Bidirectional association between injuries and mental health symptoms among elite athletes: a systematic review.

Abstract

To assess (1) the association between mental health symptoms and subsequent injury and (2) the association between injury and subsequent mental health symptoms. Systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. EBSCO APA, PsycINFO, EBSCO SportDiscus, Scopus and PubMed (Medline) from inception until June 2025. We included original quantitative studies, written in English, of current or former elite athletes that included the incidence or prevalence of musculoskeletal injury (not including head injuries) resulting in time loss or modified sport activity and incidence or prevalence of mental health symptoms or disorders. A total of 25 studies were included; 13 prospective, 9 cross-sectional, 2 mixed and 1 interventional study. Differing definitions of injury and substantial heterogeneity of symptom measures (including related psychosocial outcomes) assessed mental health. Nine of 11 studies that assessed mental health symptoms found an association with subsequent injury and 10 of 13 studies that assessed injury found an association with subsequent mental health symptoms. In elite athletes, there is an association between injuries and mental health symptoms though study designs limit the ability to determine bidirectionality. This warrants standardised screening for mental health symptoms in elite athletes as a potential risk factor for injury as well as in assessing the response to injury.