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Meta-Analysis
, 53 (11), 722-730

Determinants of Anxiety in Elite Athletes: A Systematic Review and Meta-Analysis

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Meta-Analysis

Determinants of Anxiety in Elite Athletes: A Systematic Review and Meta-Analysis

Simon M Rice et al. Br J Sports Med.

Abstract

Objective: To identify and quantify determinants of anxiety symptoms and disorders experienced by elite athletes.

Design: Systematic review and meta-analysis.

Data sources: Five online databases (PubMed, SportDiscus, PsycINFO, Scopus and Cochrane) were searched up to November 2018 to identify eligible citations.

Eligibility criteria for selecting studies: Articles were included if they were published in English, were quantitative studies and measured a symptom-level anxiety outcome in competing or retired athletes at the professional (including professional youth), Olympic or collegiate/university levels.

Results and summary: We screened 1163 articles; 61 studies were included in the systematic review and 27 of them were suitable for meta-analysis. Overall risk of bias for included studies was low. Athletes and non-athletes had no differences in anxiety profiles (d=-0.11, p=0.28). Pooled effect sizes, demonstrating moderate effects, were identified for (1) career dissatisfaction (d=0.45; higher anxiety in dissatisfied athletes), (2) gender (d=0.38; higher anxiety in female athletes), (3) age (d=-0.34; higher anxiety for younger athletes) and (4) musculoskeletal injury (d=0.31; higher anxiety for injured athletes). A small pooled effect was found for recent adverse life events (d=0.26)-higher anxiety in athletes who had experienced one or more recent adverse life events.

Conclusion: Determinants of anxiety in elite populations broadly reflect those experienced by the general population. Clinicians should be aware of these general and athlete-specific determinants of anxiety among elite athletes.

Keywords: anxiety; athlete; elite performance; injury; meta-analysis.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA study selection flow chart.
Figure 2
Figure 2
Forest plot for anxiety in athletes and non-athletes.
Figure 3
Figure 3
Subgroup analyses for anxiety outcomes in male and female athletes.
Figure 4
Figure 4
Forest plot for anxiety among athletes older and younger than 25 years.
Figure 5
Figure 5
Forest plot for anxiety in athletes with and without concussion history.
Figure 6
Figure 6
Subgroup analyses for anxiety outcomes in injured and uninjured athletes.
Figure 7
Figure 7
Forest plot for anxiety in athletes with and without career dissatisfaction.
Figure 8
Figure 8
Forest plot for anxiety in athletes with and without adverse life events within six months.

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