Depression and performance outcomes in athletes - A narrative literature review
DOI:
https://doi.org/10.12775/QS.2026.66.74177Keywords
depression, athletic performance, elite athletes, sports psychology, mental healthAbstract
Background. Depression is a common mental disorder that may affect athletes as much as the general population, challenging the long-standing assumption that sport protects against it.
Aim. To summarize current evidence on the impact of depression on athletic performance outcomes.
Material and methods. A narrative review was conducted using PubMed, Scopus, and Google Scholar, covering studies published between 1994 and 2026 on depression, athletes, and performance.
Results. Reported depression prevalence among athletes ranges from 4% to 68%, with female sex, individual-sport participation, and injury history as consistent risk factors. Depression affects performance through biological mechanisms (HPA-axis dysregulation, elevated cortisol, sleep disturbance, inflammation, monoaminergic dysfunction) and psychological mechanisms (reduced motivation, loss of confidence, fear of failure, social withdrawal), increasing fatigue and impairing endurance, recovery, attention, and reaction time. Depression is closely linked to injury risk, overtraining, performance inconsistency, and possible career stagnation. The causal direction remains unresolved.
Conclusions. Early recognition and a multidisciplinary approach (screening, psychotherapy, coach support) are essential; further longitudinal, sport-specific research is needed linking depression directly to objective performance outcomes.
References
1. WHO (2025) World Health Organization. Depressive disorder (depression) https://www.who.int/news-room/fact-sheets/detail/depression
2. Gorczynski PF, Coyle M, Gibson K (2017) Depressive symptoms in high-performance athletes and non-athletes: A comparative meta-analysis. Br J Sports Med 51:1348–1354. https://doi.org/10.1136/bjsports-2016-096455
3. Golding L, Gillingham RG, Perera NKP (2020) The prevalence of depressive symptoms in high-performance athletes: a systematic review. Physician and Sportsmedicine 48:247–258. https://doi.org/10.1080/00913847.2020.1713708
4. Gulliver A, Griffiths KM, Christensen H, et al (2012) Internet-based interventions to promote mental health help-seeking in elite athletes: An exploratory randomized controlled trial. J Med Internet Res 14:. https://doi.org/10.2196/jmir.1864
5. Beable SE (2024) Depressive Disorders in Athletes. Clin Sports Med 43:53–70. https://doi.org/10.1016/j.csm.2023.06.011
6. Raglin JS, Morgan WP (1994) Development of a scale for use in monitoring training-induced distress in athletes. Int J Sports Med 15:84–88. https://doi.org/10.1055/s-2007-1021025
7. McLoughlin E, Arnold R, Fletcher D, et al (2022) Assessing lifetime stressor exposure in sport performers: Associations with trait stress appraisals, health, well-being, and performance. Psychol Sport Exerc 58:. https://doi.org/10.1016/j.psychsport.2021.102078
8. Reardon CL, Factor RM (2010) Sport psychiatry: A systematic review of diagnosis and medical treatment of mental Illness in athletes. Sports Medicine 40:961–980. https://doi.org/10.2165/11536580-000000000-00000
9. Castaldelli-Maia JM, Gallinaro JGDME, Falcão RS, et al (2019) Mental health symptoms and disorders in elite athletes: A systematic review on cultural influencers and barriers to athletes seeking treatment. Br J Sports Med 53:707–721. https://doi.org/10.1136/bjsports-2019-100710
10. Lebrun F, MacNamara À, Rodgers S, Collins D (2018) Learning from Elite Athletes’ experience of depression. Front Psychol 9:. https://doi.org/10.3389/FPSYG.2018.02062
11. Ströhle A (2019) Sports psychiatry: mental health and mental disorders in athletes and exercise treatment of mental disorders. Eur Arch Psychiatry Clin Neurosci 269:485–498. https://doi.org/10.1007/S00406-018-0891-5
12. McLoughlin E, Fletcher D, Slavich GM, et al (2021) Cumulative lifetime stress exposure, depression, anxiety, and well-being in elite athletes: A mixed-method study. Psychol Sport Exerc 52:101823. https://doi.org/10.1016/j.psychsport.2020.101823
13. Tahtinen RE, Shelley J, Morris R (2021) Gaining perspectives: A scoping review of research assessing depressive symptoms in athletes. Psychol Sport Exerc 54:. https://doi.org/10.1016/J.PSYCHSPORT.2021.101905
14. Kuettel A, Larsen CH (2020) Risk and protective factors for mental health in elite athletes: a scoping review. Int Rev Sport Exerc Psychol 13:231–265. https://doi.org/10.1080/1750984X.2019.1689574
15. Fletcher D HSMSD (2006) An organizational stress review: conceptual and theoretical issues in competitive sport. In: Hanton S, Mellalieu S.D (eds) Literature Reviews in Sport Psychology. Nova Science Publishers, Hauppauge (NY), pp 321–374
16. Arnold R, Fletcher D, Daniels K (2017) Organisational stressors, coping, and outcomes in competitive sport. J Sports Sci 35:694–703. https://doi.org/10.1080/02640414.2016.1184299
17. Rice SM, Purcell R, De Silva S, et al (2016) The Mental Health of Elite Athletes: A Narrative Systematic Review. Sports Medicine 46:1333–1353. https://doi.org/10.1007/s40279-016-0492-2
18. Wolanin A, Hong E, Marks D, et al (2016) Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport. Br J Sports Med 50:167–171. https://doi.org/10.1136/bjsports-2015-095756
19. Sanfilippo JL, Haralsdottir K, Watson AM (2024) Anxiety and Depression Prevalence in Incoming Division I Collegiate Athletes From 2017 to 2021. Sports Health 16:776–782. https://doi.org/10.1177/19417381231198537
20. Silva RC, Meattini M, Perusi G, et al (2025) Disentangling the biological mechanisms underlying the effects of physical exercise in major depressive disorder: a comprehensive systematic review of randomized controlled trials. Psychol Med 55:. https://doi.org/10.1017/S0033291725100743
21. Schuch FB, Deslandes AC, Stubbs B, et al (2016) Neurobiological effects of exercise on major depressive disorder: A systematic review. Neurosci Biobehav Rev 61:1–11. https://doi.org/10.1016/j.neubiorev.2015.11.012
22. Arnold LM (2008) Understanding fatigue in major depressive disorder and other medical disorders. Psychosomatics 49:185–190. https://doi.org/10.1176/APPI.PSY.49.3.185
23. Glick ID, Stillman MA, McDuff D (2020) Update on integrative treatment of psychiatric symptoms and disorders in athletes. Physician and Sportsmedicine 48:385–391. https://doi.org/10.1080/00913847.2020.1757370
24. Volgemute K, Ulme G, Vazne Z (2026) Predictors of Latent Reaction Speed in Athletes: The Role of Performance Level and Stress Tolerance at Different Competitive Levels. Sports Med Open 12:. https://doi.org/10.1186/S40798-026-01023-Y
25. Gerber M, Cody R, Beck J, et al (2023) Differences in Selective Attention and Inhibitory Control in Patients with Major Depressive Disorder and Healthy Controls Who Do Not Engage in Sufficient Physical Activity. J Clin Med 12:. https://doi.org/10.3390/JCM12103370
26. Gil-Caselles L, Barquín RR, Egido JMG, Olmedilla-Zafra A (2024) Relación bidireccional entre salud mental y lesiones deportivas: Revisión de revisiones. Apunts Sports Medicine 59:. https://doi.org/10.1016/J.APUNSM.2024.100452
27. Stillman MA, Brown T, Ritvo EC, Glick ID (2016) Sport psychiatry and psychotherapeutic intervention, circa 2016. International Review of Psychiatry 28:614–622. https://doi.org/10.1080/09540261.2016.1202812
28. Heissel A, Heinen D, Brokmeier LL, et al (2023) Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. Br J Sports Med 57:1049–1057. https://doi.org/10.1136/bjsports-2022-106282
29. Stanton R, Reaburn P (2014) Exercise and the treatment of depression: A review of the exercise program variables. J Sci Med Sport 17:177–182. https://doi.org/10.1016/j.jsams.2013.03.010
30. Frank R, Nixdorf I, Beckmann J (2017) Analyzing the relationship between burnout and depression in junior elite athletes. J Clin Sport Psychol 11:287–303. https://doi.org/10.1123/JCSP.2017-0008
31. Vella SA, Swann C, Allen MS, et al (2017) Bidirectional associations between sport involvement and mental health in adolescence. Med Sci Sports Exerc 49:687–694. https://doi.org/10.1249/MSS.0000000000001142
32. Gulliver A, Griffiths KM, Christensen H (2012) Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC Psychiatry 12:157. https://doi.org/10.1186/1471-244X-12-157
33. Pérez Bedoya ÉA, Puerta-López LF, López Galvis DA, et al (2023) Physical exercise and major depressive disorder in adults: systematic review and meta-analysis. Sci Rep 13:. https://doi.org/10.1038/s41598-023-39783-2
34. Reardon CL, Hainline B, Aron CM, et al (2019) Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med 53:667–699. https://doi.org/10.1136/bjsports-2019-100715
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