title: Osteoarthritis is associated with symptoms of common mental disorders among former elite athletes.
abstract: OBJECTIVE
  The primary aim was to establish the association between osteoarthritis (OA) and the occurrence and comorbidity of symptoms of common mental disorders (CMD: distress, anxiety/depression, sleep disturbance, adverse alcohol use) in a group of former elite athletes (rugby, football, ice hockey, Gaelic sports and cricket). A secondary aim was to explore this association in the subgroups of sports.
  
  
  METHODS
  Cross-sectional analysis was performed on the baseline questionnaires from five prospective cohort studies conducted between April 2014 and January 2016 in former elite athletes of rugby, football, ice hockey, Gaelic sports and cricket. The presence of OA (diagnosed by a medical professional) was examined with a single question, and symptoms of CMD were evaluated through multiple validated questionnaires (4DSQ, GHQ-12, PROMIS, AUDIT-C).
  
  
  RESULTS
  There was a significant association between OA and symptoms of distress (OR 1.7, 95 % CI 1.2-2.6), sleep disturbance (OR 1.6, 95 % CI 1.1-2.3), adverse alcohol use (OR 1.8, 95 % CI 1.2-2.6) and a comorbidity of symptoms of CMD (OR 1.5, 95 % CI 1.0-2.1) in former elite athletes.
  
  
  CONCLUSIONS
  OA might be a risk factor for developing symptoms of CMD in former elite athletes. The clinical relevance of this study is that an interdisciplinary approach to the clinical care and support of former elite athletes after their careers is advocated as the interaction between the physical and mental health issues occurring on the long term is complex. Monitoring OA among former elite athletes should be empowered while strategies to prevent symptoms worsening should be developed and implemented. The self-awareness, prevention and care of mental health problems that might occur after a professional sports career should also be addressed.
  
  
  METHODS
  Level III.
authors.affiliation: Academic Center for Evidence-based Sports medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Nannet
authors.initials: N
authors.lastname: Schuring
authors.affiliation: St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Haruhito
authors.initials: H
authors.lastname: Aoki
authors.affiliation: Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Janine
authors.initials: J
authors.lastname: Gray
authors.affiliation: Academic Center for Evidence-based Sports medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands.|Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.|Amsterdam Collaboration for Health & Safety in Sports (ACHSS), Academic Medical Center/VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Gino M M J
authors.initials: GMMJ
authors.lastname: Kerkhoffs
authors.affiliation: Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.|EMGO + Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Mike
authors.initials: M
authors.lastname: Lambert
authors.affiliation: Academic Center for Evidence-based Sports medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands. v.gouttebarge@fifpro.org.|Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa. v.gouttebarge@fifpro.org.|Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands. v.gouttebarge@fifpro.org.|Amsterdam Collaboration for Health & Safety in Sports (ACHSS), Academic Medical Center/VU 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
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000209:etiology*; D001007:Anxiety / Q000175:diagnosis / Q000209:etiology*; D056352:Athletes / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology*; D013177:Sports / Q000523:psychology*
keywords: Common mental disorders; Elite athletes; Mental health; Osteoarthritis; Quality of life