{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T11:11:56Z","timestamp":1760353916004,"version":"build-2065373602"},"reference-count":27,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Sport Exerc Med"],"accepted":{"date-parts":[[2025,9,23]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To assess the mental health status of referees in Cameroonian professional football and identify associated risk factors.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A cross-sectional analytical study was conducted among referees from the Cameroon Elite One, Elite Two and Female Super League during the 2024\u20132025 season. The Depression Anxiety Stress Scale-21 was used to assess mental health status after officiating a match, classifying scores as normal, mild, moderate, severe or extremely severe for depression, anxiety and stress symptoms. Data were analysed using R Studio (V.4.2.2). Logistic regression identified associations with statistical significance set at p&lt;0.05.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Out of 179 professional referees in Cameroon, 150 (83.8%) participated. Ages ranged from 18 to 45 years (mean=30\u00b15.86 years). Depression symptoms were observed in 28%, with higher rates in assistant referees (32.4%) than in central referees (23.7%). Anxiety symptoms were present in 42.7% of participants, while 12% exhibited stress symptoms. Lower level referees had higher levels of all symptoms. Notably, 90.5% of referees with symptoms of depression had at least one additional mental health symptom. Severe symptoms of depression co-occurred with severe anxiety and stress symptoms. Having another profession significantly increased risks of depression symptoms (p=0.007, OR 7.7) and anxiety (p=0.003,\u2009OR 4.2). Performance concerns were the main psychological stressor (74.0%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Cameroonian referees experience high levels of depression, anxiety and stress symptoms, with assistant referees more affected. Holding another profession increases mental health risks. Targeted interventions are needed to address psychological stressors and improve referees\u2019 well-being.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjsem-2025-002678","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T10:40:12Z","timestamp":1760352012000},"page":"e002678","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Mental health of professional football referees in Cameroon: exploring challenges and developing support interventions"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9187-6749","authenticated-orcid":false,"given":"Leonard Tanko","family":"Tankeng","sequence":"first","affiliation":[{"name":"Department of Surgery and Specialties, University of Douala Faculty of Medicine and Pharmaceutical Sciences, Douala, Cameroon"},{"name":"Department of Research, SportsMed Foundation, Douala, Cameroon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Eyoum","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, University of Douala Faculty of Medicine and Pharmaceutical Sciences, Douala, Cameroon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilbert Mua","family":"Akwa","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, University of Yaounde I Faculty of Medicine and Biomedical Sciences, Yaound\u00e9, Cameroon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Randol Tsowa","family":"Vouomene","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Universit\u00e9 F\u00e9lix Houphou\u00ebt-Boigny, Abidjan, C\u00f4te d\u2019Ivoire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronique Ange","family":"Ngo Bilong","sequence":"additional","affiliation":[{"name":"Medical Commission, Cameroon Football Federation, Yaound\u00e9, Cameroon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Livingstone","family":"Dziany","sequence":"additional","affiliation":[{"name":"School of Sports and Exercise Medicine, University of Health and Allied Sciences, Ho, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Narcisse","family":"Tinkeu","sequence":"additional","affiliation":[{"name":"Medical Commission, Cameroon Football Federation, Yaound\u00e9, Cameroon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8868-7799","authenticated-orcid":false,"given":"Maurice","family":"Douryang","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Physical Medicine, University of Dschang, Dschang, Cameroon"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"2025101303400509000_11.4.e002678.1","doi-asserted-by":"crossref","first-page":"S543","DOI":"10.1016\/j.hlc.2024.06.912","article-title":"Cardiovascular Risk-Factors and Emotional Stressors in Football (Soccer) Referees: A Scoping Review","volume":"33","author":"Plasto","year":"2024","journal-title":"Heart, Lung and Circulation"},{"key":"2025101303400509000_11.4.e002678.2","unstructured":"Weltgesundheitsorganisation . 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