A Five-Timepoint Longitudinal Study of Sports Injury and Mental Health in Elite Sport

Background Elite athletes often report psychological distress following injury, yet longitudinal research on injury and mental health is scarce, and existing studies rarely apply clinically validated mental health measures. Consequently, little is understood about how injury and mental health influence each other over time or which factors shape athletes’ mental health during injury. Thus, this study aimed to examine the: 1) relationship between injury and mental health over time, and 2) personal and situational factors that contributed to athletes’ mental health during injury. Seventy-two elite athletes (43 female, M age = 25.58 ± 5.79 years) completed questionnaires across five timepoints over 12 months, during which 47 injuries were recorded. Four mental health related outcomes were assessed—psychological distress, symptoms of anxiety and depression, and psychological well-being—alongside personal (e.g., athletic identity) and situational (e.g., social support) factors. Results At each timepoint, injury status was significantly associated with distress and well-being. Over time, symptoms of anxiety predicted injury status, and reciprocal effects were observed between injury status and depressive symptoms. Regarding contributing factors, greater intolerance of uncertainty and lower perceived support were associated with poorer mental health for all outcomes, while stronger athletic identity was associated with greater distress and lower well-being. Feeling less able to cope with psychological load in sport was associated with greater distress, more depressive symptoms, and lower well-being. Experiencing more intense life load was associated with lower well-being, and feeling less able to cope with life load was associated with greater distress and depressive symptoms. Conclusions Injury and mental health are dynamically and reciprocally related over time in elite athletes, particularly for symptoms of depression. Intolerance of uncertainty and perceived social support were consistent correlates across all mental health and well-being outcomes, whereas perceived coping with sport and life load was associated with mental health outcomes. Practitioners could prioritise (1) routine screening for anxiety and depressive symptoms before and after injury, and (2) interventions that strengthen tolerance of uncertainty, social support, and ability to cope with psychological load.