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We explored the epidemiological evidence on the prevalence of mental health symptoms among current and former elite athletes as well as among their entourage members.

A systematic review and meta-analysis were conducted in PubMed, PsycINFO, SportDiscus and Scopus to retrieve original quantitative studies that (i) were written in English, (ii) were conducted exclusively among current or former elite athletes and/or their entourage members, and (iii) presented prevalence rates of mental health symptoms.

In total, 72 studies were included, focusing on self-reported mental health symptoms (not on clinically diagnosed mental health disorders). Meta-analyses comprising 2596 to 10,927 current elite athletes showed that the prevalence of mental health symptoms ranged from 4% for drug misuse to 33% for distress. Meta-analyses comprising 2070 to 3405 former elite athletes showed that the prevalence of mental health symptoms ranged from 12% for depression to 28% for alcohol misuse. Because of the considerable heterogeneity among the included studies, the pooled prevalence estimates from these meta-analyses should be interpreted cautiously, as they summarize highly heterogeneous populations. Mental health symptoms were found to also be common among entourage members, with prevalence rates ranging from 5% for depression or anxiety to 53% for alcohol misuse in high-performance staff (including coaches) and reaching up to 36-58% for burnout in healthcare professionals working during the Paralympic games.

Showing considerable heterogeneity across included studies, our systematic review and meta-analysis established that mental health symptoms are commonly reported by current and former elite athletes, as well as by their high-performance staff (including coaches) and medical staff. This warrants the implementation of various tailored resources, such as mental health literacy, screening programs and the availability of interdisciplinary medical and psychological support.