Factors Associated With Mental Health Outcomes Among Professional Athletes During the Social Isolation to COVID-19 Pandemic

doi:10.21203/rs.3.rs-3246072/v1

Download PDF

Research Article

Factors Associated With Mental Health Outcomes Among Professional Athletes During the Social Isolation to COVID-19 Pandemic

https://doi.org/10.21203/rs.3.rs-3246072/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Purpose: The impact of the COVID-19 pandemic on athletes' mental health has been significant, leading to concerns about their careers due to suspended training and competitions. Thus, understanding the psychological mechanisms involved is crucial to promote mental health in athletes. This study aimed to evaluate the effects of the pandemic on the mental health of high-performance athletes.

Methods: A total of 676 participants completed an online form during the early stages of the pandemic, providing demographic data and responding to four inventories measuring psychological variables.

Results: results indicated that women, young adult athletes, and those facing financial loss exhibited higher levels of anxiety, depression, insomnia, and distress. Athletes receiving psychological assistance showed increased distress levels, while isolation did not significantly influence symptoms.

Conclusion: the COVID-19 pandemic negatively affected the mental health of professional athletes, particularly those experiencing financial difficulties, women, and young adults. However, further research is necessary to comprehend these findings' mechanisms.

COVID-19

high-performance athletes

mental health

social isolation

The COVID-19 pandemic became the world's health headline in 2020, with the World Health Organization (WHO) declaring a public health emergency (World Health Organization, 2020). Rapid transmission, high mortality rate, lack of effective treatment, and mass quarantine measures have triggered fear, anxiety, and depression - leading to a greater apprehension of the global population and special attention regarding mental health. (Xiang et al., 2020).

Quarantine was a measure that contributed to reducing the risk of infection in the general population, especially when there was no possibility of mass testing (Brooks et al., 2020). Although voluntary quarantine is associated with less distress and few long-term complications, the combination of lack of social contact, the real threat to life, and doubts about future economic aspects ended up producing direct effects on anxiety levels and mental health (Brooks et al., 2020; Cava et al., 2005). Qiu et al. (2020) and Wang et al. (2020) investigated the prevalence and severity of stress, anxiety, and depression in the Chinese population. Most respondents reported symptoms of the disorders assessed.

Another group directly affected is high-performance athletes who had their training routine interrupted. Given the evolving nature of the pandemic, all sporting competitions, including the Olympic Games due to be held in Tokyo, have been postponed, and athlete training halted. These measures were due to the commitment of sports institutions to protect athletes, the public, and the health of everyone involved (Corsini et al., 2020; Pensgaard et al., 2021).

The competition's cancellation can cause suffering, stress, anxiety, frustration, and deep sadness for an athlete (Toresdahl & Asif, 2020). Athletes are people of habit, with predictable routines, and sudden change due to the state of quarantine can be a frustrating and painful experience, putting significant mental strain on even the most resilient athletes. The adverse effects of isolation for the athlete lead to inadequate nutrition and insomnia, with reduced activity contributing to anxiety and depression, in addition to feelings of loneliness (Chen et al., 2020).

In addition, professional athletes demonstrated worsening mood and increased symptoms of stress, depression, and anxiety during the period of restrictive measures (Håkansson et al., 2020). In a study carried out in Estonia during the beginning of the pandemic, one-third of the participants reported symptoms of psychological stress, among high levels of insomnia, fatigue, and depressive symptoms (Parm et al., 2021). Therefore, the lack of systematic training, the cancellation of major competitions, and limited social contact are risk factors that may be associated with a decline in the mental health of athletes, which justifies this study. Therefore, the objective of the present study was to evaluate the effects of the COVID-19 pandemic on mental health and its associated factors in high-performance athletes who had their training routine interrupted during the year 2020, mapping the levels of anxiety, depression, and stress, in addition to verifying whether demographic factors make athletes more vulnerable in terms of mental health. This study is based on previous research with chinese health care workers during the COVID-19 pandemic (Lai et al, 2020). In our study, we hypothesized that the context of the pandemic has increased levels of anxiety, depression, distress, and insomnia, especially in athletes in unstable socioeconomic conditions.

Study Design

This study was developed following the Declaration of Helsinki and approval from the ethics committee was received before the initiation of this study (opinion: 4,134,004). Written online informed consent was provided by all survey participants prior to their enrollment. Participants were allowed to initiate and terminate the online survey whenever they desired. The survey was anonymous, and the confidentiality of information was assured. This study consists of a cross-sectional study of a descriptive and exploratory nature, carried out between July 4th and September 26th, 2020, totaling two months and 22 days of collection. To compare the differences of mental health outcomes among athletes, samples were stratified by: gender, age, financial loss, unemployment, social isolation and psychological support

Participants

Nine hundred-one high-performance athletes who had their training routine interrupted due to the COVID-19 pandemic volunteered to participate in the study, whose recruitment took place remotely through Google Forms. Due to the exclusion and withdrawal criteria, the results of 676 (75.02%) athletes were analyzed. The eligibility criteria adopted included high-performance athletes who participated in national or international competitions and were in training or competition at the beginning of the COVID-19 pandemic. Athletes not in training or competition at the beginning of the pandemic and amateur athletes were excluded from the study.

Outcomes and Covariates

We focused on symptoms of depression, anxiety, insomnia and distress for all participants, using Portuguese versions of validated measurement tools. Accordingly, the 9-item Patient Health Questionnaire (PHQ-9; range, 0–27) (Osório et al., 2009), the 7-item Generalized Anxiety Disorder (GAD-7) scale (range, 0–21) (Bergerot et al, 2014), the 7-item Insomnia Severity Index (ISI; range, 0–28) (Castro, 2011), and the 15-item Impact of Event Scale (IES; general range, 0–66, avoidance range 0–38, intrusion range 0–35) (Caiuby et al., 2012) were used to assess the severity of symptoms of depression, anxiety, insomnia and distress, respectively. All instruments were completed in digital format. Participants also filled out a form for collecting demographic data including gender (male or female), age (18–22, 23–27, 28–32, 33–37, 38–42, 43–47), financial loss (yes or no), unemployment (yes or no), social isolation (alone, with family, with partner, others) and psychological support (yes or no). The total scores of these measurement tools were interpreted as follows: PHQ-9, minimal (1–4), mild (5–9), moderate (10–14), moderately severe (15–19) and severe (20–27) depression; GAD-7, minimal (1–4), mild (5–9), moderate (10–14) and severe (15–21) anxiety; ISI, normal (0–7), subthreshold (8–14), moderate (15–21) and severe (22–28) insomnia; IES, normal (0–23), mild (24–32), moderate (33–36) and severe (37–66) distress. The cutoff score for detecting symptoms of major depression, anxiety, insomnia, and distress were 10, 10, 8 and 24, respectively. These categories were based on values established in the literature (Osório et al, 2009; Bergerot et al., 2014; Castro, 2011; Caiubyet al., 2012).

Statistical analysis

Data were analyzed using the SPSS statistical analysis program (IBM Corp). The significance was set at α = .05, and all tests were 2-tailed. The classification of data from the 4 measurement tools derived from the scores of each level of depression, anxiety, insomnia and stress symptoms were presented in numbers and percentages. The data, derived from the counts of each level for symptoms of depression, anxiety, insomnia, and distress, are presented as numbers and percentages. The nonparametric Mann-Whitney U and Kruskal-Wallis tests were applied to compare the severity of symptoms between 2 or more groups (i.e., gender, financial situation, the presence or absence of psychological support, age, and social isolation). The results were presented in ranks, with a 95% confidence interval (CI). The r value was used to measure the effect size according to the formula (r = z / square root of N, where N = total number of subjects). The criteria "0.2 = low", "0.5 = medium", and "0.8 = high" were used as a reference.

Sociodemographic characteristics

In the study, 901 high-performance athletes participated, and 676 (75.02%) completed the survey. Most participants were men (395 [58%]), were single (457 [68%]), and between 23 and 27 years old (222 [33%]). The demographic characteristics of the 676 participants with valid responses on the form are shown in Table 1. Of the participants, 579 (85.65%) lived in Brazil, and 73 (14,35%) lived abroad.

Table 1

*Demographic information for the high-perfomance athletes*
Demographic characteristics	N (%)
GENDER
Female	281 (42)
Male	395 (58)
AGE
18 to 22 years old	211 (31)
23 to 27 years old	222 (33)
28 to 32 years old	149 (22)
33 to 37 years old	57 (8)
38 to 42 years old	17 (3)
43 to 47 years old	20 (3)
MARITAL STATUS
Single	457 (68)
Married/Dating	200 (30)
Divorced	19 (3)
GEOGRAPHIC LOCATION
BRAZIL
North region	3 (0,44)
Northeast region	33 (5)
Midwest region	16 (2)
Southeast Region	454 (67,16)
South region	73 (10,80)
OVERSEAS
Europe	85 (13)
North America	12 (2)

Severity of Measurements and Associated Factors

Anxiety

Many participants had mild anxiety symptoms (310 [46%]). Women had higher anxiety scores compared to men (U = 43058.500; Z = -4.993; p < 0.001), but the effect size was small (r = 0.19). No significant difference was found between those who had been unemployed or not (U = 25544.500; Z = -1.169; p = 0.243). Participants who experienced some financial loss during the pandemic (U = 45405,000; Z = -2.820; p = 0.005) had the highest score whose effect size was also small (r = 0,11) (Twenty-eight participants indicated "I prefer not to answer", and they were not included in this analysis and subsequent ones). No significant difference was found between the groups (U = 52891,000; Z = -1.059; p = 0.290) with and without psychological support (eight subjects declared they preferred not to answer and had their results excluded from the analysis). We did not find a difference between the groups ([H (3) = 1.560; p = 0.668]) "alone", "with family", "with partner" and "others". A significant difference was found for the age variable ([H² (5) = 24.767; p < 0.001]). In the comparison by pairs, it was observed that older athletes (between 43 and 47 years old) demonstrated lower levels of anxiety than younger athletes (respectively: p < 0.001; p = .031; p = .005; p = .039), except among athletes aged 38 to 42 years, where there was no significant difference (p = 1.000). Among younger athletes, those aged between 18 and 22 showed higher anxiety scores than those aged between 23 and 27 years (p = .034). The distribution of participants by anxiety scores will be shown in Table 2.

Table 2

Fulfillment of at least mild anxiety symptoms (GAD-7 score of 5 or above) and Mann-Whitney U analyses for group. Comparison between groups were made with Kruskal-Wallis analyses and reported in footnotes.
Group characteristics	No anxiety	Anxiety	Mean Rank	P value
Gender
Female	36% (102)	64% (179)	382,77	.000
Male	48% (190)	52% (205)	307,01	.000
Unemployment
Yes	44% (253)	56% (328)	334,97	.243
No	41% (39)	59% (56)	360,11	.243
Financial loss
Yes	39% (136)	61% (217)	343,37	.005
No	51% (150)	49% (145)	301,92	.005
Psychological support
Yes	41% (129)	59% (182)	342,93	.290
No	44% (158)	56% (199)	327,15	.290
Social Isolation
Alone	40% (25)	60% (38)	362,86	.668
With family	45% (173)	55% (212)	338,62
With partner	42% (74)	58% (104)	327,95
Others	40% (20)	60% (30)	344,45
Age
18–22	37% (78)	63% (133)	375,62	.000*
23–27	47% (104)	53% (118)	318,51
28–32	40% (59)	60% (90)	345,76
33–37	51% (29)	49% (28)	330,53
38–42	53% (9)	47% (8)	293,44
43–47	65% (13)	35% (7)	178,55
Note. comparison between groups by age: 23 to 27–43 to 47(.031); 33 to 37–43 to 47(.039); 28 to 32–43 to 47(.005); 18 to 22–43 to 47(.000).*

Insomnia

Most athletes (415 [61%]) did not have clinically significant insomnia, whereas 204 (30%) had insomnia symptoms but not enough for clinical diagnosis. Only 55 (8%) had clinical insomnia and 2 had severe clinical insomnia. No significant difference was found for gender (U = 51435.500; Z = -1.627; p = 0.104), unemployment (U = 27367 .000; Z = − .131; p = 0.896), financial loss (U = 46147,000; Z = -2.501; p = 0.012), social isolation ([H (3) = 1.373; p = 0.712]), age ([H (5) = 4.598; p = 0.467]) and psychological support (U = 55470.500; Z = − .017; p = 0.986) (Table 3).

Table 3

*Fulfillment of at least subthreshold symptoms (ISI score of 8 or above) and Mann-Whitney U analyses for group.*
Group characteristics	No insomnia	Insomnia	Mean Rank	P value
Gender
Female	59% (165)	41% (116)	352,96	.104
Male	63% (250)	37% (145)	328,22	.104
Unemployment
Yes	61% (357)	39% (224)	338,10	.896
No	61% (58)	39% (37)	340,93	.896
Financial loss
Yes	57% (201)	43% (152)	341,27	.012
No	67% (199)	33% (96)	304,43	.012
Psychological support
Yes	60% (186)	40% (125)	334,64	.986
No	63% (224)	37% (133)	334,38	.986
Social Isolation
Alone	52% (33)	48% (30)	365,53	.712
With family	63% (243)	37% (141)	334,86
With partner	60% (107)	40% (71)	336,33
Others	64% (32)	36% (18)	340,16
Age
18–22	63% (133)	37% (78)	345,73	.467
23–27	60% (134)	40% (88)	322,97
28–32	63% (94)	37% (55)	349,76
33–37	49% (28)	51% (29)	359,05
38–42	53% (9)	47% (8)	351,79
43–47	80% (16)	20% (4)	282,00

Stress

A considerable proportion of athletes did not present distress symptoms (583 [86%]). Women have higher levels of stress (U = 46525.500; Z = -3.602; p < 0.001), but the effect size is considered low (r = 0.14). Athletes who suffered financial loss showed higher stress scores than those who did not experience restrictions (U = 46332.000; Z = -2.429; p = 0.015), but the effect size is considered low (r = 0.10). Athletes who received psychological support during the quarantine had higher scores (U = 50300,000; Z = -2.105; p = 0.035) than those who were not supported, whose effect size was also considered low (r = 0.08). We did not find a difference for the unemployment (U = 27293,000; Z = -0.173; p = 0.862) and social isolation factors ([H (3) = 2.413, p = 0.491]), as well as the age group variable ([H (5) = 8.097, p = 0.151]) (Table 4).

We also compared each of the factors by subscales separately. Women obtained higher scores both in the "intrusion" (U = 43281.000; Z = -4.944; p < 0.001) and in the "avoidance" subscales (U = 48966.000; Z = -2.635; p < 0.008). The avoidance subscale showed a significant difference between those who experienced financial loss and those who did not (U = 46,371,000; Z = -2.425; p = 0.015). There was a difference in the avoidance subscale (U = 49581.500; Z = -2.406; p = 0.016) between those who had psychological support and those who did not (Table 4).

Depression

Forty-two percent (286) of the athletes showed minimal depression symptoms. Women have higher depression scores (U = 40448.000; Z = -6.064; p < 0.001). Athletes between 18 and 22 years old showed higher scores of depression ([H (5) = 19.649, p = 0.007]) compared to the 23–27 years old group.

Table 4

*Fulfillment of at least mild symptoms (IES score of 24 or above), Mann-Whitney U analyses for group and P values for each subscale.*
Group characteristics	No distress	Distress	Mean Rank	P value
Gender				IES	Avoidance	Intrusion
Female	82% (230)	18% (51)	370,43	.000	.008	.000
Male	89% (353)	11% (42)	315,79	.000	.008	.000
Unemployment
Yes	87% (504)	13% (74)	337,98	.862	.839	.973
No	83% (79)	17% (16)	341,71	.862	.839	.973
Financial loss
Yes	84% (296)	16% (57)	340,75	.015	.015	.126
No	89% (262)	11% (33)	305,06	.015	.015	.126
Psychological support
Yes	83% (258)	17% (53)	351,26	.035	.016	.328
No	89% (53)	11% (33)	305,06	.035	.016	.328
Social Isolation
Alone	83% (52)	17% (11)	357,49	.491	.313	.536
With family	86% (332)	14% (53)	339,26
With partner	87% (154)	13% (24)	340,46
Others	90% (45)	10% (5)	301,75
Age
18–22	85% (179)	15% (32)	349,55	.151	.158	.055
23–27	86% (192)	14% (30)	332,86
28–32	85% (127)	15% (22)	358,84
33–37	91% (52)	9% (5)	296,37
38–42	82% (14)	18% (3)	325,24
43–47	95% (19)	5% (1)	265,23

We did not find significant differences for the unemployment factor (U = 25964.500; Z = -0.933; p = 0.351), for the financial loss factor (U = 49899.500; Z = -0.921; p = 0.357), for the social isolation factor ([H (3) = 5.731, p = 0.125]) and also for the presence or absence of psychological support (U = 52529.500; Z = -1.209; p = 0.227) (Table 5).

Table 5

*Fulfillment of at least mild symptoms (PHQ-9 score of 5 or above) and Mann-Whitney U analyses for group. Comparison between groups were made with Kruskal-Wallis analyses.*
Group characteristics	No depression	Depression	Mean Rank	P value
Gender
Female	52% (147)	48% (136)	392,06	.000
Male	73% (288)	27% (107	300,40	.000
Unemployment
Yes	65% (378)	35% (203)	335,69	.351
No	58% (55)	42% (40)	355.69	.351
Financial loss
Yes	62% (219)	38% (134)	330,64	.357
No	68% (200)	32% (95)	317,15	.357
Psychological support
Yes	66% (206)	34% (105)	324,91	.227
No	62% (223)	38% (134)	342,86	.227
Social Isolation
Alone	62% (39)	38% (24)	327,52	.125
With family	63% (242)	37% (142)	352,44
With partner	67% (120)	33% (58)	311,27
Others	62% (31)	38% (19)	341,93
Age
18–22	58% (122)	42% (89)	384,12	.001*
23–27	68% (151)	32% (71)	319,12
28–32	66% (98)	34% (51)	331,15
33–37	63% (36)	37% (21)	304,76
38–42	65% (11)	35% (6)	293,62
43–47	75% (15)	25% (5)	264,68
Note. Comparison between groups by age: 18 to 22–23 to 27(.007).*

The present study sought to investigate the possible impacts of social isolation on the mental health of professional athletes, focusing on symptoms of anxiety, stress, insomnia, and depression. We hypothesized that certain groups would be more vulnerable to these situations, such as women, athletes who have experienced financial instabilities, and athletes in total quarantine. The discussion has four subtopics, according to the investigated variables of interest: gender, financial conditions, age group, psychological support, and social isolation.

Women and mental health

Women had higher anxiety, stress, and depression scores. Similar results were found in a study among health professionals who worked on the front lines in the fight against COVID-19 in China (Lai et al., 2020), where professionals also showed high scores in symptoms of anxiety, stress, and depression, measured through the same scales used in this research (GAD-7, PHQ-9, and IES). In another study carried out in the United States with adolescent athletes, a high rate of depression was found in girls (Adams et al., 2022).

The hypothesis that being a woman is a risk factor for mental health during the pandemic has been reinforced in recent literature. A study in the Italian sports community showed that women had high-stress levels. According to the authors, these results are due to a more hostile environment for women who, during the critical period of the pandemic, saw investments in women's sports fall even further, in addition to the difficult access to mental health programs for this specific audience (Fiorelli et al., 2021). Women also showed higher stress levels than men, especially in the "avoidance" subscale – which, according to the authors, could be a strategy to avoid unpleasant feelings and thoughts (Di Cagno et al., 2020).

The gender difference in mental health indicators is also confirmed in a sample of the general Spanish population (Gómez-Salgado et al., 2021), as well as high anxiety levels in women from Turkey (Özdin & Özdin, 2020), both during the COVID-19 pandemic. However, in a study with Turkish athletes, no gender difference was found in mental health indicators, which the authors attributed to a more excellent self-efficacy among women compared to men, relating isolation at home with gender roles. culturally expected (Şenişik et al., 2021). Despite this, the hypothesis that women are more vulnerable to symptoms of depression, anxiety, and stress has robust evidence.

There are many possible explanations for this phenomenon, such as gender disparity. Women lead the diagnosis of depressive and anxiety disorders; then, pre-existing disorders may have influenced the scores in this study. In addition, among the consequences of social isolation is increased domestic violence, given that the home is the least safe environment for many women. According to a narrative literature review, housework and motherhood during the COVID-19 pandemic can be significant stressors for women (Almeida et al., 2020). These two factors may be analysis variables in a future study since the sociodemographic questionnaire does not contain specific questions about the athletes' children or home life.

Economic conditions and mental health

A considerable proportion of the athletes (86%) who participated in the study did not lose their contracts, but more than half (52%) experienced financial impacts. The uncertainty and instability in professional and financial life have significantly impacted mental health. Wilson et al. (2020) identified a high prevalence of anxious and depressive symptoms among participants and concerns about professional and financial instability resulting from the pandemic (Wilson et al. 2020). In another study, participants most affected by the quarantine and with low family income showed higher levels of anxiety and depression than those with higher incomes (Lei et al., 2020). Another study corroborates the hypothesis that financial losses and economic concerns related to COVID-19 are risk factors for higher levels of anxiety (Cao et al., 2020)

Few studies specifically evaluated the effect of economic conditions on the mental health of athletes; however, through several similar studies in experimental design and neuropsychological scales, it is possible to say that the results related to anxiety, depression, and stress of the current study corroborate the previous findings. The relationship between instabilities or financial restrictions and worse mental health scores has been recurrent in the literature (Drydakis, 2015; Kopasker et al., 2018; Pieh et al., 2020; Rohde et al., 2016), mainly during major financial crises.

Age as a possible risk factor

Throughout the study, some statistical differences were observed between the six age groups in the sample, specifically in the anxiety and depression variables. Athletes between 43 and 47 years old had the lowest scores in the variables above, while athletes between 18 and 22 years old had the highest scores in anxiety and depression when compared to the other age groups. These results agree with previous studies on the general population and athletes. In both cases, the highest depression and anxiety scores were found among subjects aged 18 to 24 (Pieh et al., 2020). According to the authors, this can be explained by the more significant impact of isolation measures on the young population and greater instability in the sports career of those who are just beginning compared to those already consolidated in the sport.

The hypothesis of age as a risk factor is also confirmed in a longitudinal study, which specifically assessed the mental health levels of young adults between 18 and 25 years old during the first months of the pandemic and found high levels of depression and anxiety in this group (Kujawa et al., 2020). These findings may be related to the critical period for the appearance of the first symptoms of psychological disorders, which commonly occurs between 18 and 25 years of age – concomitantly with the peak of the athletic career. Despite the positive impact that physical activity can generate on mental health, professional athletes are under constant pressure from the sports environment and have a high degree of demand for their performances, which makes them more vulnerable to the development of psychological symptoms (Rice et al., 2020; Thelwell & Greenlees, 2003).

Psychological support and social isolation

Previous studies corroborate the importance of psychological support in competitive sports, whether through individual therapy or sports psychology programs (Andersen et al., 2016; Brown & Fletcher, 2017; Gardner & Moore, 2012; Shannon et al., 2019). However, the athletes who declared that they had psychological follow-up did not show a significant difference compared to those who did not and, surprisingly, showed higher levels of post-traumatic stress. A possible explanation for this result is that the COVID-19 pandemic was traumatic, leading these athletes to seek psychological help. This study did not measure the moment of initiation of psychological follow-up, so in future analyses, the inclusion of a variable related to time is considered.

The same occurred in the social isolation variable, where it was conjectured that athletes who live alone would demonstrate worse mental health indices compared to those who quarantined with a partner or family – which is confirmed in previous studies (Dönmez et al., 2022; Jalloh et al., 2018; Ko et al., 2006; Lei et al., 2020). However, no differences were found between any of the analyzed groups – which may be related to the type of target population. As much as professional athletes are vulnerable to psychological symptoms, as explained above, constant physical exercise works as a protective factor. A study with athletes and non-athletes during the beginning of the pandemic demonstrated that the first group had lower stress and depression scores (Şenişik et al., 2021), which was related to the athletes' active history and maintenance of physical activity.

Despite the results found in this study not replicating previous findings, the importance of psychological support to sports professionals is undeniable, regardless of external or internal circumstances. Concerning the consequences of COVID-19, this result suggests that confederations, clubs, and sports associations formulate support policies not only for those who have suffered from the pandemic but also for athletes in general. Mental health is of great concern and needs constant investment by everyone.

Limitations

This study has several limitations. First, the sample size could be higher if the online self-report survey has not allowed the participants to skip inventory questions, which led to exclusions from the analysis. The virtual and self-administered nature of the experiment's psychological instruments may generate less robust results, considering that the variables environment and verbal instruction were not present. Second, the study was carried out during 2 months and lacks longitudinal follow-up. Because of the increasingly arduous situation, the mental health symptoms of health care workers could become more severe. Thus, the long-term psychological implications of this population are worth further investigation. Third, more detailed socio-demographic information, including ethnicity, were not available in the present study, although some data, like the type of sports and COVID-19 infection factors, were not considered. Fourth, there was no previous information of scale scores for participants in order to compare our results with the pre-COVID period.

Through the analysis of four neuropsychological scales, athletes demonstrated high levels of anxiety, depression, insomnia and post-traumatic stress, mainly women, athletes who suffered financial restrictions during the pandemic, younger athletes. As for the presence of psychological support, higher post-traumatic stress scores were demonstrated, which may corroborate the hypothesis of the profound impacts of COVID-19 in this group. On the other hand, social isolation has not been shown to cause changes in the mental health of athletes. Therefore, it can be said that the population of professional athletes was affected by the consequences of the pandemic, but further investigations will be needed to clarify some points that were not so clear.

Author Note

We have no conflicts of interest to disclose. Correspondence concerning this article should be addressed to Isabelle A. Fernandes, Neurophysiology and Neuropsychology of Attention Laboratory, Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. Email: [email protected]

Adams, D. P., Holt, J. R., Martin, J. A., Houpy, D. M., & Hollenbach, K. A. (2022). The effect of COVID-19 lockdown on PHQ depression screening scores for high school athletes. International Journal of Environmental Research and Public Health, 19(16), 9943.
Almeida, M., Shrestha, A. D., Stojanac, D., & Miller, L. J. (2020). The impact of the COVID-19 pandemic on women’s mental health. Archives of women's mental health, 23, 741-748.
Bergerot, C. D., Laros, J. A., & Araujo, T. C. C. F. D. (2014). Avaliação de ansiedade e depressão em pacientes oncológicos: comparação psicométrica. Psico-USF, 19, 187-197.
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The lancet, 395(10227), 912-920.
Brown, D. J., & Fletcher, D. (2017). Effects of psychological and psychosocial interventions on sport performance: A meta-analysis. Sports Medicine, 47, 77-99.
Caiuby, A. V. S., Lacerda, S. S., Quintana, M. I., Torii, T. S., & Andreoli, S. B. (2012). Adaptação transcultural da versão brasileira da Escala do Impacto do Evento-Revisada (IES-R). Cadernos de Saúde Pública, 28, 597-603.
Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J., & Zheng, J. (2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry research, 287, 112934.
Castro, L. D. S. (2011). Adaptação e validação do índice de gravidade de insônia (IGI): caracterização populacional, valores normativos e aspectos associados.
Cava, M. A., Fay, K. E., Beanlands, H. J., McCay, E. A., & Wignall, R. (2005). The experience of quarantine for individuals affected by SARS in Toronto. Public health nursing, 22(5), 398-406.
Chen, P., Mao, L., Nassis, G. P., Harmer, P., Ainsworth, B. E., & Li, F. (2020). Coronavirus disease (COVID-19): The need to maintain regular physical activity while taking precautions. Journal of sport and health science, 9(2), 103.
Corsini, A., Bisciotti, G. N., Eirale, C., & Volpi, P. (2020). Football cannot restart soon during the COVID-19 emergency! A critical perspective from the Italian experience and a call for action. British Journal of Sports Medicine, 54(20), 1186-1187.
Di Cagno, A., Buonsenso, A., Baralla, F., Grazioli, E., Di Martino, G., Lecce, E., ... & Fiorilli, G. (2020). Psychological impact of the quarantine-induced stress during the coronavirus (COVID-19) outbreak among Italian athletes. International journal of environmental research and public health, 17(23), 8867.
Dönmez, G., Özkan, Ö., Menderes, Y., Torgutalp, Ş. Ş., Karaçoban, L., Denerel, N., & Kudaş, S. (2022). The effects of home confinement on physical activity level and mental status in professional football players during COVID-19 outbreak. The Physician and Sportsmedicine, 50(2), 157-163.
Drydakis, N. (2015). The effect of unemployment on self-reported health and mental health in Greece from 2008 to 2013: a longitudinal study before and during the financial crisis. Social science & medicine, 128, 43-51.
Fiorilli, G., Grazioli, E., Buonsenso, A., Di Martino, G., Despina, T., Calcagno, G., & Di Cagno, A. (2021). A national COVID-19 quarantine survey and its impact on the Italian sports community: Implications and recommendations. Plos one, 16(3), e0248345.
Gilat, R., & Cole, B. J. (2020). COVID-19, medicine, and sports. Arthroscopy, sports medicine, and rehabilitation, 2(3), e175-e176.
Gómez-Salgado, J., Domínguez-Salas, S., Rodríguez-Domínguez, C., Allande-Cussó, R., Romero-Martín, M., & Ruiz-Frutos, C. (2021). Gender perspective of psychological discomfort during COVID-19 confinement among Spanish adult population: a cross-sectional study. BMJ open, 11(12), e051572.
Håkansson, A., Jönsson, C., & Kenttä, G. (2020). Psychological distress and problem gambling in elite athletes during COVID-19 restrictions—A web survey in top leagues of three sports during the pandemic. International journal of environmental research and public health, 17(18), 6693.
Huebner, M., & Perperoglou, A. (2019). Performance development from youth to senior and age of peak performance in Olympic weightlifting. Frontiers in Physiology, 10, 1121.
Jalloh, M. F., Li, W., Bunnell, R. E., Ethier, K. A., O’Leary, A., Hageman, K. M., ... & Redd, J. T. (2018). Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone, July 2015. BMJ global health, 3(2), e000471.
Jukic, I., Calleja-González, J., Cos, F., Cuzzolin, F., Olmo, J., Terrados, N., ... & Alcaraz, P. E. (2020). Strategies and solutions for team sports athletes in isolation due to COVID-19. Sports, 8(4), 56.
KO, C. H., YEN, C. F., YEN, J. Y., & YANG, M. J. (2006). Psychosocial impact among the public of the severe acute respiratory syndrome epidemic in Taiwan. Psychiatry and clinical neurosciences, 60(4), 397-403.
Kopasker, D., Montagna, C., & Bender, K. A. (2018). Economic insecurity: A socioeconomic determinant of mental health. SSM-Population Health, 6, 184-194.
Kujawa, A., Green, H., Compas, B. E., Dickey, L., & Pegg, S. (2020). Exposure to COVID‐19 pandemic stress: Associations with depression and anxiety in emerging adults in the United States. Depression and anxiety, 37(12), 1280-1288.
Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., ... & Hu, S. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA network open, 3(3), e203976-e203976.
Lei, L., Huang, X., Zhang, S., Yang, J., Yang, L., & Xu, M. (2020). Comparison of prevalence and associated factors of anxiety and depression among people affected by versus people unaffected by quarantine during the COVID-19 epidemic in Southwestern China. Medical science monitor: international medical journal of experimental and clinical research, 26, e924609-1.
Mann, R. H., Clift, B. C., Boykoff, J., & Bekker, S. (2020). Athletes as community; athletes in community: covid-19, sporting mega-events and athlete health protection. British Journal of Sports Medicine, 54(18), 1071-1072.
Osório, F.L., Vilela Mendes, A., Crippa, J. A., & Loureiro, S. R. (2009). Study of the Discriminative Validity of the PHQ‐9 and PHQ‐2 in a Sample of Brazilian Women in the Context of Primary Health Care. Perspectives in psychiatric care, 45(3), 216-227.
Özdin, S., & Bayrak Özdin, Ş. (2020). Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. International Journal of Social Psychiatry, 66(5), 504-511.
Parm, Ü., Aluoja, A., Tomingas, T., & Tamm, A. L. (2021). Impact of the COVID-19 pandemic on Estonian elite athletes: survey on mental health characteristics, training conditions, competition possibilities, and perception of supportiveness. International Journal of Environmental Research and Public Health, 18(8), 4317.
Pensgaard, A. M., Oevreboe, T. H., & Ivarsson, A. (2021). Mental health among elite athletes in Norway during a selected period of the COVID-19 pandemic. BMJ Open Sport & Exercise Medicine, 7(1), e001025.
Pieh, C., Budimir, S., & Probst, T. (2020). The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria. Journal of psychosomatic research, 136, 110186.
Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General psychiatry, 33(2).
Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., ... & Engebretsen, L. (2019). Mental health in elite athletes: International Olympic Committee consensus statement (2019). British journal of sports medicine, 53(11), 667-699.
Rice, S., Olive, L., Gouttebarge, V., Parker, A. G., Clifton, P., Harcourt, P., ... & Purcell, R. (2020). Mental health screening: severity and cut-off point sensitivity of the athlete psychological strain questionnaire in male and female elite athletes. BMJ Open Sport & Exercise Medicine, 6(1), e000712.
Rohde, N., Tang, K. K., Osberg, L., & Rao, P. (2016). The effect of economic insecurity on mental health: Recent evidence from Australian panel data. Social science & medicine, 151, 250-258.
Şenışık, S., Denerel, N., Köyağasıoğlu, O., & Tunç, S. (2021). The effect of isolation on athletes’ mental health during the COVID-19 pandemic. The Physician and sportsmedicine, 49(2), 187-193.
Shannon, S., Hanna, D., Haughey, T., Leavey, G., McGeown, C., & Breslin, G. (2019). Effects of a mental health intervention in athletes: Applying self-determination theory. Frontiers in psychology, 10, 1875.
Thelwell, R. C., & Greenlees, I. A. (2003). Developing competitive endurance performance using mental skills training. The Sport Psychologist, 17(3), 318-337.
Toresdahl, B. G., & Asif, I. M. (2020). Coronavirus disease 2019 (COVID-19): considerations for the competitive athlete. Sports health, 12(3), 221-224.
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International journal of environmental research and public health, 17(5), 1729.
Wilson, J. M., Lee, J., Fitzgerald, H. N., Oosterhoff, B., Sevi, B., & Shook, N. J. (2020). Job insecurity and financial concern during the COVID-19 pandemic are associated with worse mental health. Journal of occupational and environmental medicine, 62(9), 686-691.
World Health Organization (2020). Proceedings of COVID 19 Public Health Emergency of International concern forum. Acessed:December 7, 2022: https://www.who.int/publications/m/item/covid-19-public-health-emergency-of-international-concern-(pheic)-global-research-and-innovation-forum
Xiang, Y. T., Jin, Y., & Cheung, T. (2020). Joint international collaboration to combat mental health challenges during the coronavirus disease 2019 pandemic. JAMA psychiatry, 77(10), 989-990.

No competing interests reported.

Download PDF

Reviewers agreed at journal
13 May, 2024
Reviews received at journal
21 Nov, 2023
Reviewers agreed at journal
13 Nov, 2023
Reviewers invited by journal
12 Nov, 2023
Submission checks completed at journal
10 Aug, 2023
Editor assigned by journal
10 Aug, 2023
First submitted to journal
08 Aug, 2023

You are reading this latest preprint version

Factors Associated With Mental Health Outcomes Among Professional Athletes During the Social Isolation to COVID-19 Pandemic

Status:

Version 1

Abstract

Introduction

Methodology

Study Design

Participants

Outcomes and Covariates

Statistical analysis

Results

Sociodemographic characteristics

Severity of Measurements and Associated Factors

Anxiety

Insomnia

Stress

Depression

Discussion

Women and mental health

Economic conditions and mental health

Age as a possible risk factor

Psychological support and social isolation

Limitations

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1