Anxiety and Depression in Athletes of Different Levels Without Current Injury: A Systematic Review With Meta-Analyses

Context: Exercise has been demonstrated to positively affect the prevention and treatment of anxiety and depression; however, athletes face an increased risk of mental health issues. Objectives: To determine the prevalence and incidence of anxiety and depression among athletes and explore potential factors influencing these outcomes. Data Sources: PubMed, Embase, and Web of Science databases were searched between inception and August 18, 2025, for studies in which anxiety and depression in athletes were investigated. Study Selection: Studies were included according to the following criteria: (1) athletes of any level including high school or collegiate level, amateur, and elite and (2) prevalence or incidence of moderate to severe anxiety or depressive symptoms or diagnosis of anxiety or depressive disorders. Data Extraction: Study characteristics, type of modality, anxiety or depressive symptoms tools with cutoffs for moderate to severe symptoms, and participant characteristics were extracted. Two reviewers assessed risk of bias of the included studies using the Newcastle-Ottawa Scale. Meta-analysis was performed using random-effects models. We calculated incidence and prevalence estimates with 95% CIs for each study, then pooled the data for symptom groups. Subanalyses by level of sport and type of sport were conducted. Data Synthesis: We included 64 studies (n = 131 840 athletes) in the systematic review and 64 studies (97 events) in the meta-analysis. The prevalence of diagnosed disorders was 21% for anxiety (95% CI = 0.14, 0.29; 3 studies, 106 403 athletes), 6% for depression (95% CI = 0.04, 0.10; 1 study, 290 athletes), and 14% for combined anxiety and depression (95% CI = 0.12, 0.15; 1 study, 3719 athletes). However, the prevalence of moderate to severe anxiety symptoms was 16% (95% CI = 0.13, 0.21; 33 studies, 12 893 athletes), 18% for moderate to severe depressive symptoms (95% CI = 0.14, 0.22; 46 studies, 19 290 athletes), and 35% for moderate to severe anxiety and depressive symptoms (95% CI = 0.29, 0.43; 11 studies, 4069 athletes). The 12-month incidence for moderate to severe anxiety and depressive symptoms was 40% (95% CI = 0.24, 0.58; 3 studies, 611 athletes). Conclusions: The prevalence rates for moderate to severe anxiety, depressive, or anxiety and depressive symptoms are relatively different when diagnosed by specialists or assessed using validated screening tools. These findings underscore the importance of early identification and focused attention on athletes' mental health.