Document Type : Research paper
Authors
1 Psychiatry, School of Medicine, Cardiff University, Cardiff, United Kingdom
2 Psychiatry, Centre for Medical Education, Cardiff University, Cardiff, United Kingdom
3 BSc Medical Pharmacology, Cardiff University School of Medicine, Cardiff, United Kingdom
Abstract
Background: The mental health of professional athletes can be unstable from the start to the end of their careers, especially when the latter comes prematurely. Injured athletes require equal physical and mental health support, which must be tailored to individual needs. There is a paucity of studies on mental health challenges and support for prematurely retired professional rugby players (PRPRP). We hypothesised that their mental health support remains inadequate.
Methods: A phenomenological approach was used to investigate changes in the subjective lived experiences of PRPRP. We devised a semi-structured questionnaire to help participants focus on any perceived decline in their mental health, including suicidality (thoughts, feelings and behaviour related to suicide). Additional open-ended questions enabled participants to highlight perceived deficits in care and offer suggestions for improvement. Invites were sent through the e-zine of the Rugby Players Association (RPA), with an embedded questionnaire. Responding to the invite implied that people were opting into the survey and giving consent. Data was collected from participants’ anonymised responses and interpreted by descriptive statistics and thematic analysis.
Results: The main cause of premature retirement was traumatic injury with a consequential decline in mental health. Participants reported suicidality, following premature retirement and confirmed the lack of holistic support. They suggested strategies for improvement in care that are identical to those in existing literature, and reiterated the need to equalise their mental and physical health support.
Conclusions: Shortcomings in psychological support remain significant with a major gap between it and support for physical health. Other existing literature also suggests abolishing the gap between theoretical findings and practical provision of support, but that remains unaccomplished. We propose introducing mandatory legislation for sports clubs to implement support measures, and recommend involving all main stakeholders in future research.
Keywords
Main Subjects
About us (no date), The RPA. Available at: https://therpa.co.uk/
about-us (Accessed: 11 May 2024).
Alfermann, D. and Stambulova, N.B. (2012) ‘Career transitions
and career termination’, APA PsycNet. Available at: https://doi.
org/10.1002/9781118270011.ch32. (Accessed: 11 May 2024).
Analysing qualitative data for evaluation. (no date). NCVO.
Available at: https://www.ncvo.org.uk/help-and-guidance/
strategy-and-impact/impact-evaluation/evaluation-andimpact-
reporting/how-to-analyse-qualitative-data-forevaluation/#
think-critically-about-your-data (Accessed: 11 May
2024).
Anderson, M. L., Goodman, J. and Schlossberg, N. K. (2011)
‘Counseling adults in transition: linking Schlossberg’s theory
with practice in a diverse world’, Available at: https://ci.nii.ac.jp/
ncid/BB17211952 (Accessed: 11 May 2025).
Ardern, C.L., Glasgow, P., Schneiders, A., Witvrouw, E., Clarsen,
B., Cools, A., Gojanovic, B. et al. (2016) ‘Consensus statement on
return to sport from the First World Congress in sports physical
therapy, Bern’. British Journal of Sports Medicine, 50(14), pp853–
864. Available at: https://doi.org/10.1136/bjsports-2016-096278.
Arnold, R. and Fletcher, D. (2012) ‘A research synthesis
and taxonomic classification of the organizational stressors
encountered by sport performers.’ Journal of Sport & Exercise
Psychology, 34(3), pp397–429. https://doi.org/10.1123/
jsep.34.3.397.
Arvinen-Barrow, M. (2017) ‘Transitioning out of professional
sport: the psychosocial impact of career-ending injuries among
elite Irish rugby football union players’, Journal of Clinical Sport
Psychology. Available at: https://journals.humankinetics.com/
view/journals/jcsp/11/1/article-p67.xml.
Arvinen-Barrow M, DeGrave K, Pack S, Hemmings B. (2019)
‘Transitioning out of professional sport: the psychosocial
impact of career-ending non-musculoskeletal injuries among
male cricketers from England and Wales’, J Clin Sport Psychol.
13(4):629-644. doi: 10.1123/jcsp.2017-0040.
Bernes, K.B., McKnight, K.M., Gunn, T.M., Chorney, D., Orr,
D.T. and Bardick, A.D. (2009) ‘Life after sport: athletic career
transition and transferable skills’, Journal of Excellence. Available
at: https://opus.uleth.ca/bitstream/10133/1175/1/Life_After_
Sport.pdf.
Bhandari, P., (2023) ‘What is qualitative research?| methods &
examples’, Scribbr, 30 Jan. Available at: https://www.scribbr.com/
methodology/qualitative-research/.
Bhandari, P., (2023) ‘Questionnaire design|methods, question
types & examples’, Scribbr, 22 June. Available at: https://www.
scribbr.com/methodology/questionnaire/.
Boardman, N. (2022) ‘Athlete transitions into retirement:
experiences in elite sport and options for effective support’,
Sports Coaching Review, 1–4. Available at: https://doi.org/10.10
80/21640629.2022.2117517.
Brady, E.M., ed., (1988) ‘Retirement: the challenge of change’,
Portland, ME: University of Southern Maine. Available at:
ED313587.pdf
Braun, V. and Clarke, V. (2022) ‘Conceptual and design thinking
for thematic analysis’, Qualitative Psychology, 9(1), pp3–26.
Available at: https://doi.org/10.1037/qup0000196.
Brooks, J.H. and Kemp, S.P. (2008) ‘Recent trends in Rugby
Union injuries’, Clinics in Sports Medicine, 27(1), pp51–viii.
Available at: https://doi.org/10.1016/j.csm.2007.09.001
Brown, C.J., Webb, T.L., Robinson, M.A. and Cotgreave, R.
(2018) ‘Athletes’ experiences of social support in their transition
out of elite sport: an interpretive phenomenological analysis’,
Psychology of Sport and Exercise, 36, pp71–80. Available at:
https://doi.org/10.1016/j.psychsport.2018.01.003.
Brown, J.C., Kerkhoffs, G., Lambert, M.I. and Gouttebarge, V.
(2017) ‘Forced retirement from professional Rugby Union is
associated with symptoms of distress’, International Journal of
Sports Medicine, 38(8), pp582–587. Available at: https://doi.
org/10.1055/s-0043-103959.
Carapinheira, A., Torregrossa, M., Mendes, P., Carvalho,
P.G. and Travassos, B.F.R., (2018) ‘A retrospective analysis of
career termination of football players in Portugal’, Motricidade,
14(4), pp74–85. Available at: https://doi.org/10.6063/
motricidade.14982.
Caulfield, J. (2023) ‘How to do thematic analysis|step-by-step
guide & examples’, Simply Psychology. Available at: https://
www.scribbr.com/methodology/thematic-analysis (Accessed 11
March).
Champions Rugby (no date) ‘The evolution of women’s rugby’.
Available at: https://rugbyspeakersuk.com/news/evolutionwomens-
rugby (Accessed: 11 April 2023).
Chesney, E., Goodwin, G.M., & Fazel, S. (2014) ‘Risks of allcause
and suicide mortality in mental disorders: a meta-review’,
World Psychiatry, vol. 13, no. 2, pp153–160. Available at: https://
doi.org/10.1002/wps.20128.
CoachMePlus (2023) ‘Key principles of effective collaboration
in sport’, CoachMePlus, 17 February. Available at: https://
coachmeplus.com/principles-team-staff-collaboration-sport/.
Coenen, M., Stamm, T., Stucki, G., & Cieza, A. (2011) ‘Individual
interviews and focus groups in patients with rheumatoid
arthritis: a comparison of two qualitative methods’, Quality of
Life Research, vol. 21, no. 2, pp359–370. Available at: https://doi.
org/10.1007/s11136-011-9943-2.
Favril, L., Yu, R., Uyar, A., Sharpe, M., & Fazel, S. (2022) ‘Risk
factors for suicide in adults: systematic review and meta-analysis
of psychological autopsy studies’, Evidence-based Mental Health,
vol. 25, no. 4, pp148–155. Available at: https://doi.org/10.1136/
ebmental-2022-300549.
Filbay, S., Pandya, T., Thomas, B., McKay, C., Adams, J., & Arden,
N. (2019) ‘Quality of life and life satisfaction in former athletes:
a systematic review and meta-analysis’, Sports Medicine, vol.
49, no. 11, pp1723–1738. Available at: https://doi.org/10.1007/
s40279-019-01163-0.
Finn, J. & McKenna, J. (2010) ‘Coping with academy-tofirst-
team transitions in elite English male team sports: the
coaches’ perspective’, International Journal of Sports Science
& Coaching, vol. 5, no. 2, pp257–279. Available at: https://doi.
org/10.1260/1747-9541.5.2.257.
Freeman, C. and Tyrer, P. (2006). Research Methods in Psychiatry.
3rd edn. Cambridge University Press.
Fuller, C.W. (2008) ‘Catastrophic injury in Rugby Union:
is the level of risk acceptable?’, Sports Medicine (Auckland,
N.Z.), vol. 38, no. 12, pp975–986. Available at: https://doi.
org/10.2165/00007256-200838120-00002.
Furie, K., Park, A.L., & Wong, S.E. (2023) ‘Mental health and
involuntary retirement from sports post-musculoskeletal
injury in adult athletes: a systematic review’, Current Reviews in
Musculoskeletal Medicine, vol. 16, no. 5, pp211–219. Available at:
https://doi.org/10.1007/s12178-023-09830-6.
Gilmore, O. (2008) ‘Leaving competitive sport: Scottish female
athletes’ experiences of sport career transitions’, (Unpublished
doctoral dissertation), University of Stirling. Available from:
STORRE: Stirling Online Research Repository.
Gouttebarge, V. & Aoki, H. (2014) ‘Lifespan perspective of
professional footballers’ health’, Asian Journal of Sports Medicine,
vol. 5, no. 4, e23813. Available at: https://doi.org/10.5812/
asjsm.23813.
Gouttebarge, V., Kerkhoffs, G.M.M.J., & Lambert, M. (2015)
‘Prevalence and determinants of symptoms of common mental
disorders in retired professional Rugby Union players’, European
Journal of Sport Science, vol. 16, no. 5, pp595–602. Available at:
https://doi.org/10.1080/17461391.2015.1 086819.
Gulliver, A., Griffiths, K.M., & Christensen, H. (2012) ‘Barriers
and facilitators to mental health help-seeking for young elite
athletes: a qualitative study’, BMC Psychiatry, vol. 12, p. 157.
Available at: https://doi.org/10.1186/1471-244X-12-157.
Gulliver, A., Griffiths, K.M., Mackinnon, A., Batterham, P.J.,
& Stanimirovic, R. (2015) ‘The mental health of Australian
elite athletes’, Journal of Science and Medicine in Sport, vol.
18, no. 3, pp255–261. Available at: https://doi.org/10.1016/j.
jsams.2014.04.006.
Hawton, K., Casañas I Comabella, C., Haw, C., & Saunders, K.
(2013) ‘Risk factors for suicide in individuals with depression:
a systematic review’, Journal of Affective Disorders, vol. 147,
nos. 1-3, pp17–28. Available at: https://doi.org/10.1016/j.
jad.2013.01.004
Hong, H.J. & Fraser, I. (2023) ‘High-performance athletes’
transition out of sport: developing corporate social responsibility’,
International Journal of Sport Policy and Politics, vol. 15, no. 4,
pp725–741. Available at: https://doi.org/10.1080/19406940.2023
.2242877.
Hughes, L. & Leavey, G. (2012) ‘Setting the bar: athletes and
vulnerability to mental illness’, The British Journal of Psychiatry.
Available at: https://doi.org/10.1192/bjp.bp.111.095976.
International Social Security Association (2009) ‘Health and life
at work: a basic human right’, 28 April. Available at: https://www.
ilo.org/safework/info/publications/WCMS_108686/lang--en/
index.htm.
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas,
K.R., & Walters, E.E. (2005) ‘Lifetime prevalence and ageof-
onset distributions of DSM-IV disorders in the National
Comorbidity Survey Replication’, Archives of General Psychiatry,
vol. 62, no. 6, pp593–602. Available at: https://doi.org/10.1001/
archpsyc.62.6.593.
Klein, A.S., Cooke, R.A., & Wallis, J. (2013) ‘The impact of
leadership styles on organizational culture and firm effectiveness:
an empirical study’, Journal of Management & Organization,
vol. 19, pp241–254. Available at: https://doi.org/10.1017/
jmo.2013.34.
Knights, S., Sherry, E., Ruddock-Hudson, M., & O’Halloran,
P. (2019) ‘The end of a professional sport career: ensuring a
positive transition’, Journal of Sport Management, vol. 33, no. 6,
pp518–529. Available at: https://doi.org/10.1123/jsm.2019-0023.
Kruyt, N. & Grobbelaar, H. (2019) ‘Psychological demands of
international Rugby Sevens and well-being needs of elite South
African players’, Frontiers in Psychology, vol. 10, p676. Available
at: https://doi.org/10.3389/fpsyg.2019.00676
Lancet (2017) ‘Improving mental health in the workplace’, The
Lancet, vol. 390, no. 10107, p2015. Available at: https://doi.
org/10.1016/s0140-6736(17)32807-6.
Lebrun, F., MacNamara, À., Rodgers, S., & Collins, D. (2018)
‘Learning from elite athletes’ experience of depression’, Frontiers
in Psychology, vol. 9, p2062, 26 October. Available at: https://doi.
org/10.3389/fpsyg.2018.02062
Madden, J.S. (1993) ‘Alcohol and depression’, British Journal
of Hospital Medicine, vol. 50, no. 5, pp261–264. Available at:
Alcohol and depression - PubMed.
Mammen, G. & Faulkner, G. (2013) ‘Physical activity and the
prevention of depression: a systematic review of prospective
studies’, American Journal of Preventive Medicine, vol. 45,
no. 5, pp649–657. Available at: https://doi.org/10.1016/j.
amepre.2013.08.001.
Mannes, Z.L., Waxenberg, L.B., Cottler, L.B., Perlstein, W.M.,
Burrell, L.E., Ferguson, E.G., Edwards, M.E., & Ennis, N. (2019)
‘Prevalence and correlates of psychological distress among
retired elite athletes: a systematic review’, International Review
of Sport and Exercise Psychology, vol. 12, no. 1, pp265–294.
Available at: https://doi.org/10.1080/1750984X.2018.1469162.
Markser, V.Z. (2011) ‘Sport psychiatry and psychotherapy.
Mental strains and disorders in professional sports. Challenge
and answer to societal changes’, European Archives of Psychiatry
and Clinical Neuroscience, vol. 261, Suppl. 2, ppS182–S185.
Available at: https://doi.org/10.1007/s00406-011-0239-x.
McAuley, A., Baker, J., & Kelly, A.L. (2021) ‘Defining “elite” status
in sport: from chaos to clarity’, German Journal of Exercise and
Sport Research, vol. 52, no. 1, pp193–197. Available at: https://
doi.org/10.1007/s12662-021-00737-3.
McManus, S., Bebbington, P., Jenkins, R., & Brugha, T. (2016)
Mental health and wellbeing in England: adult psychiatric
morbidity survey 2014. NHS Digital. Available at: adult
psychiatric morbidity survey.
Mind (no date) ‘Thriving at Work guide’. Available at: https://
www.mind.org.uk/about-us/our-policy-work/sport-physicalactivity-
and-mental-health/thriving-at-work-guide (Accessed:
13 April 2023).
Mountjoy, M., Brackenridge, C., Arrington, M., Blauwet, C.,
Carska-Sheppard, A., Fasting, K., Kirby, S., (2016) ‘The IOC
consensus statement: harassment and abuse (non-accidental
violence) in sport’, British Journal of Sports Medicine, vol. 50,
no. 17, pp1019–1029. Available at: https://doi.org/10.1136/
bjsports-2016-096121.
National Institute of Mental Health (NIMH) (2023) ‘Major
depression’. Available at: https://www.nimh.nih.gov/health/
statistics/major-depression. (Accessed: 1 June 2024).
Neubauer, B.E., Witkop, C.T., & Varpio, L. (2019) ‘How
phenomenology can help us learn from the experiences of
others’, Perspectives on Medical Education, vol. 8, no. 2, pp90–97.
Available at: https://doi.org/10.1007/s40037-019-0509-2.
Online-surveys (2019) The online survey tool designed for
academic research, education and public sector organisations.
Bristol: Jisc. Available at: https://www.jisc.ac.uk/online-surveys
(Accessed: 20 November 2019).
Park, S., Lavallee, D., & Tod, D. (2013) ‘Athletes’ career transition
out of sport: a systematic review’, International Review of Sport
and Exercise Psychology, vol. 6, no. 1, pp22–53. Available at:
https://doi.org/10.1080/1750984X.2012.687053.
Patel, V., Saxena, S., Frankish, H., & Boyce, N. (2016) ‘Sustainable
development and global mental health—a Lancet Commission’,
The Lancet, vol. 387, no. 10024, pp1143–1145. Available at:
https://doi.org/10.1016/s0140-6736(16)00208-7.
Pope, C. & Mays, N. (eds.) (2006) ‘Qualitative research in health
care’, 3rd edn. Blackwell Publishing; BMJ Books. Available at:
https://doi.org/10.1002/9780470750841.
Purcell, R., Pilkington, V., Carberry, S., Reid, D., Gwyther, K., Hall,
K. (2022) ‘An evidence-informed framework to promote mental
wellbeing in elite sport’, Frontiers in Psychology, vol. 13, p780359.
Available at: https://doi.org/10.3389/fpsyg.2022.780359.
Reardon, C.L. & Factor, R.M. (2010) ‘Sport psychiatry’, Sports
Medicine, vol. 40, no. 11, pp961–980. Available at: https://doi.
org/10.2165/11536580-000000000-00000.
Reardon, C.L., Hainline, B., Aron, C.M., Baron, D., Baum, A.L.
Bindra, A., Budgett, R., et al. (2019) ‘Mental health in elite
athletes: International Olympic Committee consensus statement
(2019)’, British Journal of Sports Medicine, vol. 53, no. 11, pp667–
699. Available at: https://doi.org/10.1136/bjsports-2019-100715.
Rice, S., Purcell, R., De Silva, S., Mawren, D., McGorry, P.D., &
Parker, A.G. (2016) ‘The mental health of elite athletes: a narrative
systematic review’, Sports Medicine, vol. 46, no. 9, pp1333–1353.
Available at: https://doi.org/10.1007/s40279-016-0492-2.
Smith, A.M. (1996) ‘Psychological impact of injuries in athletes’,
Sports Medicine, vol. 22, no. 6, pp391–405. Available at: https://
doi.org/10.2165/00007256-199622060-00006.
Smith, A.M. & Milliner, E.K. (1994) ‘Injured athletes and the risk
of suicide’, Journal of Athletic Training, vol. 29, no. 4, pp337–341.
Available at: https://pubmed.ncbi.nlm.nih.gov/16558297/.
Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., de Pablo,
G.S., Il Shin, J., et al. (2021) ‘Age at onset of mental disorders
worldwide: large-scale meta-analysis of 192 epidemiological
studies’, Molecular Psychiatry, vol. 27, no. 1, pp281–295. Available
at: https://doi.org/10.1038/s41380-021-01161-7.
Sood, A.B. (2018) ‘2.4 suicidal behaviors and prevention of
suicide in TAY’, Journal of the American Academy of Child &
Adolescent Psychiatry, vol. 57, no. 10, p S4. Available at: https://
doi.org/10.1016/j.jaac.2018.07.018.
Stoltenburg, A.L., Kamphoff, C.S., & Lindstrom Bremer, K.
(2011) ‘Transitioning out of sport: the psychosocial effects of
college athletes’ career-ending injuries’, Athletic Insight, vol. 3,
pp115–133.
Voorheis, P., Silver, M., & Consonni, J. (2023) ‘Adaptation to life
after sport for retired athletes: a scoping review of existing reviews
and programs’, PLOS ONE, vol. 18, no. 9, Article e0291683.
Available at: https://doi.org/10.1371/journal.pone.0291683.
Williams, A., Day, S., Stebbings, G., & Erskine, R. (2017) ‘What
does “elite” mean in sport and why does it matter?’, The Sport
and Exercise Scientist, no. 51, pp10–11. Available at: https://www.
researchgate.net/publication/315720117.
Wolanin, A., Gross, M., & Hong, E. (2015) ‘Depression in athletes:
prevalence and risk factors’, Current Sports Medicine Reports,
vol. 14, no. 1, pp56–60. Available at: https://doi.org/10.1249/
JSR.0000000000000123.
World Health Organization: WHO (2022) ‘Mental health’.
Available at:
https://www.who.int/news-room/fact-sheets/detail/mentalhealth-
strengthening-our-response%23SnippetTab (Accessed:
18 September 2022).
Wylleman, P., Alfermann, D., & Lavallee, D. (2004) ‘Career
transitions in sport: European perspectives’, Psychology of Sport
and Exercise, vol. 5, no. 1, pp7–20. Available at: https://doi.
org/10.1016/s1469-0292(02)00049-3.
Zuelke, A.E., Luck, T., Schroeter, M.L., Witte, A.V., Hinz, A.,
Engel, C., Enzenbach, C., (2018) ‘The association between
unemployment and depression—results from the populationbased
LIFE-adult-study’, Journal of Affective Disorders, vol.
235, pp399–406. Available at: https://doi.org/10.1016/j.
jad.2018.04.073
)