Mental Health in German Paralympic Athletes During the 1st Year of the COVID-19 Pandemic Compared to a General Population Sample

Abstract

IntroductionThe COVID-19 pandemic has huge influences on daily life and is not only associated with physical but also with major psychological impacts. Mental health problems and disorders are frequently present in elite paralympic athletes. Due to the pandemic situation, new stressors (e.g., loss of routine, financial insecurity) might act upon the athletes. Therefore, the assessment of mental health in athletes during the COVID-19 pandemic is important to identify prevalence of psychological problems and propose countermeasures.MethodsThe mental health of German paralympic athletes was longitudinally monitored (starting in May 2019). The athletes completed the Patient Health Questionnaire 4 (PHQ-4) on a weekly basis and reported a stress level, training hours, and training load. During the pandemic, 8 measurement time points (March 2020 to April 2021) were used to reflect the psychological health course of the athletes. In parallel, a convenience sample of the general population was questioned about their psychological distress, including the PHQ-4. To be included in the analysis, participants of both groups had to complete at least 4 measurement time points. Matching of the para-athletes and the general population sample was prioritized upon completion of the same measurement time points, gender, and age.ResultsSeventy-eight paralympic athletes (40 women, 38 men, age: 29.8 ± 11.4 years) met the inclusion criteria. Seventy-eight matched pairs of the general population (40 women; 38 men; age: 30.5 ± 10.9 years) were identified. The para-athletes had a significantly (p <0.0001; 0.39 < r <0.48) lower PHQ-4 value at each measurement time point compared to the matched control group. No significant age or sex differences were evident regarding the symptom burden. In para-athletes, no significant and a weak positive correlation was found between decreased training load and PHQ-4 values and a stress level, respectively. Reduced physical activity was significantly (p <0.0001) associated with higher PHQ-4 values in the general population sample.DiscussionLower PHQ-4 values were reported by the para-athletes compared to the general population sample. However, small sample sizes must be considered while interpreting the data. Nevertheless, adequate support for individuals suffering from severe psychopathological symptoms should be provided for para-athletes as well as for the general population.

A tale of two stories: COVID-19 and disability. A critical scoping review of the literature on the effects of the pandemic among athletes with disabilities and para-athletes

“…Half of the participants worried about their own well-being, 25% about their career, and only 8% had economical-financial preoccupations. Similar results were reported by the same author group in another investigation (Busch et al, 2022), where seventy-eight paralympic athletes (40 women, 38 men, mean age 29.8 ± 11.4 years) were recruited and matched against the general population (mean age 30.5 ± 10.9 years). The para-athletes reported significantly lower scores on the "Patient Health Questionnaire 4" (PHQ-4) scale at each measurement time point compared to the matched control group.…”

“…These populations have had to experience unique challenges during the COVID-19 pandemic, which has been "a tale of two stories": the infectious outbreak and disability. Living with disabilities, these populations are at higher risk for contracting the emerging coronavirus compared with the general population, besides facing psychological distress (Busch et al, 2022;Dehghansai et al, 2021;Hu et al, 2021;Kaneda et al, 2021), due to several, intersecting mediators (Jesus et al, 2020;Lund, 2020;Lund et al, 2020;Jesus et al, 2021a;Jesus et al, 2021b;Kamalakannan et al, 2021;Goddard et al, 2022), as mentioned before. Dehghansai et al (2021) performed a qualitative study interviewing seven Australian para-athletes, in order to capture the unique challenges of athletes with disabilities during the outbreak.…”

Monitoring mental distress in Para athletes in preparation, during and after the Beijing Paralympic Games 2022: A 22 week prospective mixed-method study

“…However, this study did not do separate analysis on Olympic and Paralympic athletes. Also a recent study from Germany assessed elite Para athletes' mental health during the pandemic, and it was demonstrated that lower PHQ-4 values were reported by the para-athletes compared to the general population ( 53 ).…”

“…The PHQ-4 is a brief screening scale with four items in total for anxiety (e.g., “Feeling nervous, anxious or on the edge”) and depression (e.g., “Feeling down, depressed or hopeless”) ( 52 ). PHQ-4 has been used in other studies in sports medicine ( 30 , 53 , 54 ). The participants were asked to report how often they had been bothered with the following problems on this scale in the last week: 0 = Not at all; 1 = Several days; 2 = More than half the days; 3 = Nearly every day.…”

“…However, this study was designed to weekly monitor athletes' distress, which is established procedure in athlete health monitoring ( 50 , 56 ). Also, another recent study in sports medicine have used PHQ-4 with weekly measurement points ( 53 ).…”