Bidirectional Relationship Between Mental Health and Sports Injury in Adolescents: A Systematic Review and Meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of predominantly observational (cohort and cross-sectional) studies.
PubMed 41528417 · doi:10.1007/s40279-025-02379-z
What was done
This systematic review and meta-analysis (registered on PROSPERO) evaluated the bidirectional relationship between sports injuries and mental health/well-being in adolescents and young people aged 10 to 24 years. Searches across 10 databases and engines identified English-language quantitative studies published from 1990 to 2023 examining all-complaints sports injuries and mental health/well-being across all competition levels.
What was found
Across 84 included studies encompassing 221,095 participants, sports injury incidence was significantly associated with worse mental health/well-being (Z r = 0.34, 95% CI 0.17 to 0.50), and concussion incidence showed a similar significant association (Z r = 0.19, 95% CI 0.08 to 0.30), with no evidence of publication bias. Conversely, worse mental health/well-being was initially associated with increased sports injury incidence (OR = 1.54, 95% CI 1.13 to 2.10); however, this relationship lost statistical significance after adjusting for potential publication bias.
Why it matters
This review demonstrates a clear link between sports injuries or concussions and worse mental health in adolescent athletes, but shows that the evidence for poor mental health predisposing athletes to injury is weakened by publication bias.
Limits
Much of the primary evidence relies on cross-sectional data rather than longitudinal designs, restricting causal inference. The pooled association between pre-existing mental health deficits and subsequent injury risk was sensitive to publication bias, and few studies formally investigated underlying psychosocial mechanisms.
Cited by
- supports Psychological stress increases injury risk and compromises athletic training performance.