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Injury Associated with Higher Prevalence of Psychological Distress and Depressive Symptoms Among South African Female Athletes: Findings from the Female Athlete Lifestyle and Mental Health Evaluation I (FLAME I) study

Naidoo D, Burger J, Jordaan E, Boer P, Gouttebarge V, MacMillan C et al. · Research Square · 2026

This study surveyed 376 South African female athletes and found that mental health symptoms were common, with disordered eating (75%), psychological distress (67%), and sleep disturbances (45%) being most prevalent. The research identified previous injury as a risk factor for psychological distress and depression, while younger age and academic commitments were associated with increased anxiety.
Takeaway: Screen female athletes for mental health symptoms, especially those with a history of injury.
Abstract (source)

Abstract

Background: Female athletes may be at greater risk of experiencing mental health symptoms than their male counterparts due to unique biological, psychological, and sport-related stressors. In South Africa, however, there is limited evidence regarding the mental health status of female athletes. The

Aim: of the study was to estimate the prevalence of mental health symptoms among South African female athletes by level of participation (elite vs amateur) and sport type (team vs individual), and to identify demographic and sport-related risk indicators associated with these symptoms.

Methods: A cross-sectional study was conducted using an online questionnaire. A total of 376 athletes participated. The survey assessed symptoms of psychological distress, anxiety, depression, disordered eating, sleep disturbance and alcohol misuse, as well as demographic and sport-related characteristics.

Results: Disordered eating had the highest prevalence (75%), followed by psychological distress (67%) and sleep disturbances (45%). Lower prevalence rates were observed for alcohol misuse (36%), anxiety (27%), and depression (25%). One-third (33%) of participants reported no symptoms of psychological distress. Previous injury was identified as a risk indicator for psychological distress and depression, while younger age and studying were associated with increased anxiety symptoms.

Conclusions: Mental health symptoms are common among South African female athletes, with particularly high rates of disordered eating and psychological distress. Injury history, younger age, and academic commitments may increase vulnerability to certain symptoms. These

Findings: highlight the need for targeted mental health screening, prevention strategies, and support services tailored to the needs of female athletes across different sporting contexts.

Primary studyRecovery & Sleep
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