An interesting review published by Wolanin et al. (3) discussed the prevalence of depression in athletes, suggesting that athletes present increased prevalence of depression when compared with nonathletes. In addition, the authors discussed some potential risk factors that may lead to depression such as injuries, career termination, and decline in performance or a catastrophic performance.
The article discusses a relevant aspect that deserves more attention. However, the terminological use of depression may lead to erroneous interpretation, leading the reader to conclude that the articles showed increased prevalence of depression when the studies discussed the increased prevalence of increased depressive symptoms.
There is a crucial difference between increased prevalence of depression and increased prevalence of elevated depressive symptoms. To determine the diagnostic of Major Depressive Disorder (MDD), several criteria of a diagnosis instrument based on current criteria for depression (1) such as the Mini International Neuropsychiatric Interview, Structured Clinical Interview or Composite International Diagnostic Interview, must be fulfilled. However, the authors discussed data of studies that have not used diagnostic instruments but instead used dimensional instruments to assess depression severity such as Center for Epidemiologic Studies Depression Scale and Beck Depression Inventory. In addition, none of the cited studies evaluated the diagnosis of Bipolar Disorder (BD).
Finally, Bär and Markser (2) have discussed the potential confusion factor that Overtraining Syndrome (OTS) plays in identifying MDD or BD in athletes. OTS and depression have an overlap of several symptoms such as fatigue, problems with sleep, weight loss, appetite change, lack of motivation, and concentration difficulties, symptoms that are evaluated by dimensional instruments to assess severity. Thus, most of the discussed articles have potentially evaluated an OTS but not depression.
Felipe Barreto Schuch, PhD
Programa de Pós-graduação em Ciências Médicas
Psiquiatria, Universidade Federal do Rio Grande do Sul
Rio Grande do Sul, Brazil
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders
. 5th ed. Arlington (VA): American Psychiatric Association, 2013.
2. Bär KJ, Markser V. Sport specificity of mental disorders: the issue of sport psychiatry. Eur. Arch. Psychiatry Clin. Neurosci.
2013; 263: 205–10.
3. Wolanin A, Gross M, Hong E. Depression in athletes: prevalence and risk factors. Curr. Sports Med. Rep.
2015; 14: 56–60.