title: A multifactorial evaluation of illness risk factors in athletes preparing for the Summer Olympic Games.
abstract: OBJECTIVE
  Illness can disrupt training and competition performance of athletes. Few studies have quantified the relative contribution of the known medical, behavioural and lifestyle risk factors.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Olympic athletes from 11 sports (n=221) were invited to complete questionnaires administered nine months before the Rio 2016 Olympic Games. These included the Depression, Anxiety and Stress Questionnaire (DASS-21), Perceived Stress Scale (PSS), Dispositional Resilience Scale (DRS), Recovery-Stress Questionnaire (REST-Q-52 item), Low Energy in Females Questionnaire (LEAF-Q), a modified Personal and Household Hygiene questionnaire, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and custom-made questionnaires on probiotic usage and travel. An illness (case) was defined as an event which limited training or competition for greater hours in the prior month. Odds ratios and attributable fractions in the population (AFP) were utilised for categorical variables with independent t-tests or Wilcoxon rank-sum for continuous variables.
  
  
  RESULTS
  Eighty-one athletes responded (male, n=26; female, n=55). There were 16 illness cases and 65 controls. Female athletes were at higher odds of illness (OR=9.4, 95%CI 1.3-410, p=0.01, AFP=0.84). Low energy availability (LEAF-Q score ≥8: OR=7.4, 95%CI 0.78-352, p=0.04, AFP=0.76), depression symptoms (DASS-21: depression score >4, OR=8.4, 95%CI 1.1-59, p<0.01; AFP=0.39) and higher perceived stress (PSS: 10-item, p=0.04) were significantly associated with illness.
  
  
  CONCLUSIONS
  Female sex, low energy availability, and mental health are associated with sports incapacity (time loss) due to illness. Low energy availability had high attributable fractions in the population and stands out as a primary association with illness.
authors.affiliation: Australian Institute of Sport, Australia; Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia. Electronic address: Michael.drew@ausport.gov.au.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Drew
authors.affiliation: Australian Institute of Sport, Australia; Bond University, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Vlahovich
authors.affiliation: Australian Institute of Sport, Australia; Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Hughes
authors.affiliation: Australian Institute of Sport, Australia.
authors.forename: Renee
authors.initials: R
authors.lastname: Appaneal
authors.affiliation: Australian Institute of Sport, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Peterson
authors.affiliation: Australian Institute of Sport, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Burke
authors.affiliation: Australian Institute of Sport, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Australia.
authors.forename: Bronwen
authors.initials: B
authors.lastname: Lundy
authors.affiliation: Queensland Academy of Sport, Australia; Department of Physiotherapy, Griffith University, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Toomey
authors.affiliation: Queensland Academy of Sport, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Watts
authors.affiliation: Australian Institute of Sport, Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Lovell
authors.affiliation: Australian Institute of Sport, Australia.
authors.forename: Stephan
authors.initials: S
authors.lastname: Praet
authors.affiliation: Australian Institute of Sport, Australia.
authors.forename: Shona
authors.initials: S
authors.lastname: Halson
authors.affiliation: Menzies Institute, Griffith University, Australia.
authors.forename: Candice
authors.initials: C
authors.lastname: Colbey
authors.affiliation: Australian Institute of Sport, Australia.
authors.forename: Silvia
authors.initials: S
authors.lastname: Manzanero
authors.affiliation: Australian Institute of Sport, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia.
authors.forename: Marijke
authors.initials: M
authors.lastname: Welvaert
authors.affiliation: Menzies Institute, Griffith University, Australia.
authors.forename: Nic
authors.initials: N
authors.lastname: West
authors.affiliation: Australian Institute of Sport, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia.
authors.forename: David B
authors.initials: DB
authors.lastname: Pyne
authors.affiliation: Australian Institute of Sport, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE), Australia.
authors.forename: Gordon
authors.initials: G
authors.lastname: Waddington
mesh_terms: D000328:Adult; D056352:Athletes / Q000523:psychology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D012307:Risk Factors; D012737:Sex Factors; D013178:Sports Medicine / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Athlete; Case-control; Illness; Prevention; Risk factor