Mapping mental health problems in elite female athletes—a scoping review. Emphasising limited research in Africa and South America

Abstract

BACKGROUND : Mental health symptoms and disorders are growing concerns among elite athletes facing unique psychological stressors from high-performance competition. While prevalence has been studied in male athletes and regions like Europe and Australia, significant gaps exist regarding elite female athletes from underrepresented regions, including Africa. OBJECTIVES : To conduct a scoping review on the literature of mental health symptoms and disorders in elite female athletes globally, identify geographic research gaps, and summarise key contributing factors and methodologies. DESIGN : Scoping review. METHODS : While focusing on mental health symptoms and disorders among elite female athletes, studies including both female and male participants were considered to provide a comprehensive overview. A search was conducted in PubMed, PsycINFO, CINAHL, and Scopus databases. Two reviewers independently screened studies, extracted data, and charted results on study characteristics, descriptive study-level prevalence estimates, associated factors, and methodologies. RESULTS : Fifty-nine studies were included. Only seven investigated elite female athletes, 22 reported sex-disaggregated prevalence estimates, and 30 presented aggregated results. Most studies (88.1%) were cross-sectional. Only three studies investigated disorders, and the remaining 56 investigated symptoms such as depression, anxiety, and disordered eating. Risk associations included injury, illness, career dissatisfaction, financial stress, and gender. Research originated mainly from Europe (n = 27), with only one study from Africa and three from South America. CONCLUSIONS : Mental health symptoms are prevalent among elite female athletes, yet evidence is skewed toward high-income regions and often lacks female-specific data. More geographically inclusive, longitudinal, and sex-disaggregated research is needed, particularly in Africa and South America, to ensure the development of equitable interventions and policies.