Retiring athletes experiences when transitioning out of competitive sports vary. In this study, Esopenko et al., noted that 59% of retired NHL athletes experienced current or past psychological distress, compared to just 19% of matched controls. Concussions, pain, injury, osteoarthritis, physical inactivity, and psychosocial factors were associated with psychological distress among retired elite athletes. The acute post-retirement phase can be stressful for many athletes, but studies have reported significant positive relationships between the length of time following retirement and the quality of subjective well-being in former athletes. Also, team medical staff should focus particular attention to athletes who may be suffering from chronic injuries or medical conditions, in addition to athletes with significant concussive histories. The key is to help athletes develop into well-rounded people, so that their identities do. The relationship between psychological distress and baseline sports-related concussion testing. Anabolic Androgenic steroid use (AAS), Lifetime illicit drug use, & Lifetime treatment seeking for psychological distress (i.e., depression & anxiety), Depression: Former AAS Users: 13.0% Lifetime Nonusers: 5.0% Anxiety: Former AAS Users: 13.0% Lifetime Nonusers: 6.0% Lifetime Illicit Drug Use: Former AAS Users: 18.0% Lifetime Nonusers: 4.0%, Sweden; Wrestlers, Olympic lifters, Powerlifters, and the throwers in track and field top 10 national ranking lists. Overall, retired athletes obtained significantly higher scores on all three Buckley factors on the BDI-II, in comparison to the controls. Greater physical activity decreased the risk of depression by 8.0% and acted as a protective factor against anxiety onset, while less physical activity led to a threefold increase in the odds of being classified as depressed at ten-year follow-up (Bckmand et al., 2003; Bckmand et al., 2009). Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL 32610-0165, ude.lfu.phhp@1nosugrefe, Phone: (352)-273-6617, Mary E. Edwards, M.L.I.S, Ed.D., University Librarian, University of Florida, P.O. The Health Status of Retired American Football Players Super Bowl III Revisited, Career termination issues among elite athletes, Epidemiology of injuries in the Australian Football League, seasons 19972000. 8600 Rockville Pike Potential bias is also a concern in the literature examining determinants to psychological distress in retired elite athletes (Manley et al., 2017). (2009). Meir RA, Weatherby RP, & Rolfe MI (2007). Horn S, Gregory P, & Guskiewicz KM (2009). Indebtedness has a myriad of well-documented physical and psychological health consequences (Turunen & Hiilamo, 2014). Causes of Depression in Athletes After Retirement In addition to brain fog and memory loss, many former athletes battle depression. It is estimated that approximately 78.0% of NFL players file for bankruptcy or are under financial stress as soon as two years following their career, while 60.0% of National Basketball Association (NBA) players file for bankruptcy within the first five years of retirement (Torre, 2009). Esopenko C, Chow TW, Tartaglia MC, Bacopulos A, Kumar P, Binns MA, & Levine B (2017). Pain increases the likelihood of moderate to severe depression. Retired athletes expressed lower perceived social support (family and friends) than those who were still competing. A number of articles in our review found null and attenuated relationships between concussions and psychological distress, with several additional studies demonstrating no significant differences in prevalence of psychological distress between retirees of collision/contact sports compared to non-athletes. Over half (62%) of the included studies did not include information related to age, average years of play, or average years of retirement, all factors that can influence the trajectory and prevalence of psychological distress. Gulliver A, Griffiths KM, & Christensen H (2012). The prevalence of failure-based depression among elite athletes. If studies did not report the average number of years of retirement, studies examining the psychological functioning of samples with an average age of 40 and older were also included in the review (Arthur, 2016; Hadavi, 2011). Endurance athletes (cross country skiing & long distance running) and team sport athletes (soccer, ice hockey, & basketball) evidenced significantly less mean depressive scores than non-athlete controls at 10-year follow-up. Personality and mood of former elite male athletes-a descriptive study. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL 32610-0165, The publisher's final edited version of this article is available at, Retirement, Elite Athletes, Retired Athletes, Psychological Distress. Study selection: Original research; incidence, risk factors or causation related to long-term mental health or neurological problems; individuals who have suffered a concussion; retired athletes as the subjects and possible long-term sequelae . According to the SCID-IV, approximately 59.0% of retired hockey athletes met criteria for current or past psychiatric diagnoses. HHS Vulnerability Disclosure, Help Hoffman BM, Papas RK, Chatkoff DK, & Kerns RD (2007). Several studies showed a nonsignificant relationship between concussion history during playing career and psychological distress in adulthood (Casson, et al., 2014; Esopenko et al., 2017; Kerr, DeFreese, & Marshall, 2014). Additionally, three cohorts stratified by age (59 years, 6069 years, 70 years) demonstrated a significant linear decrease in psychological distress with age, such that the 59 year old group reported significantly higher depressive distress than the two older cohorts (Bckmand et al., 2009). Leaving competitive sport: retirement or rebirth? Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. Participants described both sport and non-sport related triggers in regard to their depression (e.g., institutional mistreatment and bullying, injuries, previous MHI, and miscarriage), as well as a range of behaviour, performance (e.g., decline), and personality changes compared to their normal functioning. Manley GT, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC, & Dvok J (2017). In the one longitudinal study examining the relationship between concussion and clinical depression among retired NFL players, Kerr and colleagues (2012) found that the 9-year risk of depression showed a linear relationship with an increasing number of self-reported concussions such that 3.0% were classified as depressed in the no concussions group while 26.8% were classified as depressed in the 10+ concussion group. Studies examining cognitive impairment exclusively were not included in this review. In order to overcome the self-report and recall bias associated with the self-report measures of psychological distress, several studies utilized a self-report measure assessing for clinically diagnosed depression preceding study participation. Depression is more common in retired NFL athletes as compared to the general population. Competed for 34 years: 77.0% Competed for 5 years: 12.0% Competed for 2 years: 22.0% 17 years competing in pro. Our review suggests the prevalence of psychological distress among retired athletes is similar to that found in the general population. Additionally, two studies demonstrated that lifetime prevalence of AAS abuse was approximately 21.0%, and these athletes had a greater likelihood of using other illicit substances as well as seeking professional help for depression and anxiety in retirement as compared to non-AAS users (Bagge et al., 2017; Lindqvist et al., 2013). Pain, injury, and depression may be risk factors of less engagement in physical activity, as former NFL players who scored as moderate to severely depressed were more likely to report a loss of fitness and lack of exercise, while former intercollegiate athletes reported significantly greater physical activity limitations compared to age-matched non-athlete controls (Simon & Docherty; 2013; Schwenk et al., 2007). Emotional response to sport concussion compared to ACL injury. Thus, psychological distress may ultimately manifest later in retirement and not necessarily follow the described linear transition paths as evidenced by the aforementioned studies. Depression. Box 100165, 1225 Center Drive, Room 3146, Gainesville, FL 32610-0165, ude.lfu.phhp@pmw, Phone: (352)-273-6617, Larry E. Burrell II, M.S., Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Similarly, though NFL players endorsed more symptoms on cognitive, somatic, and affective domains of depression on the BDI-II than none NFL players, only the cognitive factor was significantly correlated with the number of concussions, which included feelings of sadness, guilt, and self-criticism (Didehbani et al., 2013). Weigand et al. Bankruptcy Rates among NFL Players with Short-Lived Income Spikes. Additionally, Wippert and Wippert (2008) found that approximately 20% of the former German National Ski Team reported clinical traumatic stress at 3 and 8 months retirement. Longitudinal designs, matched control groups, more heterogeneous samples, and use of multivariate analyses would also help to more accurately determine the prevalence and risk factors of psychological distress in this population. The site is secure. Approximately 50% of people with chronic pain suffer from depression (Bair, Robinson, Katon, & Kroenke, 2003). Additionally, Schwenk and colleagues (2007) noted that retired professional football players experienced depression severity comparable to that of the general population, but more severe self-reported pain exacerbated symptoms of depression. "This study showed that, unfortunately, when athletes retire many struggle to identify with anything other than their sport, which for many, has been the principal focus of . Weigand S, Cohen J, & Merenstein D (2013). Bair MJ, Robinson RL, Katon W, & Kroenke K (2003). For example, the global prevalence of anxiety and depression increased by 25 percent in the first year of the pandemic. Psychological distress was associated with concussion history, more severe pain, greater prevalence of sustained injuries and osteoarthritis, psychological distress during career, and psychosocial difficulties in retirement. The term elite has been previously used to describe athletes participating at varying levels of sports competition (Swann, Moran, & Piggott, 2015). Among former NFL players, five studies assessed depression through utilizing a postcareer clinical diagnosis, of which, more often resulted in a higher prevalence of depression compared to studies utilizing a self-report measure of depressive distress (Amen et al., 2016; Guskiewicz et al., 2007; Hart et al., 2013; Horn et al., 2009; Kerr et al., 2012). The majority of reviewed studies investigated factors associated with later-life psychological distress, while few examined potential protective factors against distress. The pandemic has exacerbated the existing worldwide mental health crisis. Additionally, because the primary aim of the study was to investigate prevalence and correlates of psychological distress among retired elite athletes, search criteria were limited to this terminology. However, when collision athletes were compared to that of the general population, composite mental health scores did not differ significantly. Susceptibility for depression in current and retired student athletes, Concussion incidence and time lost from play in the NHL during the past ten years, The Canadian Journal of Neurological Sciences, Retirement experiences of successful Olympic athletes, International journal of sport psychology, Perceived stress and prevalence of traumatic stress symptoms following athletic career termination, The effects of involuntary athletic career termination on psychological distress, A developmental perspective on transitions faced by athletes. Depression/Anxiety: 39% Tobacco Smoking: 12.0% Adverse Alcohol Use: 39%, Australia, Ireland, The Netherlands, New Zealand, Scotland and the United States; World Footballers Union (FIFPro). Despite limitations, this review highlights the multifaceted nature of the sources of psychological functioning in retired elite athletes. Retired athletes sustaining at least three concussions during their playing career were 2.4 times more likely to be categorized as depressed compared to those reporting no prior concussions. Meta-analysis of psychological interventions for chronic low back pain. Also, only 13 of the 40 studies compared prevalence rates to a matched, non-athlete control group. Depression/Anxiety: 35.0% Adverse Alcohol Use: 23.8%. Gayman AM, Fraser-Thomas J, Dionigi RA, Horton S, & Baker J (2017). A preliminary investigation into the long-term injury consequences reported by retired baseball players. Forty articles assessed the prevalence of psychological distress associated with symptomatology related to depressed mood, anxiety, and substance use/misuse. Neuroimaging of cognitive distress and depression in aging retired National Football League players: a cross-sectional study. Conversely, being employed, having a greater number of working hours, and a longer duration of retirement from sport were negatively associated with symptoms of depression and anxiety (Gouttebarge, Aoki et al., 2016; Kerr et al., 2012). In a recent study (N = 409) of active and retired professional hockey players, retired players exhibited significantly higher self-reported depressive symptoms compared to the general population, and approximately twice the rate of moderate to very severe levels of depression compared to active players (Aston et al., Citation 2020). Is sport good for older adults? A phenomenological exploration of the sport-career transition experiences that affect subjective well-being of former national football players. 2013;23(4):273-7. Specifically, up to 34.5% of athletes reported alcohol misuse in samples of retired rugby, soccer, and hockey players (Brown et al., 2017; Esopenko et al., 2017; Gardner et al., 2017; Gouttebarge, Frings-Dresen, & Sluiter, 2015; Schuring et al., 2016). For elite athletes who have dedicated their lives to sport, what happens when your time comes to an end, if you aren't an athlete, then who are you? The authors chose the exclusive use of quantitative studies to best assess for prevalence of psychological distress. OA was associated with distress, sleep disturbance, and adverse alcohol use. To this point, additional studies are needed to examine the prevalence of psychological distress among retired professional athletes of sports alternative to the ones already in the literature, specifically those at higher risk for the experiencing painful medical conditions during playing career such as college or professional baseball, basketball, and tennis, as well as contact/collision sports such as boxing, wrestling, and mixed martial arts. Notably, studies evidencing null-relationships between examined risk factors and psychological outcomes are less likely to be published, leading to publication bias. Among elite football players, there is evidence showing a significant association between sustained concussions and depressive symptomatology. This particular review relied on the definition of elite athletes provided by the Dictionary of Modern Medicine: a person who is currently or has previously competed as a varsity player (individual or team), or a professional player or national team/international level player (Segen, 2012). Evaluation criteria included: 1) English language, 2) published in peer-reviewed journals, and 3) quantitative studies. Similar to the National Football League and World Rugby Organization, the National Hockey League (NHL) has faced recent legal scrutiny, as more than 100 players have filed class-action lawsuits for detrimental health effects resulting from sustained concussions during their playing career (Kilgore, 2015). A multitude of psychosocial factors were associated with psychological distress in retirement. Prevalence and determinants of symptoms related to mental disorders in retired male professional footballers, Journal of Sports Medicine and Physical Fitness. Brown JC, Kerkhoffs G, Lambert MI, Gouttebarge V, Aktekin M, Karaman T, & Zemaityte A (2017). Physician diagnosed osteoarthritis also appeared to have a moderating effect on alcohol consumption behaviors, with 33.8% of retired soccer players with osteoarthritis reporting adverse alcohol use compared to only 22.5% of those without osteoarthritis (Schuring et al., 2016). The .gov means its official. Gouttebarge V, Frings-Dresen M, & Sluiter J (2015). Completing ones career and starting anew transforms an individuals previously established roles to new roles that are less familiar. Athletes of contact sports and sports demonstrating higher rates of injury reported a higher prevalence of alcohol misuse in retirement. This review suggests a number of different clinical implications and highlights directions for future research to enhance our understanding of the long-term psychological health of former elite athletes. Steroid use was significantly related to depression. Though athletes experience a multitude of psychosocial stressors that can impact their psychological functioning, a prominent psychosocial stressor amongst retired athletes and one identified by this review was financial instability. Psychological distress was associated with greater negative life events and a higher level of Rugby Union career dissatisfaction. Though many studies controlled for important sociodemographic variables, this review evidenced potential factors that are often unaccounted for in multivariate models, such as pain, substance use/misuse, marital status, employment, financial status, social support, career satisfaction, retirement transition experience, relationships with players and coaches, and other medical conditions that may influence a retired athletes psychological functioning in late-adulthood.