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What is the background to this research?
This specific article has focussed on the sport 'Football' or Soccer as some may call it within Europe. By looking deeper in the mental aspect of elite athletes and their sport, articles like this, show how important picking up these issues are and the benefits of performance after acting on these issues. This article studies the top footballers of Switzerland (male and female) in the first team league, as well as the under 21's team, and runs them through a depression, and anxiety test, looking for particular signs and symptoms of these two mental illnesses.

The vast amounts of pressure an elite footballer has to deal with must be hard to handle. Players are relied on to perform week in, week out in front of huge crowds which must be nerve racking. We know especially in the young ranks (under 21's & 23's) that various mental health issues arise in regards to performance, especially if playing for a major European club. Various factors could relate as to why players are suffering from mental illness, and this article may show why.

Where is the research from?
The organization this article was published by BMJ Journals, whom are a Sports & Exercise medicine based journal cite that cover a vide variety of the particular field but have a huge range of articles specific to physical activity for chronic disease prevention.

The authors have previous articles that have been focussed on injury prevention and psychology as well which is very similar to this particular article.

What kind of research was this?
This type of study was a 'questionnaire' based on the players characteristics with the questions falling under the Centre of Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder (GAD-7) scale.

Although there are a variety of tests to be completed for Anxiety and Depression, few articles have stated that these two questionnaires are good and basic, but true and proper results will come from the gold standard tests of that field.

What did the research involve?
Overlooking the method of this article, the questionnaires of both the CES-D and the GAD-7 scales were very characteristic specific. Both questionnaires asked the players questions relating to the playing position, number of matches and training sessions, number of injuries and frequency of intake of any medication (for pain, sleep, relaxation, depression, anxiety and others) within the last 12 months, as well as current injuries of the players. All players participated in both scaled tests. The CES-D was a self-reported questionnaire which looked at symptoms of Depression from the player over that past week. The GAD-7 however, measured the symptoms of Anxiety experienced in the past two weeks.

Both of these scales/tests have been deemed 'acceptable' for the general public, however ineffective with a isolated group in measuring Depression and Anxiety.

There have been many 'Gold Standard' tests for both Depression and Anxiety, which most have been compared in various studies. The Composite International Diagnostic Interview (CIDI), and the Patient Health Questionnaire-9 (PHQ-9) have both proven to gold standard for a Depression screening instrument. As for an Anxiety instrument, many tests have proven results, but as for the Zung scales, this instrument indicates and shows predictors more than the acceptable level.

Due to the study choosing Questionnaires to be the main instrument of diagnosis, there can be few limitations to the method. Questionnaires allow for the participant to answer in any form they feel, whether it being truthful of not, there can be times where participants will lie whilst answering the questions which leads to inconsistency of results. Another limitation to the study in general was the population, as this study looked at European teams (Switzerland League Teams), its a very country based population. Studies in various countries would help this study overall and boost results.

What were the basic results?
The main finding for the entire study was that the Swiss first team players were at the same risk of Depression and Anxiety as the general population. However, as for the male under 21's team, players had a higher prevalence of depression than the male general population. The study did show scores of the different positions play and their relationship to the scale. For the CES-D scale, results showed that players in an attacking position had a higher score than any other position on the team (male and female). For the GAD-7 scale, players of the Goalkeeper position scored higher than any other player (male and female).

Both scales had results for players playing in more than one position at different times, had a higher scale score than a player in one set position.

This was also the case of players being currently injured or not, stating that players are more likely to show characteristics of Depression and Anxiety whilst being injured.

What conclusions can we take from this research?
By how many elite footballers there were taking place in this study, there were bound to be results swaying towards high levels of depression and anxiety. The fact that the male U21's players scaled higher levels of depression was surprising. This could possibly be from pressure from managers, nervous in losing games, getting relegated or even just a lack of knowledge towards mental health and wellbeing. However, it is eye opening that specific positions show different levels of depression and anxiety.

Whilst similar authors of this study also completed the exact same trial in the Female German League, results show similarities in that depression and anxiety symptoms are influenced majorly by sport-specific variables such as player position, age and gender.

Practical advice
Someone's Mental Health and Wellbeing is a very serious thing and if not discovered, can be very serious. Especially for elite football players, playing a match every 4 or 5 days, coaches and staff of clubs would not like to see players in an unhealthy mental state.

The biggest thing clubs could do to help prevent these issues from arising is creating awareness on not just depression and anxiety but mental wellbeing as a whole. Clubs could consider:


 * Team talks with a psychologist (every week)
 * 24/7 professional assistance
 * Meditation sessions (daily)

By creating as much awareness as possible, the less likely for mental health symptoms to arise. To the athletes in need however, Adequate psychotherapeutic and/or pharmacological treatment should be provided ensuring that the athletes are going about these issues the correct way, which is seeking help or assistance professionally.