Influences on the mental health and well-being of retired professional athletes from high contact team sports: a mixed methods systematic review.
Level 4 - case-series / case-control
Systematic review of predominantly cross-sectional observational studies
PubMed 40930571 · doi:10.1136/bjsports-2024-108953
What was done
A mixed-methods systematic review searched PsycINFO, Embase, Medline, SPORTDiscus, and Scopus through March 2025 for peer-reviewed studies examining mental health symptoms and influencing factors in retired professional high-contact team sport athletes. The review included 85 studies comprising 53,996 participants (247 females, 0.46%) across six sports: Australian Football League, Canadian Football League, soccer, ice hockey, National Football League, and rugby.
What was found
Prevalence rates varied widely across studies: depression (3% to 49%), anxiety (4.3% to 42%), anxiety/depression (10.2% to 39%), stress (8.7% to 26.9%), adverse alcohol use (6.4% to 68.8%), illicit drug use (10% to 63.2%), opioid use (7% to 23.6%), cannabis use (5% to 15.7%), smoking (0.9% to 16%), and adverse nutritional behaviour (23.8% to 64.5%). For studies reporting mean validated scale scores, depression, anxiety, and sleep disturbance were equivalent to general population norms, whereas scores for stress and adverse alcohol use were mild or higher. Concussion, pain, injury, neurological factors, and physical decline consistently exerted negative influences on mental health, while athletic identity, psychosocial support, retirement autonomy, osteoarthritis, and cognitive function showed both positive and negative influences.
Why it matters
This review shows that while retired contact-sport athletes experience substantial physical morbidity, stress, and substance misuse, baseline rates of depression and anxiety align with population norms rather than being universally elevated.
Limits
Only 48% of included studies demonstrated good methodological quality. Most literature is cross-sectional, dependent on unverified self-report measures, lacks longitudinal follow-up, and almost entirely excludes female athletes (under 0.5% of total participants).
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