{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T16:29:45Z","timestamp":1792772985088,"version":"4.5.0"},"reference-count":28,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Football (soccer) referees are crucial to contol of football matches. Exposure to emotional stressors may precipitate coronary events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To characterise emotional stressors, including abuse faced by football (soccer) referees, which may lead to burnout and potential cardiac risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The survey was disseminated to referees from eight referee associations ranging from grassroots\/amateur to professional competitions in Sydney, Australia. The questionnaire assessed the level and type of emotional stressors that football referees faced in the preceding 12 months and whether they had experienced verbal or physical abuse in the prior 12 months or at any time in their career.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One hundred thirty\u2010four participants undertook the survey, mean age 44.0\u2009years, 117 (87.3%) male and 17 (12.7%) female, 83.6% Caucasian with 62.7% refereeing grassroots football, 23.9% semi\u2010professional and 13.4% professional football. Most participants had experienced stress (69.8%), anxiety (58.3%), frustration (57.2%) and\/or anger (42.9%) during at least one match in the previous 12 months. Younger referees and those refereeing at higher levels reported higher levels of psychological stressors than their colleagues, with age remaining a multivariable predictor. Most participants (93.6%) during their career had experienced verbal abuse while refereeing, while 15.2% reported physical abuse, with younger age being a positive predictor. One in five (21.5%) referees had considered quitting due to the stress they experienced.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings show a significant emotional stress burden exists with Australian football referees. These findings can guide support and education for referees about stress management techniques and highlight the need to reduce stress and abuse that might contribute to referee burnout and cardiac risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/imj.70601","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T02:00:23Z","timestamp":1785981623000},"page":"1699-1708","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychological stress in referees during a football (soccer) match: a potential cause of burnout and cardiac risk"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8379-3530","authenticated-orcid":false,"given":"Toby M.","family":"Plasto","sequence":"first","affiliation":[{"name":"School of Medicine and Health The University of Sydney  Sydney Australia"},{"name":"Department of Medicine St Vincent's Hospital  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1902-9113","authenticated-orcid":false,"given":"Thomas","family":"Buckley","sequence":"additional","affiliation":[{"name":"School of Medicine and Health The University of Sydney  Sydney Australia"},{"name":"Department of Cardiology Royal North Shore Hospital  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0716-596X","authenticated-orcid":false,"given":"Judith","family":"Fethney","sequence":"additional","affiliation":[{"name":"School of Medicine and Health The University of Sydney  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey H.","family":"Tofler","sequence":"additional","affiliation":[{"name":"School of Medicine and Health The University of Sydney  Sydney Australia"},{"name":"Department of Cardiology Royal North Shore Hospital  Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"21","article-title":"Acute psychological stress as a precipitant of acute coronary syndromes in patients with undiagnosed ischemic heart disease: a case report and literature review","volume":"11","author":"Zupancic ML","year":"2009","journal-title":"Prim Care Companion J Clin Psychiatry"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2008.04.010"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602153340701"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2010.03.026"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200737070-00006"},{"key":"e_1_2_8_7_1","unstructured":"Various. 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