Influences on the mental health and well-being of retired professional athletes from high contact team sports: a mixed methods systematic review.

OBJECTIVE To report the prevalence of mental health symptoms and influencing factors in retired professional high contact team sport (HCTS) athletes. DESIGN Mixed-methods systematic review. DATA SOURCES PsycINFO, Embase, Medline, SPORTDiscus and Scopus were searched in July 2023 and March 2025. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies that investigated mental health and/or influencing factors within retired professional HCTS athletes were included. Studies that were non-peer-reviewed, could not obtain full text, used secondary data or focused on non-elite/individual/low-contact sports were excluded. RESULTS 85 studies were included in the final review, comprising 53 996 participants (females; n=247, 0.46%) from six sports (Australian Football League, Canadian Football League, football/soccer, ice hockey, National Football League and rugby). Prevalence ranges varied for each condition; smoking (0.9%-16%), depression (3%-49%), anxiety (4.3%-42%), cannabis use (5%-15.7%), adverse alcohol use (6.4%-68.8%), opioid use (7%-23.6%), stress (8.7%-26.9%), illicit drug use (10%-63.2%), anxiety/depression (10.2%-39%) and adverse nutritional behaviour (23.8%-64.5%). Of the studies including M and SD of validated scales, scores for depression, anxiety and sleep disturbance were equivalent to population norms, whereas mild or higher scores were reported for stress and adverse alcohol use. Concussion, pain, injury, neurological factors and declined physical function were shown to have a negative influence on mental health. Both negative and positive influences were observed for: athletic identity, psychosocial support, retirement autonomy, life events, osteoarthritis, retirement and cognitive function. 48% of studies had good methodological quality; however, most studies were cross-sectional, relied on self-report measures and lacked follow-up data and female athletes. CONCLUSION Retired HCTS athletes experience high levels of psychological distress and adverse alcohol use, but depression, anxiety and sleep disturbance were similar to population norms. These results call for greater support measures for retired athletes. PROSPERO REGISTRATION NUMBER CRD42023449114.