Mental Well-Being and Risk of Depression in Amateur Soccer Players
A Multilevel Analysis
Abstract
Abstract. Although athletes are exposed to various stressors and adversities that may negatively impact mental well-being, only few studies focus on mental well-being in amateur soccer players. The study aims were to analyze mental well-being in amateur soccer players, and whether it is related to team membership. The sample consisted of N = 20 soccer teams with a total of N = 285 athletes. Mental well-being was assessed using the WHO-5 Well-Being Index, and the risk of depression was assessed using the Patient-Health Questionnaire-2. The results showed that approximately 4 % of all players were at risk of suffering from impaired mental well-being. Although the results demonstrated that team membership explained 5 % of mental well-being cases and 10 % of the risk of depression cases, no team level variables were identified that explain this variance. Group processes and environmental factors that inhibit mental well-being in soccer players should be identified in future studies.
Zusammenfassung. Obwohl Athlet_innen einer Vielzahl von Stressoren ausgesetzt sind, die sich negativ auf ihre psychische Gesundheit auswirken können, untersuchen wenige Studien die psychische Gesundheit bei Amateurfußballer_innen. Die Ziele der Studie waren die psychische Gesundheit von Amateurfußballer_innen einerseits und die Beziehung zwischen psychischer Gesundheit und der Mannschaftszugehörigkeit andererseits zu analysieren. Die Untersuchungsgruppe bestand aus N = 20 Fußballmannschaften mit N = 285 Spieler_innen. Das psychische Wohlbefinden wurde mittels des WHO-5 Well-Being Index und das Risiko, eine Depression zu entwickeln, mittels des Patient-Health-Questionnaire-2 erfasst. Die Ergebnisse zeigen, dass ca. 4 % aller Spieler_innen ein erhöhtes Risiko einer beeinträchtigten psychischen Gesundheit aufwiesen. Obwohl die Ergebnisse zeigen, dass die Mannschaftszugehörigkeit 5 % der eingeschränkten psychischen Gesundheit und 10 % der Fälle mit dem Risiko, eine Depression zu entwickeln, erklären konnten, konnten keine Teamvariablen identifiziert werden, die diese Varianz erklären. Gruppenprozesse und Rahmenbedingungen, die die psychische Gesundheit von Fußballspieler_innen negativ beeinflussen, müssen in zukünftigen Studien identifiziert werden.
Psychological well-being and risk of depression are important factors in the mental health of soccer players. Considering the mental well-being and risk of depression of soccer players is important because athletes are exposed to a wide variety of stressors and adversities that may negatively impact mental health and, consequently, impair performance (Belz et al., 2020; Heidari et al., 2019; Howells & Fletcher, 2015). However, there is little literature regarding this topic, possibly because of social stigma that still exists surrounding mental illness (Glick & Horsfall, 2001; Linder et al., 1991). The publication of several reviews and meta-analyses on depression and depressive symptoms in high-performance sports mirrors the growing scientific interest in the topic of mental health in athletes (e. g., Frank et al., 2015; Gorczynski et al., 2017; Gouttebarge et al., 2019; Reardon & Factor, 2010; Rice et al., 2016; Wolanin et al., 2016). Yet only a few studies deal with mental well-being and risk of depression in soccer players (Belz et al., 2020; Heidari et al., 2019; Junge & Feddermann-Demont, 2016), and even fewer studies look at depression prevalences in amateur soccer players. Hence, this study examines mental well-being and risk of depression in amateur soccer players and thus contributes to a better understanding of mental health in this group of athletes.
Mental health is characterized as ”… a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (World Health Organization, 2004). Following that definition, mental well-being is an integral part of mental health. At the same time, if another part of mental health, like coping with the stressors of life, is impaired, people are at risk of experiencing periods of depression. Thus, this study looks at mental well-being and risk of depression as two significant components of mental health of amateur soccer players.
To date, studies focusing on mental well-being and risk of depression in amateur soccer players are scarce (Junge & Feddermann-Demont, 2016). However, indicators of mental health have been reported in several studies on elite soccer players over the past 5 years. In a study on elite soccer players in Switzerland, results showed that the prevalence for risk of depression was 9 % in male athletes and 13 % in female athletes (Junge & Feddermann-Demont, 2016), similar to the prevalence in the general population (Storch et al., 2005). Researchers also reported that 26 % of current male professional soccer players had experienced symptoms of anxiety and depression within the month prior to data collection (Gouttebarge, Frings-Dresen & Sluiter, 2015); Gouttebarge and colleagues described a prevalence of 38 % for anxiety/depression in a sample of professional soccer players in 11 countries from three continents. Further, Prinz et al. (2016) observed a career-time prevalence of depression symptoms of 32.3 % in German female elite players. Nylandsted Jensen and colleagues (2018) reported an overall prevalence rate of 16.7 % for depressive symptoms among Danish and Swedish elite soccer players.
The aforementioned prevalence rates of impaired mental health both in elite athletes in general and in elite soccer players in particular differ depending on the performance level, the sex, and the age of the athletes studied. In terms of the performance level, youth squads (Belz et al., 2018; Kleinert et al., 2016), first-division collegiate athletes (Armstrong & Oomen-Early, 2009), national level athletes (Hammond et al., 2013; Schaal et al., 2011), and Olympic competitors (Kotnik et al., 2012) differ. The reported prevalence of impaired mental health in these athletes ranges from less than 10 % (Junge & Feddermann-Demont, 2016), 10 – 20 % (Belz et al., 2018; Kleinert et al., 2016), 20 – 40 % (Armstrong & Oomen-Early, 2009; Brewer & Petrie, 1995; Gouttebarge, Frings-Dresen & Sluiter, 2015; Prinz et al., 2016; Wolanin et al., 2016), and up to 68 % (Hammond et al., 2013). Several studies found that female athletes are more likely to experience impaired mental health than male athletes (Belz et al., 2018; Hammond et al., 2013; Junge & Feddermann-Demont, 2016; Kleinert et al., 2016; Wolanin et al., 2016). In contrast, some studies found no differences in mental health between the sexes (Kotnik et al., 2012) or assessed only male athletes (Brewer & Petrie, 1995; Gouttebarge, Frings-Dresen & Sluiter, 2015). Moreover, studies found that differences in the probability of suffering from impaired mental health may be related to the athletes’ age (e. g., Belz et al., 2018; Belz et al., 2020; Kleinert et al., 2016; Junge & Feddermann-Demont, 2016; Schaal et al., 2011), although their results are inconsistent. Whereas in several studies younger athletes reported significantly higher scores for depression than older athletes (Belz et al., 2018; Kleinert et al., 2016; Junge & Feddermann-Demont, 2016; Prinz et al., 2016), another study reported the exact opposite (Schaal et al., 2011). On the other hand, Nixdorf and colleagues (2013) found no association between age and depressive symptoms. In the context of elite soccer, Belz et al. (2020) observed that soccer players aged 15 years and older exhibited higher depression scores than younger players. Furthermore, players of elite junior soccer teams were found to express higher levels of depressive symptoms than those on professional teams (Nylandsted Jensen et al., 2018). In addition to several individual factors, like perfectionism (e. g., Eklund & DeFreese, 2015) or coping strategies (e. g., Goodger et al., 2007), studies showed that failure or success may also influence mental health in athletes (Nixdorf et al., 2016).
Although several studies exist that deal with mental health in soccer players (e. g., Belz et al., 2020; Nylandsted Jensen et al., 2018), to the best of our knowledge no study has analyzed mental well-being and the risk of depression as components of mental health, neither on a team level nor on an amateur level. Studying the mental health of soccer players on a team level (i. e., the membership in a specific team) is important as individual factors like personality, injuries, or psychological strain or stress (Prinz et al., 2016; Nixdorf et al., 2013) can impact the well-being and risk of depression of athletes. Other group-related factors such as the team or club culture, leadership styles (Munir, Nielsen, & Carneiro Gomes, 2010), the coach- or peer-induced motivational climate (Reinboth & Duda, 2006), or other intragroup processes have the potential to affect the mental health of soccer players. Moreover, previous studies revealed that an impaired socioeconomic status because of salary differences in combination with emotional stress can lead to impaired mental health of athletes on teams (Wilkinson & Piccinelli, 2000). Thus, it seems important to take a closer look at the influence of team membership on mental health. In addition, it appears to be necessary to specifically look at amateur soccer players, as this group represents the largest organized body of athletes in the European countries. The major difference between professional and amateur soccer is that amateur soccer players do not financially profit from their sport and rather engage in soccer for mere pleasure. Furthermore, significant differences between professional and amateur teams regarding medical staff or sport psychological support exist, which could lead to a failure to identify impaired mental health in athletes.
Previous studies utilized a wide array of measures to assess mental health in athletes, such as the Beck’s Depression Inventory-2 (BDI-2; Beck et al., 1996; Löwe et al., 2005), the General Health Questionnaire (GHQ-12; Romppel et al., 2013), and the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977). In addition, athletes were screened for depression using both the Patient Health Questionnaire-2 (PHQ-2; Kroenke et al., 2003; Löwe et al., 2005), which focuses on mental ill-being, and the WHO-5 Well-Being Index (WHO-5; Blom et al., 2012; Bonsignore et al., 2001), an “inverse” measurement of depression through the assessment of mental well-being. Research from outside the sport context suggests that the PHQ-2 (Kroenke et al., 2003; Löwe et al., 2005) and the WHO-5 (Blom et al., 2012; Bonsignore et al., 2001) are useful tools for screening individuals for the risk of impaired mental well-being and risk of depression (Topp et al., 2015), making a comparison of athlete data with those of individuals from other contexts possible. Information on acceptable sensitivity and specificity regarding depression exist for both the PHQ-2 and the WHO-5 (Kroenke et al., 2003; Löwe et al., 2005; Bonsignore et al., 2001). Finally, it is important to emphasize that the two instruments were not developed to diagnose but to screen for risk of depression or impaired mental health.
In order to add to the limited body of literature surrounding mental health in amateur soccer players, especially on a team level, this study has three aims: First, to describe the mental well-being and risk of depression in amateur soccer players based on self-report measures; second, to examine the difference in mental well-being and risk of depression in terms of the age and sex of soccer players; third, to examine the relationship between mental well-being and risk of depression in amateur soccer players on a team level, independent of other team variables such as team size or current position in the standings which might affect mental health as well.
Method
Participants
The sample consisted of N = 285 amateur soccer players from 20 teams (54.7 % male) in Germany with a mean age of 23.6 years (SD = 4.4 years; range 16 – 39 years). One team competed in the first amateur division, eight teams competed in the third, and 11 teams in the fourth amateur division.
Measures
Mental Well-Being
The WHO-5 Well-Being Index (WHO-5; Blom et al., 2012; Bonsignore et al., 2001) measures subjective mental well-being. Respondents are asked how they felt in the past 2 weeks (e. g., “In the last 2 weeks I have felt cheerful and in good spirits”). All five items are rated on a 6-point Likert-scale (0 = at no time, 5 = all of the time). With a total score of 0 – 25, the World Health Organization (WHO) originally proposed a cut-off score ≤ 12. However, an optimal cut-off score of ≤ 9 was identified in a representative German sample (Löwe et al., 2004), which is now recommended to be applied instead of the cut-off score of ≤ 12.
Risk of Depression
The Patient-Health-Questionnaire-2 (PHQ-2; Kroenke et al., 2003; Löwe et al., 2005) is widely used as a disease-oriented screening tool for risk of depression. Respondents are asked how often they experienced core symptoms of depression during the past 2 weeks. Whereas one item refers to “little interest or pleasure in doing things,” the other item refers to “feeling down, depressed and hopeless.” Respondents are asked to mention the frequency on a 4-point Likert-scale (0 = not at all, 1= several days, 2= more than half the days, 3 = nearly every day). With a score range of 0 – 6, the authors proposed a cut-off of ≥ 3 to screen for the risk of depression (Kroenke et al., 2003).
Additional Variables
To distinguish the influence from team membership on mental well-being and risk of depression from other team variables, we assessed team size and the current position in the standings in relation to the total number of teams in their current division.
Procedures
Prior to conducting the study, ethics approval was obtained from the University’s Ethics Commission. Subsequently, the first author contacted soccer coaches and explained the purpose of the study. Participation of teams and athletes was voluntary, and athletes willing to take part in the study signed an informed consent form before the questionnaire was distributed. Questionnaires were administered at a team meeting before or after training. The coaches and the athletes were given the first author’s contact information in case they had any questions following data collection.
Data Analysis
We generated frequencies and percentages to analyze the prevalence of mental well-being and risk of depression in amateur soccer players. To examine the relationship between sex, as the independent variable, and mental well-being and risk of depression, as dependent variables, we conducted t-tests. To examine the relationship between age groups, as the independent variable, and mental well-being and risk of depression, as dependent variables, we applied a Kruskal-Wallis test; Mann-Whitney U-tests were conducted to follow up these findings. We analyzed the relationship between mental well-being and risk of depression in soccer teams by applying restricted maximum likelihood procedures in hierarchical linear modeling (HLM Version 7; Raudenbush et al., 2011), because athletes (Level 1) were nested within in teams (Level 2). We used mental well-being and risk of depression as Level 1 variables, whereas team membership (Team 1, Team 2, Team 3, … Team 20), team size, and position in the standings were used as the Level 2 variable.
Results
In total, 284 (99.6 %) amateur soccer players completed the WHO-5 questionnaire. The mean score for WHO-5, assessing mental well-being, was M = 13.30 (SD = 4.71). When the cut-off of ≤ 9 (Löwe et al., 2005) was applied, 23.6 % of all players were at risk of suffering from impaired mental well-being. The average impaired mental well-being scores based on the WHO-5 did not differ significantly between male (M = 13.74, SD = 4.96) and female players (M = 12.76, SD = 4.34), F = 2.134, p = .079. However, mental well-being significantly did correlate with players’ age, χ2 = 10.101, p = .018. In detail, mental well-being significantly differed between amateur soccer players who were older than 31 years (median = 17.0) and soccer players 16 – 20 years old (median = 13.0; U = 459.500, z = −3.03, p = .002), 21 – 25 years old (median = 14.0; U = 871.000, z = −2.64, p = .009), and 26 – 30 years old (median = 13.0; U = 349.500, z = −2.81, p = .005).
In total, 283 (99.3 %) amateur soccer players completed the PHQ-2 questionnaire. The mean score for PHQ-2, assessing risk of depression, was M = 1.61 (SD = 1.27). When the cut-off score of ≥ 3 (Kroenke et al., 2003) was applied, 22.6 % of all players were at risk of depression. The average score did not differ significantly between male (M = 1.64, SD = 1.33) and female players (M = 1.58, SD = 1.20), F = 1.465, p = .694. Furthermore, risk of depression did not significantly correlate with players’ age, χ2 = 2.441, p = .486. Table 1 presents an overview about means and standard deviations for mental well-being and risk of depression.
Because it has been shown that age and performance level are potential factors that influence the development of depression or impaired mental well-being (Gorczynski et al., 2017; Junge & Feddermann-Demont, 2016; Gouttebarge, Frings-Dresen & Sluiter, 2015), we analyzed variances in these factors between the sexes, revealing that male and female players do not differ regarding age (χ2(3) = 6.636; p = .084), but did differ regarding the performance level (χ2(2) = 19.510; p < .001), with male players competing on higher levels than female players. After applying the cut-offs for mental well-being and risk of depression, we assessed the consistency between scores for mental well-being and risk of depression. (Consistency in this sense means that a player with a conspicuous score in mental well-being also has a conspicuous score regarding risk of depression; conversely, an inconsistent score would describe a player with a conspicuous score in either mental well-being or risk of depression but not for either mental well-being or risk of depression.) Overall, 74.8 % of the results appear consistent and 25.2 % inconsistent when relating mental well-being and risk of depression (cf. Table 2).
Before examining the relationship between mental well-being and risk of depression in amateur soccer players, we thought it necessary to determine whether hierarchical linear modeling (HLM) was appropriate, and that athletes (Level 1) were nested within teams (Level 2). We conducted null models to examine the intraclass coefficients (ICCs) of the variables mental well-being and risk of depression. The ICCs for both variables (mental well-being: ρ = .05, p = .032; risk of depression: ρ = .10, p < .001) were small but significant. Specifically, 5 % of the variance in mental well-being and 10 % in risk of depression scores existed between teams. Although small, HLM may not be warranted to be abandoned, because additional dependencies can arise after other factors or predictors have been entered into the model (Roberts, 2007). Hence, the ICC was used as an initial indicator of the warrants of HLM, not ruling out its use because of the small values (Anderson, 2012). First, the regression coefficient relating player mental well-being on risk of depression was negative and statistically significant (b = -1.45, β = -.39, p < .001). Second, neither team membership, team size, nor the position in the standings could explain the player’s mental well-being or risk of depression when entered as Level 2 predictors.
Discussion
This study explored the prevalence of mental well-being and risk of depression as two substantial components of mental health in amateur soccer players. We were able to show that 23.6 % of all players were at risk of suffering from impaired mental well-being, and 22.6 % of all players were at risk of depression, based on the respective cut-off scores (Kroenke et al., 2003; Löwe et al., 2005). We also demonstrated that neither mental well-being nor risk of depression differed between male and female amateur soccer players. Our results showed that 5 % of cases for mental well-being and 10 % of cases for risk of depression can be explained through team membership. However, we were unable to show that team membership, team size, or position in the standings, as Level 2 predictors, influence mental well-being or risk of depression in amateur soccer players. Finally, we showed that in 25.2 % of the cases the screening results for mental well-being and risk of depression were inconsistent, based on the suggested cut-off scores.
The results reveal that older soccer players (> 31 years) reported overall higher mental well-being scores than young players, with athletes between 16 – 20 years reporting the lowest mental well-being scores, supporting previous studies (Gorczynski et al., 2017). Certainly, younger soccer players must deal with a variety of stressors that might negatively impact their mental well-being, such as the demands of their dual career (e. g., school, sport). Moreover, younger athletes must deal with age-related developmental tasks, such as finding one’s identity, their development in sport, and planning their future (Ohlert & Kleinert, 2014). The pressure to excel within their sport to achieve such goals (e. g., becoming a professional athlete) as well as balancing educational goals with personal relationships have been identified as potential risk factors for younger athletes, especially if there is a large discrepancy between the desired goals and the current performances (Schaal et al., 2011; McKay et al., 2008). It may be assumed that these demands impact the mental well-being in these athletes, particularly because they might not have yet developed appropriate coping strategies to deal with the different stressors (Holt et al., 2005). In contrast, older players may be more relaxed because of their experiences in life and sport and, as a result, be able to apply adequate coping strategies to several stressors. Potential stressors in older athletes are, for example, related to work commitments, such as balancing the job with their personal relationships (Noblet & Gifford, 2002) and financial and family responsibilities (Thelwell et al., 2007; Weston et al., 2009).
This study supports findings from earlier studies showing that 26 % of professional male soccer players report symptoms of anxiety and depression within the month prior to data collection (Gouttebarge, Frings-Dresen & Sluiter, 2015). However, it must be noted that only a portion of these at-risk athletes actually suffer from depression. The reason for this is that all measurements of mental well-being or risk of depression contain an error in the result. For example, if an athlete tests positive for an increased risk of depression, this result is true only with a certain probability (i. e., sensitivity of the test). If an athlete screens negative (low risk of depression), there is also a similar error (i. e., specificity of the test). For the current results this means that only a small proportion of these athletes actually suffer from depression: If we take sensitivity and specificity into account, it can be estimated that of the 23.6 % athletes at risk of depression, less than 5 % actually suffer from depression.
Regarding sex, we found that male and female athletes do not differ in their experience of impaired mental well-being or risk of depression, thus contradicting earlier studies (e. g., Belz et al., 2018; Junge & Feddermann-Demont, 2016; Wolanin et al., 2016). Because previous studies assessed mental health in professional athletes, it can be assumed that the socioeconomic status of professional male and female soccer players differs significantly in these studies. Hence, an impaired socioeconomic status because of salary differences between male and female players in combination with emotional distress can lead to a higher risk of depression (Wilkinson & Piccinelli, 2000). Although in the present study the performance level differs between male and female amateur soccer players, it is assumed that the socioeconomic status does not differ as extremely as in professional players. This could explain why we failed to identify differences regarding mental well-being and the risk of depression between the sexes in the present study.
Although many studies have applied the screening tools PHQ-2 and WHO-5 to assess mental well-being and risk of depression (e. g., Blom et al., 2012; Löwe et al., 2005; Topp et al., 2015), results from the two questionnaires are somewhat inconsistent. Although almost 75 % of amateur soccer players showed consistent results regarding mental well-being and risk of depression, 25 % of amateur soccer players showed inconsistent results. Inconsistent results here mean that a player with conspicuously impaired mental well-being (WHO5 ≤ 9) does not have a higher risk of depression (PHQ2 ≥ 3), or vice versa. Therefore, when applying both instruments simultaneously, one must be aware that, although most conspicuous cases would be identified because of the high sensitivity of the assessment, some cases do emerge as false positives or are missed altogether. To overcome this problem, future studies should use expert clinical interviews to identify impaired mental well-being and risk of depression and, thus, report reliable information on their respective prevalence.
One finding of the current study was that 5 % of the cases for mental well-being and 10 % for risk of depression depended on the team membership of the soccer players. However, this study was unable to identify any predictors that explain the development and occurrence of impaired mental well-being or higher risk of depression. It can be assumed that general factors like team membership, team size, competitive level, or the position in the standings cannot explain the variance. Instead, specific factors that relate to behavior or interaction like the team or club culture, certain leadership styles (Munir et al., 2010), the coach- or peer-induced motivational climates (Reinboth & Duda, 2006), or other intragroup processes such as identification (Zepp & Kleinert, 2015) seem to be more suitable predictors for mental well-being and the risk of depression in athletes.
One shortcoming of the study was the exclusive use of questionnaires to assess mental well-being and risk of depression as two components of mental health in soccer players. As a result of the self-report measurements of mental health, we could evaluate only players’ subjectively perceived well-being and risk of depression. To assess mental well-being and risk of depression in amateur soccer players and soccer teams more objectively, methods such as clinical interviews with psychologists, psychotherapists, or psychiatrists should also be applied, as previously discussed, which would increase the sensitivity of the assessment of mental well- and ill-being. Future studies should also consider physical (head) trauma or injury reports as potential factors influencing impaired mental health in athletes (Custer et al., 2016; Appaneal et al., 2009).
Besides this shortcoming of the exclusive use of questionnaires, the present study embodies several strengths and contributes to the existing literature on mental well-being and risk of depression in athletes, especially in amateur soccer players. Moreover, this study reduces the research gap that exists in the literature on mental well-being and risk of depression in soccer players (Junge & Feddermann-Demont, 2016). Like some previous studies on the prevalence rate of impaired mental well-being and risk of depression (e. g., Gouttebarge, Frings-Dresen & Sluiter, 2015), this study identified a rate of risk of depression of around 25 % in amateur soccer players (although the actual value is seemingly lower, given that 70 – 80 % represent false positive cases). In contrast to most existing research (e. g., Belz et al., 2018; Hammond et al., 2013; Junge & Feddermann-Demont, 2016; Kleinert et al., 2016; Wolanin et al., 2016), the present study did not find any differences in mental well-being and risk of depression between male and female amateur soccer players. One major strength of the present study is that mental well-being and risk of depression were analyzed as two significant components of mental health in amateur soccer players using hierarchical linear modeling, which, to the best of our knowledge, has not been applied in mental health research in sport teams before.
The findings of the present study have some practical implications for working with soccer players and teams. For coaches and managers, it may be necessary to focus on the environment of the team and its players, as this environment and the various intragroup processes therein might impact the mental well-being and risk of depression in soccer players. As a result, coaches may need to reflect on their coaching styles and scrutinize the effects their coaching behavior can have on players. In addition, soccer players themselves could reflect on their behavior, as it is conceivable that their behavior might negatively impact mental well-being and risk of depression in their fellow team members. Another practical implication is that it appears necessary to teach coping strategies to younger athletes. Because younger athletes in particular seem to be at risk of experiencing impaired mental well-being, these athletes need to be equipped with different methods and techniques (e. g., relaxation, time management) to better deal with the various stressors within soccer, school, or other contexts. In addition, a buddy system or team mentors could be applied, where older players guide and help younger athletes through stressful or difficult situations.
The present study suggests a number of directions for future research. First, our findings highlight that results relating to impaired mental well-being and risk of depression are somewhat inconsistent when assessed using the WHO-5 and PHQ-2 instruments. Therefore, future research should incorporate structured interviews (as used in clinical contexts) to more reliably assess mental health.
Second, future research should identify group dynamics that act as antecedents to the development of impaired mental well-being and risk of depression in soccer teams. Because team membership is somewhat related to impaired mental health in soccer players, it is necessary to reduce the likelihood of the development of impaired mental health and increased risk of depression, and to facilitate the development of a climate that improves the likelihood of sustained mental health.
To conclude, this study provided evidence that 23.6 % of all players were at risk of suffering from impaired mental well-being and 22.6 % of all players were at risk of depression. However, because of test specificity and sensitivity, an actual prevalence of approximately 4 % of amateur soccer players can be expected to suffer from depression in reality. Furthermore, no difference in impaired mental well-being or risk of depression was identified between male and female soccer players, whereas soccer players older than 31 years reported significantly higher mental well-being scores than all younger age groups. In addition, team membership was found to be related to the occurrence of impaired mental well-being and higher risk of depression. By considering the findings of this study, future research should focus on identifying group processes and environmental factors (e. g., coaching style, peer behavior) that facilitate the development of impaired mental well-being and risk of depression in soccer players.
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