title: Are severe musculoskeletal injuries associated with symptoms of common mental disorders among male European professional footballers?
abstract: OBJECTIVE
  To explore the associations of severe musculoskeletal injuries (joint and muscles) and surgeries with symptoms of common mental disorders (distress, anxiety/depression, sleeping disturbance, adverse alcohol behaviour , smoking, adverse nutrition behaviour) among male European professional footballers.
  
  
  METHODS
  Cross-sectional analyses were conducted on electronic questionnaires completed by professional footballers recruited from the national players' unions of Finland, France, Norway, Spain or Sweden. The number of severe (time loss of more than 28 days) musculoskeletal injuries (total, joint, muscle) and surgeries during a professional football career was examined through four questions, while symptoms of common mental disorders were evaluated through validated scales.
  
  
  RESULTS
  A total of 540 professional footballers (mean age of 27 years; 54 % playing in the highest leagues) participated in the study. Sixty-eight per cent of the participants had already incurred one or more severe joint injuries and 60 % one or more severe muscle injuries. Prevalence of symptoms of common mental disorders ranged from 3 % for smoking to 37 % for anxiety/depression and 58 % for adverse nutrition behaviour. The number of severe musculoskeletal injuries during a football career was positively correlated with distress, anxiety and sleeping disturbance, while the number of surgeries was correlated with adverse alcohol behaviour and smoking. Professional footballers who had sustained one or more severe musculoskeletal injuries during their career were two to nearly four times more likely to report symptoms of common mental disorders than professional footballers who had not suffered from severe musculoskeletal injuries.
  
  
  CONCLUSIONS
  It can be concluded that the number of severe musculoskeletal injuries and surgeries during a career is positively correlated and associated with symptoms of common mental disorders among male European professional footballers. This study emphasises the importance of applying a multidisciplinary approach to the clinical care and support of professional footballers, especially when a player faces lengthy periods without training and competition as a consequence of recurrent severe joint or muscle injuries.
  
  
  METHODS
  III.
authors.affiliation: Academic Center for Evidence based Sports medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands. v.gouttebarge@fifpro.org.|Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands. v.gouttebarge@fifpro.org.|Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands. v.gouttebarge@fifpro.org.|World Players' Union (FIFPro), Scorpius 161, 2132 LR, Hoofddorp, The Netherlands. v.gouttebarge@fifpro.org.
authors.forename: Vincent
authors.initials: V
authors.lastname: Gouttebarge
authors.affiliation: St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Haruhito
authors.initials: H
authors.lastname: Aoki
authors.affiliation: Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Ekstrand
authors.affiliation: Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands.|Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Evert A L M
authors.initials: EA
authors.lastname: Verhagen
authors.affiliation: Academic Center for Evidence based Sports medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands.|Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands.|Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Gino M M J
authors.initials: GM
authors.lastname: Kerkhoffs
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology / Q000523:psychology; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D001265:Athletic Injuries / Q000453:epidemiology* / Q000523:psychology / Q000601:surgery; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005247:Feeding Behavior; D005387:Finland / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D009141:Musculoskeletal System / Q000293:injuries*; D009664:Norway / Q000453:epidemiology; D060051:Occupational Injuries / Q000453:epidemiology* / Q000523:psychology / Q000601:surgery; D015995:Prevalence; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000523:psychology; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D012916:Soccer / Q000293:injuries*; D013030:Spain / Q000453:epidemiology; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: Injuries; Mental disorders; Soccer; Surgeries