# Mental health and its association with injury risk in elite adolescent athletes- a prospective cohort study

## TL;DR

This study shows that elite adolescent athletes, especially females, face higher mental health challenges and lower wellbeing, which may be linked to injury risk.

## Contribution

The study provides new insights into the relationship between mental health and injury risk in elite adolescent athletes, with a focus on sex and sport type differences.

## Key findings

- Female athletes reported higher rates of poor mental health and lower wellbeing scores compared to males.
- Athletes with new injuries had significantly lower mental wellbeing scores.
- Female ice hockey players showed the most pronounced mental health disparities compared to male counterparts.

## Abstract

Adolescent athletes face an increased risk of both sports-related injuries and mental health challenges. With the rising prevalence of these issues, understanding their interaction is increasingly important. This study aimed to evaluate the mental health of adolescent athletes, examining differences by sex and type of sport. Additionally, it aimed to investigate the association between mental health and sports-related injuries.

A prospective study including elite adolescent athletes between 16–19 years old. Mental health was assessed by the short version of the Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) to capture mental wellbeing and one additional question assessing perception of poor mental health. Prospective injury was defined as any self-reported physical complaint by the athlete. Logistic regression analysis was performed to study the influence of mental health variables as potential risk factors for injuries.

A total of 171 athletes were included (16–19 years), where 48% reported having had a severe injury past year. Mental health issues were significantly more prevalent among females (36%), who also had a significantly lower mean SWEMWBS score compared with males. Female ice hockey players reported significantly higher rates of self-reported periods of poor mental health (p = 0.03) and lower SWEMWBS scores compared to their male counterparts (p < 0.001). Athletes who reported a new injury during the follow-up had significantly lower SWEMWBS score compared with injury-free athletes (p = 0.01). No other association was found between injuries and mental illness or the SWEMWBS score.

This study found that one-fourth of adolescent athletes reported at least one period of poor mental health, with a significant overrepresentation of female athletes. Notably, female ice hockey exhibited both higher rates of poor mental health and lower scores of mental wellbeing compared with their male counterparts. Regarding injuries, lower SWEMWBS score was found among athletes who reported new injuries during the follow-up. These findings highlight the need for increased awareness and targeted mental health support within youth sports, particularly for female athletes. Future research should further investigate the underlying causes of these disparities and explore effective prevention and intervention strategies to promote mental wellbeing among adolescent athletes.

The online version contains supplementary material available at 10.1186/s13102-026-01558-3.