Level of Education and Employment Related to Symptoms of Common Mental Disorders in Current and Retired Professional Footballers? A systematic review of potential long-term effects of sport-related concussion, Enduring injustice: A case study of retirement from professional rugby union. Injured retired players struggle with pessimism, guilt, loss of pleasure, indecisiveness, decreased energy, lower sex drive, and difficulty concentrating. The percentage of retired athletes endorsing mild-to-moderate symptoms of depression (40%) is higher than the national average of 15% of older adults experiencing symptoms of depression (Penninx et al., 1998). Career termination can have a behavioral and emotional impact on the lives of retired elite athletes, consequently impairing future occupational and social functioning in these individuals (Ogilvie & Taylor, 1993; Stephan, 2003; Taylor & Ogilvie, 1994). In the fourteen studies assessing alcohol misuse, the prevalence of misuse ranged from 5.8% in a sample of former American college athletes to 39% among retired soccer players (Kerr, DeFreese, & Marshall, 2014; Van Ramele et al., 2017). Depressive symptoms and white matter dysfunction in retired NFL players with concussion history, Defining elite athletes: Issues in the study of expert performance in sport psychology, A conceptual model of adaptation to retirement among athletes. Life after sport: Depression in the retired athlete Causes of Depression in Athletes After Retirement In addition to brain fog and memory loss, many former athletes battle depression. Thus, psychological distress may ultimately manifest later in retirement and not necessarily follow the described linear transition paths as evidenced by the aforementioned studies. Competed for 34 years: 77.0% Competed for 5 years: 12.0% Competed for 2 years: 22.0% 17 years competing in pro. Gardner AJ, Iverson GL, Wojtowicz M, Levi CR, Kay-Lambkin F, Schofield PW, & Stanwell P (2017). List of reviewed articles including quality assessment rating, prevalence, primary findings, and additional pertinent information. Is retirement good or bad for subjective well-being? To this point, additional studies are needed to examine the prevalence of psychological distress among retired professional athletes of sports alternative to the ones already in the literature, specifically those at higher risk for the experiencing painful medical conditions during playing career such as college or professional baseball, basketball, and tennis, as well as contact/collision sports such as boxing, wrestling, and mixed martial arts. Weigand et al. Among the present studies examining psychological distress in sports alternative to football and conducted outside of the United States, similar prevalence rates of psychological distress associated with depression, anxiety, and substance misuse were identified. Forty articles assessed the prevalence of psychological distress associated with symptomatology related to depressed mood, anxiety, and substance use/misuse. Former athletes reported significantly less life stress three months after retirement compared to ten days post retirement (Wippert & Wippert, 2008). Introduction. Gouttebarge V, Kerkhoffs G, & Lambert M (2016). Given the robust literature demonstrating the difficult adjustment confronting athletes during the retirement transition process, studies assessing for clinically significant adjustment disorder during this period and after may help elucidate a more exact length of time that athletes cope with termination from sport, and estimate a more accurate duration for which adjustment problems may impact future psychological, occupational, and social functioning. All retired athletes classified as depressed reported at least three concussions. Our review suggests the prevalence of psychological distress among retired athletes is similar to that found in the general population. Twenty-nine percent and 22.0% of former NFL players were classified as having depression or anxiety respectively. A phenomenological exploration of the sport-career transition experiences that affect subjective well-being of former national football players. The relationship between concussion history and depressive distress was primarily examined in studies of retired NFL players. Twenty-nine studies included least 100 participants, of which 82% had 200 participants or more. HHS Vulnerability Disclosure, Help Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Harding HP, Matthews A, Cantu RC (2007). Greater pain was associated with current opioid misuse (Cottler et al., 2011). Didehbani N, Cullum CM, Mansinghani S, Conover H, & Hart J (2013). Additionally, a lack of heterogeneity in studies examining psychological distress among retired elite athletes prohibited us from reviewing articles consisting of sports alternative to the ones presented in this review. Sorenson SC, Romano R, Scholefield RM, Martin BE, Gordon JE, Azen SP, & Salem GJ (2014). Forced retirement from professional rugby union is associated with symptoms of distress. Hart J, Kraut MA, Womack KB, Strain J, Didehbani N, Bartz E, Cullum CM (2013). Results from each database were combined and duplicate references were removed prior to the initial abstract level screening. Those with painful medical conditions such as osteoarthritis were at greater risk for reporting symptoms of depression and anxiety, as well as substance misuse following retirement. Many of the studies examining psychological functioning in this population have examined the prevalence and correlates of depression only. Although overtraining . Thus, we examined the prevalence and correlates of psychological distress in former athletes that participated in organized sports at either the collegiate or professional level for at least one year. Decreased physical activity, neuroticism, marital status, life events, and social class were all associated with depression at a 10-year follow-up. Psychosocial dimensions, such as having reached sport goals and planned for life after sport, may affect how retired athletes' respond psychologically. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL 32610-0165, ude.lfu.phhp@sinnen, Phone: (352)-273-6617. Nine-year risk of depression diagnosis increases with increasing self-reported concussions in retired professional football players. Five studies utilizing longitudinal designs have shown that retired athletes tend to report higher life satisfaction over time (Douglas & Carless, 2009; Lally, 2007; McKenna & Thomas, 2007; Stephan, 2003; Wippert & Wippert, 2008). Given that positive relationships between athletes and their coaches facilitates help-seeking, coaches are in a unique position to raise awareness about the clinical manifestations of symptoms and normalize psychological distress as a commonly occurring condition, which may promote positive behavior change and decrease stigma associated with seeking mental health services (Appleton & Duda, 2016; Gulliver et al., 2012; Schwenk at el., 2007). The site is secure. Literature Review: What is post-athlete depression? - Medium Prevalence and determinants of symptoms related to mental disorders in retired male professional footballers, Journal of Sports Medicine and Physical Fitness. Physical activity decreased the risk of depression by 8.0 % from baseline to follow-up. However, sample populations were drawn from 17 different countries, resulting in geographically diverse samples. In regard to demographics, seven studies included women, though only one study examined the prevalence of psychological distress among a sample comprised of all women (Prinz, Dvok, & Junge, 2016). MR Spectroscopy Findings in Retired Professional Rugby League Players. Download .nbib Casson IR, Viano DC, Haacke EM, Kou Z, & LeStrange DG (2014). These findings indicate a need for additional studies examining the prevalence and risk factors of psychological distress among elite hockey players. Clin J Sport Med. Box 100206, Gainesville, FL, 32610-0206, ude.lfu@sdrawdeem, Phone: (352)-273-8421, Nicole Ennis, Ph.D., Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. The association between concussions and depression was significantly confounded by years since retirement and lower rated physical health in multivariate analyses, though concussion history remained a significant risk factor for diagnosed depression (Kerr et al., 2012). Analysis focused on identifying the constructions of mental health and recovery produced in this broadcast, with consideration as to how these depictions might . there is a paucity of evidence in retired professional athletes. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL 32610-0165, ude.lfu.phhp@2llerrubel, Phone: (352)-273-6617, Erin G. Ferguson, B.A., Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. The Mental Health of Elite Athletes: A Narrative Systematic Review Despite increased risk of experiencing adverse physical heath sequelae, the review yielded only three studies examining psychological distress in rugby players exclusively. Personality and mood of former elite male athletes-a descriptive study. Gouttebarge V, Aoki H, Verhagen E, & Kerkhoffs G (2016). Within this process, four distinct periods of subjective well-being during transition were identified: 1) an initial decrease immediately following retirement, 2) an increase five months after retirement, 3) stabilization after eight months, and 4) a final increase in subjective well-being one year after retirement (Stephan, 2003). This review suggests a number of different clinical implications and highlights directions for future research to enhance our understanding of the long-term psychological health of former elite athletes. College Athletes Twice as Likely to Have Depression than Retired Depressive Symptoms and Concussions in Aging Retired NFL Players Mild depression: 20.0% Moderate depression: 20.0%. Kerr ZY, Marshall SW, Harding HP, & Guskiewicz KM (2012). Gouttebarge V, Aoki H, & Kerkhoffs G (2015). The pandemic has exacerbated the existing worldwide mental health crisis. Mental health in retired professional football players: 12-month incidence, adverse life events and support. A longitudinal study among former elite male athletes and controls. Once non-relevant articles were removed at the abstract level screening, the full text of each article was reviewed by two authors to ensure it met criteria based on evaluation using various traditional markers of study rigor. Thus, results are difficult to compare across studies, and may lead to variable estimates of psychological distress (Sakakibara, Miller, Orenczuk, & Wolfe, 2009). In regard to NFL players, many former athletes file for bankruptcy within the first twelve years of their retirement (Carlson, Kim, Lusardi, & Camerer, 2015). Systematic mixed studies reviews: updating results on the reliability and efficiency of the mixed methods appraisal tool, Sports career termination of Russian athletes: readiness to the transition, Repercussions of transition out of elite sport on subjective well-being: A one-year study. Specifically, factors related to a career in competitive sports may influence psychological function in later adulthood. For elite athletes who have dedicated their lives to sport, what happens when your time comes to an end, if you aren't an athlete, then who are you? Study: Retired athletes struggle with loss of sports culture, finding Completing ones career and starting anew transforms an individuals previously established roles to new roles that are less familiar. Treatment during playing career may have a significant positive impact on both performance while in sport, as well as the longstanding psychological health of players in retirement. Multiple studies highlighted the lack of care that was currently being received by former athletes (Guskiewicz et al., 2007; Hart et al., 2013; Kerr et al., 2012; Schwenk et al., 2007; van Ramele et al., 2017). Perfusion neuroimaging abnormalities alone distinguish National Football League players from a healthy population, Potential therapeutic effects of exercise to the brain, Examining the interactive effects of coach-created empowering and disempowering climate dimensions on athletes health and functioning. The finding published in Sports Health suggests the need for more research to understand depression among college athletes. Overall, retired athletes obtained significantly higher scores on all three Buckley factors on the BDI-II, in comparison to the controls. Retirement from sport has been associated with elevated levels of depression, anxiety and/or body dissatisfaction among athletes. Similar to depression, the highest prevalence of anxiety was observed in a study assessing current distress through utilization of a board certified psychiatrist, with 22.0% of retired NFL players classified as anxious (Amen et al., 2016). In sports alternative to football, the literature yielded mixed results. However, many athletes who feel relief immediately after the sport is over can fall into some level of depression later on. Despite a wealth of literature examining various aspects of the retirement process in elite athletes, the proportion of this population who experience psychological distress (i.e., elevated unpleasant feelings or emotions related to conditions such as depression, anxiety, and substance misuse that impact physical, social, or occupational functioning) later in life remains unclear. Unpredictable adverse life events can aggregate, further compounding possible psychological distress experienced as a result of the physical consequences from a career in elite athletics. A preliminary investigation into the long-term injury consequences reported by retired baseball players. Depression/Anxiety: 28.4% Cigarette Smoking: 15.0% Adverse Alcohol Use: 23.8%. Many athletes use a sports psychologist, who may be the first to observe depression - especially when working with retired athletes. Players who misused opioids during their NFL career were more likely to misuse in retirement compared to those whom did not misuse. Over the last decade, multiple peer-reviewed articles have shed light on the prevalence and correlates of psychological distress among former elite athletes. Retired team athletes had the highest prevalence of alcohol misuse compared to non-athletes and retired athletes of other sports. Among retired NHL athletes, 12.0% continued to report opioid use after retirement (Esopenko et al., 2017). Depression was more prevalent in current college athletes compared to former athletes. After Final Whistle, Former College Athletes Face Relief, Depression Pain increases the likelihood of moderate to severe depression. . Mixed methods appraisal tool (MMAT) version 2011 In, Proposal: a mixed methods appraisal tool for systematic mixed studies reviews, Symptoms and risk factors of depression during and after the football career of elite female players. Didehbani and colleagues (2013) also noted that of the 40% of former NFL players that were classified as mildly or moderately depressed; only 17% had received assessment or treatment for their depression.
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