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      Determinants of anxiety in elite athletes: a systematic review and meta-analysis

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          Abstract

          Objective

          To identify and quantify determinants of anxiety symptoms and disorders experienced by elite athletes.

          Design

          Systematic review and meta-analysis.

          Data sources

          Five online databases (PubMed, SportDiscus, PsycINFO, Scopus and Cochrane) were searched up to November 2018 to identify eligible citations.

          Eligibility criteria for selecting studies

          Articles were included if they were published in English, were quantitative studies and measured a symptom-level anxiety outcome in competing or retired athletes at the professional (including professional youth), Olympic or collegiate/university levels.

          Results and summary

          We screened 1163 articles; 61 studies were included in the systematic review and 27 of them were suitable for meta-analysis. Overall risk of bias for included studies was low. Athletes and non-athletes had no differences in anxiety profiles ( d=−0.11, p=0.28). Pooled effect sizes, demonstrating moderate effects, were identified for (1) career dissatisfaction ( d=0.45; higher anxiety in dissatisfied athletes), (2) gender ( d=0.38; higher anxiety in female athletes), (3) age ( d=−0.34; higher anxiety for younger athletes) and (4) musculoskeletal injury ( d=0.31; higher anxiety for injured athletes). A small pooled effect was found for recent adverse life events ( d=0.26)—higher anxiety in athletes who had experienced one or more recent adverse life events.

          Conclusion

          Determinants of anxiety in elite populations broadly reflect those experienced by the general population. Clinicians should be aware of these general and athlete-specific determinants of anxiety among elite athletes.

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          Most cited references 86

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          Meta-analysis: recent developments in quantitative methods for literature reviews.

          We describe the history and current status of the meta-analytic enterprise. The advantages and historical criticisms of meta-analysis are described, as are the basic steps in a meta-analysis and the role of effect sizes as chief coins of the meta-analytic realm. Advantages of the meta-analytic procedures include seeing the "landscape" of a research domain, keeping statistical significance in perspective, minimizing wasted data, becoming intimate with the data summarized, asking focused research questions, and finding moderator variables. Much of the criticism of meta-analysis has been based on simple misunderstanding of how meta-analyses are actually carried out. Criticisms of meta-analysis that are applicable are equally applicable to traditional, nonquantitative, narrative reviews of the literature. Much of the remainder of the chapter deals with the processes of effect size estimation, the understanding of the heterogeneity of the obtained effect sizes, and the practical and scientific importance of the effect sizes obtained.
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            • Article: not found

            On the use of beta coefficients in meta-analysis.

            This research reports an investigation of the use of standardized regression (beta) coefficients in meta-analyses that use correlation coefficients as the effect-size metric. The investigation consisted of analyzing more than 1,700 corresponding beta coefficients and correlation coefficients harvested from published studies. Results indicate that, under certain conditions, using knowledge of corresponding beta coefficients to input missing correlations (effect sizes) generally produces relatively accurate and precise population effect-size estimates. Potential benefits from applying this knowledge include smaller sampling errors because of increased numbers of effect sizes and smaller non-sampling errors because of the inclusion of a broader array of research designs.
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              Psychological Balance in High Level Athletes: Gender-Based Differences and Sport-Specific Patterns

              Objectives Few epidemiological studies have focused on the psychological health of high level athletes. This study aimed to identify the principal psychological problems encountered within French high level athletes, and the variations in their prevalence based on sex and the sport practiced. Methods Multivariate analyses were conducted on nationwide data obtained from the athletes' yearly psychological evaluations. Results A representative sample of 13% of the French athlete population was obtained. 17% of athletes have at least one ongoing or recent disorder, generalized anxiety disorder (GAD) being the most prevalent (6%), followed by non-specific eating disorders (4.2%). Overall, 20.2% of women had at least one psychopathology, against 15.1% in men. This female predominance applied to anxiety and eating disorders, depression, sleep problems and self-harming behaviors. The highest rates of GAD appeared in aesthetic sports (16.7% vs. 6.8% in other sports for men and 38.9% vs. 10.3% for women); the lowest prevalence was found in high risk sports athletes (3.0% vs. 3.5%). Eating disorders are most common among women in racing sports (14% vs. 9%), but for men were found mostly in combat sports (7% vs. 4.8%). Discussion This study highlights important differences in psychopathology between male and female athletes, demonstrating that the many sex-based differences reported in the general population apply to elite athletes. While the prevalence of psychological problems is no higher than in the general population, the variations in psychopathology in different sports suggest that specific constraints could influence the development of some disorders.
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                Author and article information

                Journal
                Br J Sports Med
                Br J Sports Med
                bjsports
                bjsm
                British Journal of Sports Medicine
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0306-3674
                1473-0480
                June 2019
                16 May 2019
                : 53
                : 11
                : 722-730
                Affiliations
                [1 ] departmentResearch and Translation , Orygen, The National Centre of Excellence in Youth Mental Health , Melbourne, Victoria, Australia
                [2 ] departmentCentre for Youth Mental Health , University of Melbourne , Melbourne, Victoria, Australia
                [3 ] departmentDepartment of Psychiatry, Hotchkiss Brain Institute , University of Calgary , Calgary, Alberta, Canada
                [4 ] departmentCenter for Health and Sport , Western University of Health Sciences , Pomona, California, USA
                [5 ] departmentDepartment of Sport and Exercise Science , University of Portsmouth , Portsmouth, UK
                [6 ] departmentDepartment of Orthopaedic Surgery, Amsterdam Movement Sciences , Amsterdam UMC, University of Amsterdam , Meibergdreef, The Netherlands
                [7 ] departmentAMC/VUmc IOC Research Center of Excellence , Amsterdam Collaboration on Health and Safety in Sports (ACHSS) , Amsterdam, The Netherlands
                [8 ] departmentDepartment of Psychiatry , University of Wisconsin School of Medicine and Public Health , Madison, Wisconsin, USA
                [9 ] departmentUniversity Health Services , University of Wisconsin , Madison, Wisconsin, USA
                [10 ] departmentEbling Library for the Health Sciences , University of Wisconsin–Madison , Madison, Wisconsin, USA
                [11 ] National Collegiate Athletic Association (NCAA) , Indianapolis, Indiana, USA
                Author notes
                [Correspondence to ] Dr Simon M Rice, Research and Translation, Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC 3052, Australia; simon.rice@ 123456orygen.org.au
                Article
                bjsports-2019-100620
                10.1136/bjsports-2019-100620
                6579501
                31097452
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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                Systematic Review
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                Sports medicine

                meta-analysis, anxiety, athlete, elite performance, injury

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