Disordered eating attitudes, depressive symptomatology and alcohol consumption in young athletes
Keywords:disordered eating behaviors, athletes, depression, alcohol consumption
Purpose: The aim of the study was to investigate the prevalence of disordered eating behaviors and attitudes in Slovenian male and female categorized athletes in relation to depressive symptoms and their alcohol consumption.
Methods: The sample included 198 categorized athletes between 18 and 20 years of age. The Eating Attitude Test, the Center for Epidemologic Studies Depression Scale, and the Alcohol Use Disorders Identification Test were used to measure disordered eating behaviors, level of depression, and alcohol use, respectively.
Results: Significant differences were found between female and male athletes, with female athletes reporting higher levels of disordered eating attitudes and depressive symptoms. 13.90% of athletes reported clinically significant eating disorder symptoms, 40% reported clinically significant depressive symptoms, and 10.50% reported risky alcohol use. Results also showed that athletes with higher eating disorder attitudes had higher depressive levels.
Conclusion: These findings have important practical value and point to the importance of building a professional team trained to recognize mental health problems in athletes in order to provide appropriate help.
Ackerman, K. E., Holtzman, B., Cooper, K. M., Flynn, E. F., Bruinvels, G., Tenforde, A. S. ... Parziale, A. L. (2019). Low energy availability surrogates correlate with health and performance consequences of relative energy deficiency in sport. British Journal of Sports Medicine, 53(10), 628–633. https://doi.org/10.1136/bjsports-2017-098958
Al Bahhawi, T., Albasheer, O., Makeen, A., Arishi, A., Hakami, O., Maashi, S., ... Mahfouz, M. S. (2018). Depression, anxiety, and stress and their association with Khat use: A cross-sectional study among Jazan University students, Saudi Arabia. Neuropsychiatric Disease and Treatment., 14, 2755–2761. https://doi.org/10.2147/NDT.S182744
American Psychiatric Association. (2013). Diagnostic and Statistics Manual of Mental Disorders. 5th ed. American Psychiatric Association.
Armstrong, S., & Oomen-Early, J. (2009). Social connectedness, self-esteem, and depression symptomatology among collegiate athletes versus nonathletes. Journal of American College Health, 57(5), 521–526. https://doi.org/10.3200/JACH.57.5.521-526.
Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). The alcohol use disorders identification test. Geneva: World Health Organization.
Bratland-Sanda, S., & Sundgot-Borgen, J. (2013). Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. European Journal of Sport Science, 13(5), 499-508. https://doi.org/10.1080/17461391.2012.740504
Brenner, J., & Swanik, K. (2007). High-risk drinking characteristics in collegiate athletes. Journal of American College Health, 56(3), 267–272. https://doi.org/10.3200/JACH.56.3.267-272
Bruffaerts, R., Mortier, P., Kiekens, G., Auerbach, R. P., Cuijpers, P., Demyttenaere, K., … Kessler, R. C. (2018). Mental health problems in college freshmen: Prevalence and academic functioning. Journal of Affective Disorders, 225, 97–103. https://doi.org/10.1016/j.jad.2017.07.044.
Chapa, D. A., Hagan, K. E., Forbush, K. T., Perko, V. L., Sorokina, D. A., Alasmar, A. Y., ... & Stewart, T. M. (2018). The athletes’ relationships with training scale (ART): A self‐report measure of unhealthy training behaviors associated with eating disorders. International Journal of Eating Disorders, 51(9), 1080-1089. https://doi.org/10.1002/eat.22960
Chow, M. S., Ling Poon, S. H., Lui, K. L., Chan, C. C. Y., & Lam, W. W. (2021). Alcohol consumption and depression among university students and their perception of alcohol use. East Asian Archives of Psychiatry, 31(4), 87-96. https://doi.org/10.12809/eaap20108.
Conigrave, K. M., Saunders, J. B., & Reznik, R. B. (1995). Predictive capacity of the AUDIT questionnaire for alcohol‐related harm. Addiction, 90(11), 1479–1485. https://doi.org/10.1046/j.1360-0443.1995.901114796.x.
Corney, T., & du Plessis, K. (2022). Australian first-year university college residents’ alcohol consumption and alcohol-related harms. Nordic Studies on Alcohol and Drugs, 39(4), 406-417. https://doi.org/10.1177/14550725221090037.
Deepthi, A., Praveen, K. K., Chandrashekhar-Rao, P., Vincent, K., & Kishore, M. T. (2014). Relationship among body mass, self-esteem and depression in overweight Indian adolescents: role of binge eating. Journal of the Indian Academy of Applied Psychology, 40(2), 289-293.
Diehl, K., Thiel, A., Zipfel, S., Mayer, J., & Schneider, S. (2014). Substance use among elite adolescent athletes: Findings from the GOAL Study. Scandinavian Journal of Medicine & Science in Sports, 24(1), 250–258. https://doi.org/10.1111/j.1600-0838.2012.01472.x.
Dunn, M., Thomas, J. O., Swift, W., & Burns, L. (2011). Recreational substance use among elite Australian athletes. Drug and Alcohol Review, 30(1), 63–68. https://doi.org/10.1111/j.1465-3362.2010.00200.x.
Dunn, M. & Thomas, J. O. (2012). A risk profile of elite Australian athletes who use illicit drugs. Addictive Behaviors, 37(1), 144–147. https://doi.org/10.1016/j.addbeh.2011.09.008
Du Preez, E. J., Graham, K. S., Gan, T. Y., Moses, B., Ball, C., & Kuah, D. E. (2017). Depression, anxiety, and alcohol use in elite rugby league players over a competitive season. Clinical Journal of Sport Medicine: Official Journal of the Canadian Academy of Sport Medicine, 27(6), 530-535. https://doi.org/10.1097/JSM.0000000000000411.
Fouladi, F., Mitchell, J. E., Crosby, R. D., Engel, S. G., Crow, S., Hill, L., ... & Steffen, K. J. (2015). Prevalence of alcohol and other substance use in patients with eating disorders. European Eating Disorders Review, 23(6), 531-536. https://doi.org/10.1002/erv.2410
Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. The American journal of clinical nutrition, 109(5), 1402-1413. https://doi.org/10.1093/ajcn/nqy342
Garner, D. M., & Garfinkel, P. E. (1979). The eating attitudes test: An index of the symptoms of anorexia nervosa. Psychological Medicine, 9(2), 273–279. https://doi.org/10.1017/s0033291700030762.
Garner, D. M., Olmsted, M. P., Bohr, Y., & Garﬁnkel, P. E. (1982). The eating attitudes test: psychometric features and clinical correlates. Psychological Medicine, 12(4), 871–878. https://doi.org/10.1017/s0033291700049163
Godart, N., Radon, L., Curt, F., Duclos, J., Perdereau, F., Lang, F., ... & Flament, M. F. (2015). Mood disorders in eating disorder patients: prevalence and chronology of ONSET. Journal of Affective Disorders, 185, 115-122. https://doi.org/10.1016/j.jad.2015.06.039
Gouttebarge, V., Castaldelli-Maia, J. M., Gorczynski, P., Hainline, B., Hitchcock, M. E., Kerkhoffs, G.M., … Reardon C. L. (2019). Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. British Journal of Sports Medicine. 2019, 53(11), 700-706. https://doi.org/10.1136/bjsports-2019-100671.
Jones, L. E., Buckner, E., & Miller, R. (2014). Chronological progression of body dissatisfaction and drive for thinness in females 12 to 17 years of age. Pediatric Nursing, 40(1), 21-25.
Joy, E., Kussman, A., & Nattiv, A. (2016). 2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management. British Journal of Sports Medicine, 50(3), 154–162. https://doi.org/10.1136/bjsports-2015-095735.
Junge, A., & Feddermann-Demont, N. (2016). Prevalence of depression and anxiety in top-level male and female football players. BMJ Open Sport & Exercise Medicine, 2(1), 62–87. https://doi.org/10.1136/bmjsem-2015-000087
Keel, P. K., & Forney, K. J. (2013). Psychosocial risk factors for eating disorders. International Journal of Eating Disorders, 46(5), 433-439. https://doi.org/10.1002/eat.22094
Knapp, J., Aerni, G., & Anderson, J. (2014). Eating disorders in female athletes: use of screening tools. Current Sports Medicine Reports, 13(4), 214-218. https://doi.org/10.1249/JSR.0000000000000074
Kristjánsdóttir, H., Sigurðardóttir, P., Jónsdóttir, S., Þorsteinsdóttir, G., & Saavedra, J. (2019). Body image concern and eating disorder symptoms among elite Icelandic athletes. International Journal of Environmental Research and Public Health, 16(15), 2728. https://doi.org/10.3390/ijerph16152728
Lakasing, E., & Mirza, Z. A. (2009). Football and alcohol: a short diary of a long and complex relationship. London Journal of Primary Care, 2(1), 78–80. https://doi.org/10.1080/17571472.2009.11493253
Lewinsohn, P. M., Seeley, J. R., Roberts, R. E., & Allen, N. B. (1997). Center for epidemiological studies-depression scale (CES-D) as a screening instrument for depression among community-residing older adults. Psychology and Aging, 12(2), 277–287. https://doi.org/10.1037/0882-79188.8.131.527
Lisha, N. E., & Sussman, S. (2010). Relationship of high school and college sports participation with alcohol, tobacco, and illicit drug use: A review. Addictive Behaviors, 35(5), 399–407. https://doi.org/10.1016/j.addbeh.2009.12.032
Lorente, F. O., Souville, M., Griffet, J., & Grélot, L. (2004). Participation in sports and alcohol consumption among French adolescents. Addictive Behaviors, 29(5), 941–946. https://doi.org/10.1016/j.addbeh.2004.02.039
Manaf, N. A., Saravanan, C., & Zuhrah, B. (2016). The prevalence and inter-relationship of negative body image perception, depression and susceptibility to eating disorders among female medical undergraduate students. Journal of Clinical and Diagnostic Research: JCDR, 10(3), VC01. https://doi.org/10.7860/JCDR/2016/16678.7341
Martinsen, M., & Sundgot-Borgen, J. (2013). Higher prevalence of eating disorders among adolescent elite athletes than controls. Medicine & Science in Sports & Exercise, 45(6), 1188-1197. https://doi.org/10.1249/MSS.0b013e318281a939
McDonald, A. H., Pritchard, M., & McGuire, M. K. (2019). Self-reported eating disorder risk in lean and non-lean NCAA Collegiate Athletes. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 25, 745–750. https://doi.org/10.1007/s40519-019-00681-0
McIntyre, R. S., & Calabrese, J. R. (2019). Bipolar depression: the clinical characteristics and unmet needs of a complex disorder. Current Medical Research and Opinion, 35(11), 1993-2005. https://doi.org/10.1080/03007995.2019.1636017
Nivedita, N., Sreenivasa, G., Rao, T. S., & Malini, S. S. (2018). Eating disorders: Prevalence in the student population of Mysore, South India. Indian Journal of Psychiatry, 60(4), 433-437. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_97_16
Nixdorf, I., Frank, R., Hautzinger, M., & Beckmann, J. (2013). Prevalence of depressive symptoms and correlating variables among German elite athletes. Journal of Clinical Sport Psychology, 7(4), 313–326. https://doi.org/10.1123/jcsp.7.4.313
Nixdorf, I., Frank, R., & Beckmann, J. (2016). Comparison of athletes’ proneness to depressive symptoms in individual and team sports: research on psychological mediators in junior elite athletes. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.00893
O'Brien, K. S., Ali, A., Cotter, J. D., O'Shea, R. P., & Stannard, S. (2007). Hazardous drinking in New Zealand sportspeople: level of sporting participation and drinking motives. Alcohol & Alcoholism, 42(4), 376–382. https://doi.org/10.1093/alcalc/agm035
Okun, A., Stein, R. E., Bauman, L. J., & Silver, E. J. (1996). Content validity of the Psychiatric Symptom Index, CES-depression Scale, and State-Trait Anxiety Inventory from the perspective of DSM-IV. Psychological Reports, 79(3), 1059-1069. https://doi.org/10.2466/pr0.19184.108.40.2069
Peretti‐Watel, P., Guagliardo, V., Verger, P., Pruvost, J., Mignon, P., & Obadia, Y. (2003). Sporting activity and drug use: Alcohol, cigarette and cannabis use among elite student athletes. Addiction, 98(9), 1249–1256. https://doi.org/10.1046/j.1360-0443.2003.00490.x
Perko, U. (2021). Izbrani vidiki duševnega zdravja med športniki [Chosen aspects of mental health of athletes] (Doctoral dissertation). Retrieved from https://repozitorij.upr.si/IzpisGradiva.php?lang=slv&id=16296
Prinz, B., Dvořák, J., & Junge, A. (2016). Symptoms and risk factors of depression during and after the football career of elite female players. BMJ Open Sport & Exercise Medicine, 2(1), e000124. https://doi.org/10.1136/bmjsem-2016-000124
Purcell, R., Rice, S., Butterworth, M., & Clements, M. (2020). Rates and correlates of mental health symptoms in currently competing elite athletes from the Australian National high-performance sports system. Sports Medicine, 50(9), 1683-1694. https://doi.org/10.1007/s40279-020-01266-z
Radloff, L. S. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306
Ramón-Arbués, E., Gea-Caballero, V., Granada-López, J. M., Juárez-Vela, R., Pellicer-García, B., & Antón-Solanas, I. (2020). The prevalence of depression, anxiety and stress and their associated factors in college students. International Journal of Environmental Research and Public Health, 17(19), 7001. https://doi.org/10.3390/ijerph17197001
Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., ... Engebretsen, L. (2019). Mental health in elite athletes: International Olympic Committee consensus statement. British Journal of Sports Medicine, 53 (11), 667–699. https://doi.org/10.1136/bjsports-2019-100715
Rosendahl, J., Bormann, B., Aschenbrenner, K., Aschenbrenner, F., & Strauss, B. (2009). Dieting and disordered eating in German high school athletes and non‐athletes. Scandinavian Journal of Medicine & Science in Sports, 19(5), 731–739. https://doi.org/10.1111/j.1600-0838.2008.00821.x
Sanchis, A. M., Balmaseda, J. B., & Hidalgo, R. (2022). Trastornos de conducta alimentaria en la práctica deportiva: actualización y propuesta de abordaje integral. Endocrinología, Diabetes y Nutrición, 69(2), 131-143.
Sathyanarayana, R. T. S., Asha, M. R., Ramesh, B. N., & Jagannatha, R. K. S. (2008). Understanding nutrition, depression and mental illnesses. Indian Journal of Psychiatry. 50(2), 77–82. https://doi.org/10.4103/0019-5545.42391
Scott, C. L., Haycraft, E., & Plateau, C. R. (2019). Teammate influences on the eating attitudes and behaviours of athletes: A systematic review. Psychology of Sport and Exercise, 43, 183-194. https://doi.org/10.1016/j.psychsport.2019.02.006
Sorko, N., & Boben, D. (2014). Pasti odraščanja v alkoholni kulturi: Analiza nekaterih ključnih dejavnikov odnosa do alkohola slovenskih osnovnošolcev [The pitfalls of growing up in an alcohol culture: an analysis of some key factors of attitudes towards alcohol among Slovenian primary schoolchildren]. Ljubljana: Društvo Žarek upanja, 2014.
Sundgot‐Borgen, J., & Torstveit, M. (2010). Aspects of disordered eating continuum in elite high‐intensity sports. Scandinavian Journal of Medicine & Science in Sports, 20(2), 112-121. https://doi.org/10.1111/j.1600-0838.2010.01190.x
Syed, A., Zeb, F., Khan, S., Safdar, M., Alam, I., Shahzad, M., ... & Munir, M. (2018). Exploration of eating disorders, nutritional and health status based on Eating Attitude Test-26 amongst university adolescent girls. Journal of Food and Nutrition Research, 6(7), 464-470. https://doi.org/10.12691/jfnr-6-7-7
Ustun, G. (2021). Determining depression and related factors in a society affected by the COVID-19 pandemic. International Journal of Social Psychiatry, 67(1), 54–63. https://doi.org/10.1177/0020764020938807
Vaz-Leal, F. J., Ramos-Fuentes, M. I., Rodriguez-Santos, L., Flores-Mateos, I. S., Franco-Zambrano, A., & Rojo-Moreno, L. (2015). Neurobio-logical and clinical variables associated with alcohol abuse in bulimianervosa. European Eating Disorders Review, 23(3), 185–192. https://doi.org/10.1002/erv.2352
Villamisar, D. G., Dattilo, J., & Pozo, A. D. (2012). Depressive mood, eating disorder symptoms, and perfectionism in female college students: A mediation analysis. Eating Disorders, 20(1), 60–72. https://doi.org/10.1080/10640266.2012.635569
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17(5), 1729. https://doi.org/10.3390/ijerph17051729
Wolanin, A., Hong, E., Marks, D., Panchoo, K., & Gross, M. (2016). Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport. British Journal of Sports Medicine, 50(3), 167–171. https://doi.org/10.1136/bjsports-2015-095756
World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision).
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