{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:39:04Z","timestamp":1791999544957,"version":"4.4.0"},"reference-count":49,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T00:00:00Z","timestamp":1600041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Svenska Spel","award":["non-study-specific grants"],"award-info":[{"award-number":["non-study-specific grants"]}]},{"name":"Regional hospital system Region Sk\u00e5ne","award":["non-study-specific grants"],"award-info":[{"award-number":["non-study-specific grants"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>COVID-19 and lockdown strategies may affect mental health and addictive behavior differently in the population, and elite athletes are among the professions clearly affected by the pandemic. This study in top elite athletes aimed to study current perceived psychological influence from COVID-19 and symptoms of depression, anxiety and changes in alcohol drinking, gambling behavior and problem gambling in the midst of the COVID-19 lockdown. This web survey included athletes in top leagues of soccer, ice hockey and handball in Sweden (N = 327, 62% men). A total of 66% and 51% were worried about the future of their sport or about their own future in sports, respectively. Feeling worse psychologically during the pandemic was common (72% of women, 40% of men, p &lt; 0.001); depression criteria were endorsed by 19% of women and three percent of men (p &lt; 0.001); anxiety criteria by 20% of women and five percent of men (p &lt; 0.001). Reporting increased gambling during the pandemic was associated with gambling problem severity. Moderate-risk or problem gambling was seen in 10% of men and none of the women (p &lt; 0.001). Depression and anxiety were associated with feeling worse during the COVID-19 pandemic and with concern over one\u2019s own sports future. In conclusion, COVID-19-related distress is common in elite athletes and associated with mental health symptoms. Gambling increase during the pandemic was rare, but related to gambling problems, which were common in male athletes. The calls for increased focus on COVID-19-related concerns in athletes and on problem gambling in male athletes.<\/jats:p>","DOI":"10.3390\/ijerph17186693","type":"journal-article","created":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T20:51:12Z","timestamp":1600116672000},"page":"6693","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":91,"title":["Psychological Distress and Problem Gambling in Elite Athletes during COVID-19 Restrictions\u2014A Web Survey in Top Leagues of Three Sports during the Pandemic"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5800-8975","authenticated-orcid":false,"given":"Anders","family":"H\u00e5kansson","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Depterment of Clinical Sciences Lund, Psychiatry, Lund University, S-22100 Lund, Sweden"},{"name":"Malm\u00f6 Addiction Center, Clinical Sports and Mental Health Unit, S-20502 Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"J\u00f6nsson","sequence":"additional","affiliation":[{"name":"Malm\u00f6 Addiction Center, Clinical Sports and Mental Health Unit, S-20502 Malm\u00f6, Sweden"},{"name":"FIFPRO (global representative for professional football players), Scorpious 161, NL-2132LR Hoofdorp, The Netherlands"},{"name":"Spelarf\u00f6reningen, Sweden (national representative for football players), G\u00f6teborgsv\u00e4gen 84B, S-433 63 S\u00e4vedalen, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6ran","family":"Kentt\u00e4","sequence":"additional","affiliation":[{"name":"The Swedish School of Sport and Health Sciences, S-114 86 Stockholm, Sweden"},{"name":"School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada"},{"name":"Swedish Sport Federation, S-100 61 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S2215-0366(20)30168-1","article-title":"Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science","volume":"7","author":"Holmes","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1002\/erv.2738","article-title":"COVID-19 and implications for eating disorders","volume":"28","author":"Casas","year":"2020","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1177\/0020764020915212","article-title":"The outbreak of COVID-19 coronavirus and its impact on global mental health","volume":"6","author":"Torales","year":"2020","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"112934","DOI":"10.1016\/j.psychres.2020.112934","article-title":"The psychological impact of the COVID-19 epidemic on college students in China","volume":"287","author":"Cao","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1097\/JOM.0000000000001962","article-title":"Job Insecurity and Financial Concern during the COVID-19 Pandemic are Associated with Worse Mental Health","volume":"62","author":"Wilson","year":"2020","journal-title":"J. Occup. Environ. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Parnell, D., Widdop, P., Bond, A., and Wilson, R. (2020). COVID-19, networks and sport. Manag. Sport Leis., 1\u20137.","DOI":"10.1080\/23750472.2020.1750100"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1007\/s40279-020-01297-6","article-title":"Impact of Potential Physiological Changes due to COVID-19 Home Confinement on Athlete Health Protection in Elite Sports: A Call for Awareness in Sports Programming","volume":"50","author":"Sarto","year":"2020","journal-title":"Sports Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"961","DOI":"10.2165\/11536580-000000000-00000","article-title":"A systematic review of diagnosis and medical treatment of mental illness in athletes","volume":"40","author":"Reardon","year":"2010","journal-title":"Sports Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1007\/s40279-016-0492-2","article-title":"The Mental Health of Elite Athletes: A Narrative Systematic Review","volume":"46","author":"Rice","year":"2016","journal-title":"Sports Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.psychsport.2014.07.004","article-title":"Defining elite athletes: Issues in the study of expert performance in sport psychology","volume":"16","author":"Swann","year":"2015","journal-title":"Psychol. Sport Exerc."},{"key":"ref_11","unstructured":"(2020, June 24). Number of Footballers with Depression Symptoms Doubles during Shutdown. The Guardian, Available online: https:\/\/www.theguardian.com\/football\/2020\/apr\/20\/number-of-footballers-with-depression-symptoms-doubles-during-shutdown-survey-fifpro-coronavirus."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"102064","DOI":"10.1016\/j.ajp.2020.102064","article-title":"COVID-19 pandemic and addiction: Current problems and future concerns","volume":"51","author":"Kar","year":"2020","journal-title":"Asian J. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1111\/add.15080","article-title":"Mitigating and learning from the impact of COVID-19 infection on addictive disorders","volume":"115","author":"Marsden","year":"2020","journal-title":"Addiction"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Columb, D., Hussain, R., and O\u2019Gara, C. (2020). Addiction psychiatry and COVID-19: Impact on patients and service provision. Ir. J. Psychol. Med., 1\u20135.","DOI":"10.1017\/ipm.2020.47"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1097\/ADM.0000000000000690","article-title":"Gambling during the COVID-19 crisis\u2014A cause for concern?","volume":"14","author":"Potenza","year":"2020","journal-title":"J. Addict. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/dar.13074","article-title":"Alcohol use in times of the COVID-19: Implications for monitoring and policy","volume":"39","author":"Rehm","year":"2020","journal-title":"Drug Alcohol Rev."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Neill, E., Meyer, D., Toh, W.L., Van Rheenen, T.E., Phillipou, A., Tan, E.J., and Rossell, S.L. (2020). Alcohol use in Australia during the Early Days of the COVID-19 Pandemic: Initial results from the COLLATE project. Psychiatry Clin. Neurosci., [online ahead of print].","DOI":"10.1111\/pcn.13099"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1080\/10550887.2016.1177807","article-title":"Gambling among European professional athletes. Prevalence and associated factors","volume":"35","author":"Caillon","year":"2016","journal-title":"J. Addict. Dis."},{"key":"ref_19","first-page":"79","article-title":"Problem gambling and gaming in elite athletes","volume":"8","year":"2018","journal-title":"Addict. Behav. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1080\/14459795.2020.1726990","article-title":"Gambling and gambling problem among elite athletes and their professional coaches: Findings from a Swedish total population survey of participants in four sports","volume":"20","author":"Vinberg","year":"2020","journal-title":"Int. Gambl. Stud."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1556\/2006.5.2016.073","article-title":"Problem gambling worldwide: An update and systematic review of empirical research (2000\u20132015)","volume":"5","author":"Calado","year":"2016","journal-title":"J. Behav. Addict."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1038\/s41572-019-0099-7","article-title":"Gambling disorder","volume":"5","author":"Potenza","year":"2019","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s10899-016-9639-1","article-title":"Predictors of Problem Gambling in the U.S","volume":"33","author":"Welte","year":"2016","journal-title":"J. Gambl. Stud."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.adolescence.2017.05.016","article-title":"Magical thinking and decision-making strategies among late adolescent regular gamblers: A mediation model","volume":"59","author":"Passanisi","year":"2017","journal-title":"J. Adolesc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1046\/j.1360-0443.2002.00015.x","article-title":"A pathways model of problem and pathological gambling","volume":"97","author":"Blaszczynski","year":"2002","journal-title":"Addiction"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s10899-015-9545-y","article-title":"Towards a Validation of the Three Pathways Model of Pathological Gambling","volume":"32","author":"Valleur","year":"2015","journal-title":"J. Gambl. Stud."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1556\/2006.2020.00016","article-title":"Problematic online gaming and the COVID-19 pandemic","volume":"9","author":"King","year":"2020","journal-title":"J. Behav. Addict."},{"key":"ref_28","unstructured":"Reuters (2020, June 24). Sweden to Limit Online Betting during Coronavirus Outbreak. Available online: https:\/\/www.reuters.com\/article\/us-health-coronavirus-sweden-gambling\/sweden-to-limit-online-betting-during-coronavirus-outbreak-idUSKCN2251WC."},{"key":"ref_29","unstructured":"(2020, June 24). Coronavirus: Gambling Firms Urged to Impose Betting Cap of L50 a Day. The Guardian, Available online: https:\/\/www.theguardian.com\/sport\/2020\/mar\/22\/coronavirus-gambling-firms-urged-to-impose-betting-cap-of-50-a-day."},{"key":"ref_30","unstructured":"Swedish Government (2020, June 24). Strategy in Response to the COVID-19 Pandemic, Available online: https:\/\/www.government.se\/articles\/2020\/04\/strategy-in-response-to-the-covid-19-pandemic\/."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"H\u00e5kansson, A. (2020). Changes in Gambling Behavior during the COVID-19 Pandemic\u2014A Web Survey Study in Sweden. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17114013"},{"key":"ref_32","unstructured":"Radio Sweden (2020, June 24). Sweden Tightens Coronavirus Rules to Ban Gatherings of More Than 50. Available online: https:\/\/sverigesradio.se\/sida\/artikel.aspx?programid=2054&artikel=7440264."},{"key":"ref_33","unstructured":"Associated Press (2020, June 24). Exposed to Betting, Lowly Swedish Team Gets Death Threats. Available online: https:\/\/apnews.com\/7b1f50916ca86b46c40150368519f111."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"255","DOI":"10.3389\/fpsyt.2017.00255","article-title":"Who seeks treatment when medicine opens the door to gambling disorder patients\u2014Psychiatric co-morbidity and heavy predominance of online gambling","volume":"8","author":"Zaar","year":"2017","journal-title":"Front. Psychiatry"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A Brief Measure for Assessing Generalized Anxiety Disorder","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.jsams.2019.10.022","article-title":"The prevalence of mental health problems in elite athletes","volume":"23","author":"Eloranta","year":"2020","journal-title":"J. Sci. Med. Sport"},{"key":"ref_38","unstructured":"Wynne, H., and Ferris, J. (2001). The Canadian Problem Gambling Index: Final Report."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1111\/add.14083","article-title":"The prevalence, incidence, and gender and age-specific incidence of problem gambling: Results of the Swedish longitudinal gambling study (Swelogs)","volume":"113","author":"Abbott","year":"2017","journal-title":"Addiction"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3389\/fpsyt.2020.00007","article-title":"Over-Indebtedness and Problem Gambling in a General Population Sample of Online Gamblers","volume":"11","author":"Widinghoff","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1136\/bjsports-2017-098033","article-title":"Depression and anxiety symptoms in 17 teams of female football players including 10 German first league teams","volume":"53","author":"Junge","year":"2018","journal-title":"Br. J. Sports Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e000087","DOI":"10.1136\/bmjsem-2015-000087","article-title":"Prevalence of depression and anxiety in top-level male and female football players","volume":"2","author":"Junge","year":"2016","journal-title":"BMJ Open Sport Exerc. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1093\/occmed\/kqu202","article-title":"Mental and psychosocial health among current and former professional footballers","volume":"65","author":"Gouttebarge","year":"2015","journal-title":"Occup. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1123\/jcsp.7.4.313","article-title":"Prevalence of Depressive Symptoms and Correlating Variables Among German Elite Athletes","volume":"7","author":"Nixdorf","year":"2013","journal-title":"J. Clin. Sport Psychol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/JSM.0b013e318287b870","article-title":"The Prevalence of Failure-Based Depression Among Elite Athletes","volume":"23","author":"Hammond","year":"2013","journal-title":"Clin. J. Sport Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/JSM.0000000000000665","article-title":"Canadian Centre for Mental Health and Sport (CCMHS) Position Statement","volume":"29","author":"Bradley","year":"2019","journal-title":"Clin. J. Sport Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.psychsport.2018.05.013","article-title":"FEPSAC position statement: Mental health disorders in elite athletes and models of service provision","volume":"38","author":"Moesch","year":"2018","journal-title":"Psychol. Sport Exerc."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"H\u00e5kansson, A., Entezarjou, A., Kentt\u00e4, G., Fern\u00e1ndez-Aranda, F., Jim\u00e9nez-Murcia, S., and Gunnarsson, B. (2020). Problem gambling in the fitness world\u2014A general population web survey. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17041342"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jclinepi.2020.02.002","article-title":"Patient Health Questionnaire-9 scores do not accurately estimate depression prevalence: Individual participant data meta-analysis","volume":"122","author":"Levis","year":"2020","journal-title":"J. Clin. Epidemiol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/18\/6693\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:09:57Z","timestamp":1760177397000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/18\/6693"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,14]]},"references-count":49,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["ijerph17186693"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17186693","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,14]]}}}