Anxiety and depression in athletes assessed using the 12-item General Health Questionnaire (GHQ-12)-a systematic scoping review

Background: The poor mental health of athletes is a major concern in sport. Typically, the incidence/prevalence of mental health symptoms in athletes is studied using symptom-specific questionnaires. For symptoms of depression/anxiety, one such self-reporting questionnaire is the 12-item General Health Questionnaire (GHQ-12). Objectives: The aim of this review was to synthesise and compare studies using the GHQ-12 in athletes to inform future research bodies by identifying trends and gaps in the literature. Methods: A systematic search of five electronic databases (Google Scholar, PubMed, PsychINFO, Scopus and Web of Science) was conducted on all published studies up to 1 January 2019. Inclusion criteria: (1) participants were able-bodied athletes; (2) studies measured anxiety/depression using the GHQ-12; (3) studies were full original articles from peer-reviewed journals; (4) studies were published in English. Results: Thirty-Two studies were included in the review. The prevalence and incidence of symptoms of anxiety/depression ranged from 21-48% and 17-57%, respectively. The majority of studies screening anxiety/depression using the GHQ-12 were cross-sectional. Almost 70% of the studies used the traditional scoring method. The majority of study populations sampled all-male cohorts comprising football (soccer) players. Conclusion: The traditional scoring of 0-0-1-1 should be used with the cut-off set at ≥3. Also, the mean GHQ-12 score should be reported. Potential risk factors for symptoms of anxiety/depression (i.e. recent adverse life events, injury and illness, social support, pressure to perform and career transitioning) and a lack of prospective studies were identified. Future research should also broaden the spectrum of athlete populations used and aim to improve response rates.