A Systematic Review of the Prevalence of Mental Health Symptoms and Disorders in Rugby Players

in Journal of Clinical Sport Psychology
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  • 1 School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom
  • | 2 School of Human Sciences, University of Greenwich, London, United Kingdom
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The aim of this systematic review was to investigate the prevalence of mental health symptoms and disorders in rugby players. Six electronic databases were searched in December 2020. Studies were included if they provided quantitative data on mental health symptoms and disorders and consisted of adult rugby players. Eight studies were included, covering symptoms of anxiety, depression, alcohol use/misuse, distress, sleeping/sleep disturbance, and eating disorders/adverse nutrition behaviors. Prevalence of mental health symptoms ranged from 6% (depression) to 68.8% (alcohol use/misuse). Most rates were similar to the general population, while symptoms of sleeping/sleep disturbance were lower, and symptoms of eating disorders/adverse nutrition behaviors and alcohol use/misuse were higher than the general population. One study included female rugby players. Epidemiological evidence comprising of rigorous diagnostic data and inclusive of gender, race, ethnicity, sexuality, and other protected characteristics is needed to inform future mental health support in this population.

Oftadeh-Moghadam (Shakiba.moghadam@port.ac.uk) is corresponding author, https://orcid.org/0000-0003-4518-3413

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5).

  • Blodgett, A., Ge, Y., Schinke, R., & McGannon, K. (2017). Intersecting identities of elite female boxers: Stories of cultural difference and marginalization in sport. Psychology of Sport and Exercise, 32, 8392. https://doi.org/10.1016/j.psychsport.2017.06.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brown, J.C., Kerkhoffs, G., Lambert, M.I., & Gouttebarge, V. (2017). Forced retirement from professional rugby union is associated with symptoms of distress. International Journal of Sports Medicine, 38(8), 582587. https://doi.org/10.1055/s-0043-103959

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cosh, S., Crabb, S., & Lecouteur, A. (2013). Elite athletes and retirement: Identity, choice, and agency. Australian Journal of Psychology, 65(2), 8997. https://doi.org/10.1111/j.1742-9536.2012.00060.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cosh, S., McNeil, D.G., & Tully, P.J. (2020). Poor mental health outcomes in crisis transitions: An examination of retired athletes accounting of crisis transition experiences in a cultural context. Qualitative Research in Sport, Exercise and Health, 13(4), 604623. https://doi.org/10.1080/2159676X.2020.1765852

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Davies, M., Judge, D.A., Delmestri, A., Kemp, P.T.S., Stokes, K.A., Arden, N.K., & Newton, J.L. (2017). Health amongst former rugby union players: A cross-sectional study of morbidity and health-related quality of life. Scientific Reports, 7(1), 111. https://doi.org/10.1038/s41598-017-12130-y

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Decq, P., Gault, N., Blandeau, M., Kerdraon, T., Berkal, M., ElHelou, A., Dusfour, B., & Peyrin, J.C. (2016). Long-term consequences of recurrent sports concussion. Acta Neurochirurgica, 158(2), 289300. https://doi.org/10.1007/s00701-015-2681-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Doherty, S., Hannigan, B., & Campbell, M.J. (2016). The experience of depression during the careers of elite male athletes. Frontiers in Psychology, 7, 1069. https://doi.org/10.3389/fpsyg.2016.01069

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Du Preez, E., Graham, K., Gan, T., Ball, C., Moses, B., & Kuah, D. (2017). Mental health issues in elite rugby league players in the NRL during a competitive season—A cross sectional epidemiological study. Journal of Science and Medicine in Sport, 20, 72. https://doi.org/10.1016/j.jsams.2017.09.338

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Edwards, D., & Edwards, S. (2012). The evaluation of a psychological skills training programme for rugby players: Sport science. African Journal for Physical Health Education, Recreation, 18(3), 525534.

    • Search Google Scholar
    • Export Citation
  • England Rugby. (2019). Record breaking numbers for global game. https://www.englandrugby.com/news/article/record-breaking-numbers-for-global-game

    • Search Google Scholar
    • Export Citation
  • Golding, L., Gillingham, R.G., & Perera, N.K.P. (2020). The prevalence of depressive symptoms in high-performance athletes: A systematic review. The Physician and Sports Medicine, 48(3), 247258. https://doi.org/10.1080/00913847.2020.1713708

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gorczynski, P., Coyle, M., & Gibson, K. (2017). Depressive symptoms in high-performance athletes and non-athletes: A comparative meta-analysis. British Journal of Sports Medicine, 51(18), 13481354. https://doi.org/10.1136/bjsports-2016-096455

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gorczynski, P., Currie, A., Gibson, K., Gouttebarge, V., Hainline, B., Castaldelli-Maia, J.M., … Swartz, L. (2020). Developing mental health literacy and cultural competence in elite sport. Journal of Applied Sport Psychology, 33(4), 387401. https://doi.org/10.1080/10413200.2020.172004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gorczynski, P., & Webb, T. (2021). Developing a mental health research agenda for football referees. Soccer and Society, 22(6), 655662. https://doi.org/10.1080/14660970.2021.1952695

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gouttebarge, V., Aoki, H., Lambert, M., Stewart, W., & Kerkhoffs, G. (2017). A history of concussions is associated with symptoms of common mental disorders in former male professional athletes across a range of sports. Physician and Sports Medicine, 45(4), 443449. https://doi.org/10.1080/00913847.2017.1376572

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gouttebarge, V., Bindra, A., Blauwet, C., Campriani, N., Currie, A., Engebretsen, L., … Budgett, R. (2021). International Olympic Committee (IOC) Sport Mental Health Assessment Tool 1 (SMHAT-1) and Sport Mental Health Recognition Tool 1 (SMHRT-1): Towards better support of athletes’ mental health. British Journal of Sports Medicine, 55(1), 3037. https://doi.org/10.1136/bjsports-2020-102411

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gouttebarge, V., Castaldelli-Maia, J.M., Gorczynski, P., Hainline, B., Hitchcock, M.E., Kerkhoffs, G.M., Rice, S., & Reardon, C.L. (2019). Occurrence of mental health symptoms and disorders in current and former elite athletes: A systematic review and meta-analysis. British Journal of Sports Medicine, 53(11), 700706. https://doi.org/10.1136/bjsports-2019-100671

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gouttebarge, V., Hopley, P., Kerkhoffs, G., Verhagen, E., Viljoen, W., Wylleman, P., & Lambert, M. (2017). Symptoms of common mental disorders in professional Rugby: An international observational descriptive study. International Journal of Sports Medicine, 38(11), 864870. https://doi.org/10.1055/s-0043-114010

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gouttebarge, V., Hopley, P., Kerkhoffs, G., Verhagen, E., Viljoen, W., Wylleman, P., & Lambert, M. (2018). A 12-month prospective cohort study of symptoms of common mental disorders among professional rugby players. European Journal of Sport Science, 18(7), 10041012. https://doi.org/10.1080/17461391.2018.1466914

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gouttebarge, V., Kerkhoffs, G., & Lambert, M. (2016). Prevalence and determinants of symptoms of common mental disorders in retired professional Rugby Union players. European Journal of Sport Science, 16(5), 595602. https://doi.org/10.1080/17461391.2015.1086819

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gulliver, A., Griffiths, K.M., & Christensen, H. (2012). Barriers and facilitators to mental health help-seeking for young elite athletes: A qualitative study. BMC Psychiatry, 12(1), 157. https://doi.org/10.1186/1471-244X-12-157

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gulliver, A., Griffiths, K.M., Mackinnon, A., Batterham, P.J., & Stanimirovic, R. (2015). The mental health of Australian elite athletes. Journal of Science and Medicine in Sport, 18(3), 255261. https://doi.org/10.1016/j.jsams.2014.04.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gupta, L., Morgan, K., & Gilchrist, S. (2017). Does elite sport degrade sleep quality? A systematic review. Sports Medicine, 47(7), 13171333. https://doi.org/10.1007/s40279-016-0650-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hammond, T., Gialloreto, C., Kubas, H., & Hap-Davis, H. (2013). The prevalence of failure-based depression among elite athletes. Clinical Journal of Sport Medicine, 23(4), 273277. https://doi.org/10.1097/JSM.0b013e318287b870

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hoy, D., Brooks, P., Woolf, A., Blyth, F., March, L., Bain, C., Barker, P., Smith, E., & Buchbinder, R. (2012). Assessing risk of bias in prevalence studies: Modification of an existing tool and evidence of interrater agreement. Journal of Clinical Epidemiology, 65(9), 934939. https://doi.org/10.1016/j.jclinepi.2011.11.014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kavaliauskas, M. (2010). Relationships between muscular performance and markers of well-being in elite rugby union players. Sport Science Review, 19(3–4), 3561. https://doi.org/10.2478/v10237-011-0016-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kilic, Ö., Hopley, P., Kerkhoffs, G.M., Lambert, M., Verhagen, E., Viljoen, W., Wylleman, P., & Gouttebarge, V. (2019). Impact of concussion and severe musculoskeletal injuries on the onset of mental health symptoms in male professional rugby players: A 12-month study. BMJ Open Sport & Exercise Medicine, 5(1), Article e000693. https://doi.org/10.1136/bmjsem-2019-000693

    • Crossref
    • Search Google Scholar
    • Export Citation
  • King, D.A., Hume, P.A., Milburn, P.D., & Guttenbeil, D. (2010). Match and training injuries in rugby league: A review of published studies. Sports Medicine, 40(2), 163178. https://doi.org/10.2165/11319740-000000000-00000

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kola-Palmer, S., Buckley, S., Kingston, G., Stephen, J., Rodriguez, A., Sherretts, N., & Lewis, K. (2019). “Someone to talk to”: Influence of player welfare provision on mental health in professional Rugby league players. Journal of Clinical Sport Psychology, 13(3), 486503. https://doi.org/10.1080/2159676X.2018.1459805

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kola-Palmer, S., Lewis, K., Rodriguez, A., & Kola-Palmer, D. (2020). Help-seeking for mental health issues in professional rugby league players. Frontiers in Psychology, 11, 475. https://doi.org/10.3389/fpsyg.2020.570690

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kruyt, N., & Grobbelaar, H. (2019). Psychological demands of international rugby sevens and well-being needs of elite South African players. Frontiers in Psychology, 10, 676. https://doi.org/10.3389/fpsyg.2019.00676

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kuettel, A., & Larsen, C.H. (2020). Risk and protective factors for mental health in elite athletes: A scoping review. International Review of Sport and Exercise Psychology, 13(1), 231265. https://doi.org/10.1080/1750984X.2019.1689574

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Le, L., Barendregt, J.J., Hay, P., & Mihalopoulos, C. (2017). Prevention of eating disorders: A systematic review and meta-analysis. Clinical Psychology Review, 53, 4658. https://doi.org/10.1016/j.cpr.2017.02.001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Marsters, C., & Tiatia-Seath, J. (2019). Young Pacific male Rugby players’ perceptions and experiences of mental wellbeing. Sports, 7(4), 83. https://doi.org/10.3390/sports7040083

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McMillan, T.M., McSkimming, P., Wainman-Lefley, J., Maclean, L.M., Hay, J., McConnachie, A., & Stewart, W. (2017). Long-term health outcomes after exposure to repeated concussion in elite level: Rugby union players. Journal of Neurology, Neurosurgery and Psychiatry, 88(6), 505511. https://doi.org/10.1136/jnnp-2016-314279

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., & Prisma Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement (Reprinted from Annals of Internal Medicine). Physical Therapy, 89(9), 873880. https://doi.org/10.1371/journal.pmed.1000097

    • Crossref
    • Search Google Scholar
    • Export Citation
  • NICE. (2011). Alcohol use disorders diagnosis, assessment and alcohol dependence. https://www.nice.org.uk/guidance/cg115

  • Nicholls, A.R., Jones, C.R., Polman, R.C.J., & Borkoles, E. (2009). Acute sport-related stressors, coping, and emotion among professional rugby union players during training and matches. Scandinavian Journal of Medicine and Science in Sports, 19(1), 113120. https://doi.org/10.1111/j.1600-0838.2008.00772.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nicholls, A.R., Madigan, D.J., Fairs, L.R., & Bailey, R. (2020). Mental health and psychological well-being among professional rugby league players from the UK. BMJ Open Sport & Exercise Medicine, 6(1), Article e000711. https://doi.org/10.1136/bmjsem-2019-000711

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nowicki, Z., Grabowski, K., Cubała, W., Nowicka-Sauer, K., Zdrojewski, T., Rutkowski, M., & Bandosz, P. (2016). Prevalence of self-reported insomnia in general population of Poland. Psychiatria Polska, 50(1), 165173. https://doi.org/10.12740/pp/58771

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ojio, Y., Matsunaga, A., Hatakeyama, K., Kawamura, S., Horiguchi, M., Baron, D., & Fujii, C. (2020). Developing a Japanese version of the Baron depression screener for athletes among male professional Rugby players. International Journal of Environmental Research and Public Health, 17(15), 5533. https://doi.org/10.3390/ijerph17155533

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pfister, G. (2010). Outsiders: Muslim women and Olympic games–barriers and opportunities. The International Journal of the History of Sport, 27(16–18), 29252957. https://doi.org/10.1080/09523367.2010.508291

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pierce, M., Hope, H., Ford, T., Hatch, S., Hotopf, M., John, A., Kontopantelis, E., Webb, R., Wessely, S., McManus, S., & Abel, K. (2020). Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population. The Lancet Psychiatry, 7(10), 883892. https://doi.org/10.1016/S2215-0366(20)30308-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pluhar, E., McCracken, C., Griffith, K.L., Christino, M.A., Sugimoto, D., & Meehan, W.P., III. (2019). Team sport athletes may be less likely to suffer anxiety or depression than individual sport athletes. Journal of Sports Science and Medicine, 18(3), 490496.

    • Search Google Scholar
    • Export Citation
  • Qian, J., Hu, Q., Wan, Y., Li, T., Wu, M., Ren, Z., & Yu, D. (2013). Prevalence of eating disorders in the general population: A systematic review. Shanghai Archives of Psychiatry, 25(4), 212223. https://doi.org/10.3969/j.issn.1002-0829.2013.04.003

    • Search Google Scholar
    • Export Citation
  • Reardon, C.L., Hainline, B., Aron, C.M., Baron, D., Baum, A.L., Bindra, A., Budgett, A., Campriani, N., Castaldelli-Maia, J., Currie, A., Derevensky, J., Glick, I., Gorczynski, P., Gouttebarge, V., Grandner, M., Han, D.H., McDuff, D., Mountjoy, M., Polat, A., … Engebretsen, L. (2019). Mental health in elite athletes: International Olympic Committee consensus statement 2019. British Journal of Sports Medicine, 53(11), 667699. https://doi.org/10.1136/bjsports-2019-100715

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rice, S.M., Gwyther, K., Santesteban-Echarri, O., Baron, D., Gorczynski, P., Gouttebarge, V., Claudia, C., Hitchcock, M., Hainline, B., & Purcell, R. (2019). Determinants of anxiety in elite athletes: A systematic review and meta-analysis. British Journal of Sports Medicine, 53(11), 722730. https://doi.org/10.1136/bjsports-2019-100620

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rice, S.M., Ogrodniczuk, J.S., Kealy, D., Seidler, Z.E., Dhillon, H.M., & Oliffe, J.L. (2019). Validity of the male depression risk scale in a representative Canadian sample: Sensitivity and specificity in identifying men with recent suicide attempt. Journal of Mental Health, 28(2), 132140. https://doi.org/10.1080/09638237.2017.1417565

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rice, S.M., Purcell, R., De Silva, S., Mawren, D., McGorry, P.D., & Parker, A.G. (2016). The mental health of elite athletes: A narrative systematic review. Sports Medicine, 46(9), 13331353. https://doi.org/10.1007/s40279-016-0492-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Riley, J. (2016). Promoting mental health well-being in Rugby league communities. In D. Conrad& A. White (Eds.), Sports-based health interventions (pp. 189199). Springer.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rugby Players Association [RPA]. (n.d.). Lift-the-weight. https://therpa.co.uk/lift-the-weight/

  • Sagar, S., & Stoeber, J. (2009). Perfectionism, fear of failure, and affective responses to success and failure: The central role of fear of experiencing shame and embarrassment. Journal of Sport and Exercise Psychology, 31(5), 602627. https://doi.org/10.1123/jsep.31.5.602

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schuring, N., Aoki, H., Gray, J., Kerkhoffs, G.J., Lambert, M., & Gouttebarge, V. (2017). Osteoarthritis is associated with symptoms of common mental disorders among former elite athletes. Knee Surgery, Sports Traumatology, Arthroscopy, 25(10), 31793185. https://doi.org/10.1007/s00167-016-4255-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Senaratna, C., Perret, J.L., Lodge, C.J., Lowe, A.J., Campbell, B.E., Matheson, M.C., Hamilton, G., & Dharmage, S.C. (2017). Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Medicine Reviews, 34, 7081. https://doi.org/10.1016/j.smrv.2016.07.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Smoller, J.W. (2016). The genetics of stress-related disorders: PTSD, depression, and anxiety disorders. Neuropsychopharmacology, 41(1), 297319. https://doi.org/10.1038/npp.2015.266

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sousa, C., Mason, A., Herrenkohl, T., Prince, D., Herrenkohl, R., & Russo, J. (2018). No direct and indirect effects of child abuse and environmental stress: A lifecourse perspective on adversity and depressive symptoms. American Journal of Orthopsychiatry, 88(2), 121.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sundgot-Borgen, J., & Torstveit M.K. (2004). Prevalence of eating disorders in elite athletes is higher than in the general population. Journal, Clinical Medicine, Sport Sciences, Sport, 14, 2532. https://doi.org/10.1097/00042752-200401000-00005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • The Sleep Council. (2017). The Great British bedtime report. https://sleepcouncil.org.uk/The-Great-British-Bedtime-Report-2017

  • Thompson, R.A., & Sherman, R.T. (2011). Eating disorders in sport. Routledge.

  • Wolanin, A., Hong, E., Marks, D., Panchoo, K., & Gross, M. (2016). Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport. British Journal of Sports Medicine, 50(3), 167171. https://doi.org/10.1136/bjsports-2015-095756

    • Crossref
    • Search Google Scholar
    • Export Citation
  • World Health Organization. (2018a). International classification of diseases for mortality and morbidity statistics (ICD-11). https://icd.who.int/en

    • Search Google Scholar
    • Export Citation
  • World Health Organization. (2018b). Mental health: Strengthening our response. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

    • Search Google Scholar
    • Export Citation
  • Zhang, Y., Ren, R., Lei, F., Zhou, J., Zhang, J., Wing, Y.K., Sanford, L., & Tang, X. (2019). Worldwide and regional prevalence rates of co-occurrence of insomnia and insomnia symptoms with obstructive sleep apnea: A systematic review and meta-analysis. Sleep Medicine Reviews, 45, 117. https://doi.org/10.1016/j.smrv.2019.01.004

    • Crossref
    • Search Google Scholar
    • Export Citation
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