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Depression, Anxiety, and Alcohol Use in Elite Rugby League Players Over a Competitive Season

Du Preez, Etienne J. MBBS*; Graham, Kenneth S. PhD; Gan, Thomas Y. MBBS; Moses, Bassam MBBS§; Ball, Chris MBBS; Kuah, Donald E. MBBS

Clinical Journal of Sport Medicine: November 2017 - Volume 27 - Issue 6 - p 530–535
doi: 10.1097/JSM.0000000000000411
Original Research

Objective: To assess the prevalence of symptoms of depression, anxiety, and rates of alcohol misuse in elite rugby league players in Australasia.

Design: A cross-sectional, epidemiological study with repeated measures.

Setting: Surveys were conducted during the 2015 preseason and in-season.

Participants: Four hundred four elite rugby league players participated preseason and 278 players in-season.

Main Outcome Measures: Symptoms of depression were measured using the Patient Health Questionnaire-9 scale, symptoms of generalized anxiety disorder (GAD) with the GAD-7 scale, and the Alcohol Use Disorders Identification Test Consumption scale was used to assess hazardous alcohol use.

Results: The overall prevalence of depression was 12.6% preseason and 10.1% in-season. Generalized anxiety disorder had a prevalence of 14.6% and 10.1% for these 2 periods. Overall, 68.6% of players had hazardous levels of alcohol use preseason, and 62.8% in-season. There was no significant difference for any of the main outcomes between the periods. Players with a history of mental illnesses had 5.62 greater odds (95% confidence interval [CI], 2.62-12.04) of depression than those without during preseason, and 22.08 greater odds (95% CI, 7.77-62.71) in-season. Players reporting ≥3 previous concussions had 2.02 greater odds (95% CI, 1.07-3.82) of depression than those reporting ≤2 in the preseason sample.

Conclusions: Rugby league players have a lower prevalence of depression compared with studies of the general population and other athletes, but a higher prevalence of GAD, and high rates of alcohol misuse. Clubs may consider implementing regular screening for these conditions. Further prospective research to determine causality of independent factors is required.

*Australasian College of Sport and Exercise Physicians, Sydney, Australia;

Applied Research Program, New South Wales Institute of Sport, Sydney, Australia;

Narrabeen Sports Medicine Centre, Sydney, Australia;

§Southern Cross Orthopaedic and Sports Clinic, Sydney, Australia;

Sports Clinic NQ, North Ward, Australia; and

Sydney Sports Medicine Centre, New South Wales Institute of Sport, Sydney, Australia.

Corresponding Author: Etienne J. Du Preez, MBBS, The Stadium Sports Medicine Clinic, Sheridan Building, Moore Park Rd, Moore Park, New South Wales, Australia 2021 (

E. J. Du Preez, T. Y. Gan, B. Moses, and C. Ball consulted for the Wests Tigers, Manly Sea-Eagles, Canterbury Bulldogs, and North Queensland Cowboys football clubs, respectively, as team medical officers, and K. S. Graham is currently a member of the National Rugby League Research Board. They received no direct funding from the National Rugby League or any other institution for this study. The remaining authors report no conflicts of interest.

Received June 30, 2016

Accepted October 31, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.