Understanding the bi-directional relationship between injury and mental ill-health in elite athletes: A six-year, retrospective cohort study

Objectives: To examine in an elite UK athlete cohort: i) sport injury and mental ill-health incidence rates, and ii) the bi-directional relationship between injury and mental ill-health. Design: Retrospective, cohort design. Methods: Secondary analyses were conducted on six years of UK Sports Institute athlete medical data. Participants were 1979 elite athletes (53.4% male, M _age = 28.6 years, SD = 7.36), representing 43 Olympic and Paralympic sports. IOC guidelines were followed to calculate the incidence and burden of injuries and mental ill-health. The presence of a mental ill-health episode in the previous 12 months or the number of previous injuries were included as risk factors in separate frailty models. Results: Injuries to the lumbar/pelvis region had the highest incidence (0.26 per athlete year), whilst knee injuries had the greatest mean burden (5.93 time-loss days per athlete year). Depression had the highest incidence (0.03 diagnoses per athlete year) and mean burden (0.96 time-loss days per athlete year). Athletes who experienced an episode of mental ill-health in the past 12 months had an 18% increased risk for subsequent injury (HR = 1.18; 95% CI = 1.10–1.26, p < .001). Moreover, for each injury sustained in the previous 12 months, athletes' risk for experiencing mental ill-health increased by 10% (HR = 1.10; 95% CI = 1.07–1.13, p < .001). Conclusions: These results improve existing knowledge by revealing a bi-directional relationship between injury and mental ill-health in elite athletes, which has important implications for the prevention of injuries and mental ill-health in elite sport.