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However, there is still a paucity in the literature concerning elite Para athletes\u2019 mental health and its association with injuries and illnesses affecting athletes\u2019 participation in sports.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess the weekly prevalence of mental distress and its association with injury, illness, sleep duration, hours of participation in sports and perceived exertion over a 44-week period in a cohort of Swedish elite Para athletes. A secondary aim was to describe the period prevalence of mental distress.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a prospective longitudinal study including 59 Swedish elite Para athletes with physical, visual and intellectual impairments. Each week athletes reported mental distress according to \u2018The four-item Patient Health Questionnaire for Anxiety and Depression\u2019 (PHQ-4), sleep duration, hours of sports participation, perceived exertion as well as any new injury or illness. Descriptive statistics and multilevel regression analyses were used to analyse data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The weekly prevalence was 15% for symptoms of anxiety, and 21% for depressive symptoms. The 44-week period prevalence was 58% for anxiety, and 42% for depressive symptoms. Multilevel logistic regression analyses revealed significant associations between reporting symptoms of mental distress with an ongoing injury, illness, and low sleep duration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Elite Para athletes report a moderate rate of symptoms of anxiety and depression, and there were associations between reporting mental distress and experiencing an injury or illness affecting athletes\u2019 participation in sports. The findings highlight the importance of longitudinal mental health monitoring and multidisciplinary support systems targeting those athletes reporting mental distress, injury or illness.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsem-2024-002267","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T13:10:35Z","timestamp":1739365835000},"page":"e002267","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Mental distress is associated with injury and illness in elite Para athletes: a 44-week prospective study over 13 860 athlete days"],"prefix":"10.1136","volume":"11","author":[{"given":"Marte","family":"Bentzen","sequence":"first","affiliation":[{"name":"Department of Sport and Social Sciences, The Norwegian School of Sport Sciences, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6ran","family":"Kentt\u00e4","sequence":"additional","affiliation":[{"name":"Department of Physiology, Nutrition, and Biomechanics, The Swedish School of Sport and Health Sciences, Stockholm, Sweden"},{"name":"Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne","family":"Derman","sequence":"additional","affiliation":[{"name":"Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa"},{"name":"IOC Research Centre, Stellenbosch, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirik","family":"Halvorsen Wik","sequence":"additional","affiliation":[{"name":"Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jari","family":"Havela","sequence":"additional","affiliation":[{"name":"Parasport Sweden and The Swedish Paralympic Committee, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommy","family":"Karls","sequence":"additional","affiliation":[{"name":"Parasport Sweden and The Swedish Paralympic Committee, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Stenman","sequence":"additional","affiliation":[{"name":"Parasport Sweden and The Swedish Paralympic Committee, Stockholm, Sweden"},{"name":"Department of of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9524-7553","authenticated-orcid":false,"given":"Kristina","family":"Fagher","sequence":"additional","affiliation":[{"name":"Parasport Sweden and The Swedish Paralympic Committee, Stockholm, Sweden"},{"name":"Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,12]]},"reference":[{"key":"2025083110293268000_11.1.e002267.1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-100715"},{"key":"2025083110293268000_11.1.e002267.2","doi-asserted-by":"publisher","DOI":"10.1080\/1612197X.2024.2359872"},{"key":"2025083110293268000_11.1.e002267.3","doi-asserted-by":"publisher","DOI":"10.1097\/JSM.0000000000001077"},{"key":"2025083110293268000_11.1.e002267.4","unstructured":"Organization WH . 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