{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T08:37:44Z","timestamp":1792139864559,"version":"4.4.0"},"reference-count":98,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2024,8,11]],"date-time":"2024-08-11T00:00:00Z","timestamp":1723334400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Sports Health: A Multidisciplinary Approach"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Context:<\/jats:title>\n                    <jats:p>Mental health is a growing area of concern for elite athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To determine the sex differences in mental health symptoms in elite athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources:<\/jats:title>\n                    <jats:p>PubMed, EMBASE, and Cochrane Library databases were used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Selection:<\/jats:title>\n                    <jats:p>Included studies included comparisons of mental health symptoms of athletes by sex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis were conducted following the PRISMA guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level 2a.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Extraction:<\/jats:title>\n                    <jats:p>The rate ratio (RR) was calculated as the rates in female and male athletes. Data were pooled using a random-effects model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 1945 articles identified, 60 articles were included. Male athletes reported higher alcohol misuse (RR, 0.74; CI, 0.68-0.80), illicit drug abuse (RR, 0.82; CI, 0.75-0.89), and gambling problems (RR, 0.14; CI, 0.08-0.25). Female athletes reported higher overall anxiety (RR, 1.17; CI, 1.08-1.27), depression (RR, 1.42; CI, 1.31-1.54), distress (RR, 1.98; CI, 1.40-2.81), and disordered eating (RR, 2.19; CI, 1.58-3.02). Sleep disturbances were reported at similar rates in male and female athletes (RR, 1.13; CI, 0.98-1.30).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Female and male athletes have significant differences in reported mental health symptoms. Female athletes are more likely to report anxiety, depression, distress, and disordered eating, while male athletes report more alcohol misuse, illicit drug abuse, and gambling. Monitoring and evaluation of mental health is a necessary part of any sport, including access to resources. Longitudinal studies following athletes over time to determine the development and causation for mental health symptoms should be included in future research directions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/19417381241264491","type":"journal-article","created":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T02:35:26Z","timestamp":1723430126000},"page":"732-743","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":39,"title":["Sex Differences in Mental Health Symptoms in Elite Athletes: A Systematic Review and Meta-analysis"],"prefix":"10.1177","volume":"17","author":[{"given":"Michelle E.","family":"Kew","sequence":"first","affiliation":[{"name":"Sports Medicine Institute, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udit","family":"Dave","sequence":"additional","affiliation":[{"name":"Tulane University School of Medicine, New Orleans, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8434-2088","authenticated-orcid":false,"given":"William","family":"Marmor","sequence":"additional","affiliation":[{"name":"University of Miami, Department of Orthopaedics, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0012-1481","authenticated-orcid":false,"given":"Reena","family":"Olsen","sequence":"additional","affiliation":[{"name":"Sports Medicine Institute, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridget","family":"Jivanelli","sequence":"additional","affiliation":[{"name":"Kim Barrett Memorial Library, HSS Education Institute, Hospital for Special Surgery, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Huang Laurent","family":"Tsai","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Chiayi County, Taiwan and School of Medicine, Chang Gung University, Taoyuan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang-Tseng","family":"Kuo","sequence":"additional","affiliation":[{"name":"School of Medicine, Chang Gung University, Taoyuan, Taiwan and Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4415-2471","authenticated-orcid":false,"given":"Daphne I.","family":"Ling","sequence":"additional","affiliation":[{"name":"Sports Medicine Institute, Hospital for Special Surgery, New York, New York, Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan, and Department of Population Health Sciences, Weill Cornell Medical College, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,8,11]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40519-020-00872-0"},{"issue":"5","key":"e_1_3_2_3_2","first-page":"385","article-title":"Gender differences in mental health","volume":"48","author":"Afifi M.","year":"2007","unstructured":"Afifi M. 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