EQOL Journal (2020) 12(1):
REVIEW ARTICLE
Occurrence of common mental disorders among former elite athletes
Marija Ivanović 1 ✉ • Draženka Mačak 1
Received: 24th January, 2020 |
DOI: 10.31382/eqol.200606 |
Accepted: 21st May, 2020 |
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© The Author(s) 2020. This article is published with open access. |
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Abstract
Participating in elite sports can be beneficial for many reasons - but the question arises: what is the payoff to be an elite athlete or what are the consequences of being an elite athlete in sports? The phenomenon which became popular and opens many conversations in sport and psychology circles is the occurrence of common mental disorders (CMD) in former elite athletes.
In this literature review, three electronic databases were searched: PubMed, Web of Science, ScienceDirect.
This paper summarizes eight studies which were selected following the PRISMA guidelines. The studies covered mental health disorders among former elite athletes and their symptoms: distress, sleep disturbance, anxiety/depression, and alcohol misuse, the occurrence of life events and career dissatisfaction. This literature review showed the prevalence of CMD in former elite athletes.
There were no results about the contribution to developing CMD in former elite athletes. Factors associated with the occurrence of CMD in former athletes included involuntary retirement from the sport, concussions, collision/high contact sport, increased body mass index, osteoarthritis
Keywords mental health • retired athlete • prevalence.
✉marija.faw@gmail.com
1University of Novi Sad, Faculty of Sport and Physical Education, Novi Sad, Serbia
Introduction
Mental health issues are a widespread phenomenon. World Health Organization (WHO) defines mental health as a state of
According to WHO, health is a state of complete physical, mental and social
Compared to the general population, elite athletes are at greater risk of
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show the prevalence of CMD in former athletes (Vincent Gouttebarge et al., 2019; Mannes et al., 2019). Some studies show that prevalence is not so different compared to the general population (Mannes et al., 2019). The purpose of this review was to assess the state of current research literature regarding the occurrence of common mental disorders among former elite athletes.
Method
Study design
This paper has been developed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and
Search strategy
The search strategy was designed to be as broad as possible to identify all potentially relevant literature. Search strategy of terms: (mental health OR mental wellbeing OR mental disorders) AND (retired OR retirement OR former) AND athlete. The screening process included an electronic search of the Web of Science, ScienceDirect and PubMed databases (specific to Title, Abstract, and Keywords only).
The PICOS criterion for defining the research question and synthesis is: Population (former elite athlete), Intervention or issue (common mental disorders), Comparators (NA), Outcome or themes (occurrence).
Eligibility criteria and information sources
Inclusion and exclusion criteria were used to ensure clearly defined boundaries to identify all relevant literature. This study included: (i) former elite athletes; (ii) study design including conceptual, theoretical, and perspective articles, and any years of publication; (iii) mental health viewed as an overall mental state; (iv) the studies were written in English language. Studies were excluded: (i) college athlete;
(ii)cause of mental health (transition, drug abuse, concussion); (iii) mental illness in particular (depression, anxiety, panic attack, posttraumatic stress disorder (PTSD)). Studies that were not excluded based on participant characteristics (e.g. age, gender, ethnicity, mental health condition). The decision for inclusion or exclusion of the retrieved studies was based initially on the title, then on the abstract and finally on the full text.
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Study records, screening, and selection of citations
Identified studies were uploaded into Zotero software version 5. The citation information included the author, year of publication, title of the paper, journal name, volume, and issue number, page numbers, DOI number, keywords, and the abstract. All duplicates were eliminated from the Zotero database. The full- text articles that would be potential citations were obtained and saved as Adobe PDF files. The whole process of citation is described in Fig.1 in the flow diagram. This review examined
Results
Study selection
In total, we found 140 articles that entered the selection process (Fig. 1). There were 43 duplicates and these were removed. Furthermore, 97 articles were excluded through the screening of titles and abstracts. After screening the titles and abstracts, 54 records were excluded because they did not meet inclusion criteria, and 43 articles were read in depth to determine eligibility. Of these, 35 articles were excluded for reasons shown in Figure 1. A total of 8 articles underwent full data extraction and were included in this review.
All 8 articles were sorted by the author’s name. There were 5
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Table 1. Descriptive characteristics of article reviewed. |
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Authors |
Year |
Sample |
Design |
Instrument |
Main Findings |
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Gouttebarge |
2015 |
Current |
an |
The Distress Screener |
• In former and current professional football players the prevalence of |
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et al. |
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professional |
observational |
mental health problems was up to 26% and 39%; the most commonly |
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football |
study |
General Health Questionnaire |
reported condition was anxiety and depression. |
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players (n = 149) |
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Rosenberg’s |
•The prevalence of psychosocial difficulties such as low |
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Former professional |
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Scale |
ranged from 5% to adverse nutrition behavior to 42% in former |
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football |
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players. |
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players (n = 104) |
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Questionnaire on the |
•Former players with low supervisor support and recent life events |
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Experience and |
were more likely to have mental health complaints. |
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Evaluation of Work |
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Social Athletic Readjustment |
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Rating Scale |
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Gouttebarge |
2017 |
Current |
a prospective |
Distress Screener |
•A substantial prevalence and |
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professional |
cohort study |
General Health Questionnaire |
CMD were found among retired professional ice hockey players. |
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national ice hockey |
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•The |
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players (n = 81) |
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players ranged from 12% for distress to 29% for adverse alcohol use. |
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Former professional |
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Measurement Information |
Around 13% of the former players reported two simultaneous |
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national ice hockey |
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System (PROMIS) |
symptoms of CMD, 10% three simultaneous symptoms of CMD and |
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players (n = 77) |
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1% four simultaneous symptoms of CMD. The incidence of symptoms |
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Social Athletic Readjustment |
of CMD among elite players over the |
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Rating Scale |
ranged from 8% for distress, anxiety/depression, and eating disorders |
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to 25% for sleep disturbance. |
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•The occurrence of symptoms of CMD was related to the presence of |
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distress, severe musculoskeletal injuries, alcohol use, recent life |
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events, surgeries, and career dissatisfaction. |
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•Former professional players exposed to a higher level of career |
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dissatisfaction and/or higher level of surgeries is 7 to 8 times more |
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likely to report symptoms of CMD to compare to those who were less |
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or unexposed. |
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Gouttebarge |
2017 |
Current elite athlete |
cross- |
Distress Screener |
•Prevalence |
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et al. |
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(n = 203) |
sectional |
General Health Questionnaire |
ranged from 18% for distress to 29% for anxiety/depression among |
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Former elite athlete |
analysis |
former elite athletes. This result is similar to athletes from other sports |
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(n = 282) |
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disciplines and comparable with the lifetime prevalence estimates in |
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Measurement Information |
the general population of the Netherlands. |
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System (PROMIS) |
• A higher level of career dissatisfaction, a higher number of severe |
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injuries, surgeries, recent adverse life events, and lower level of social |
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EQOL Journal (2020) 12(1):
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The Eating disorder Screen for |
support were related to the occurrence of symptoms of CMD among |
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Primary care |
former elite athletes. |
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Social Athletic Readjustment |
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Rating Scale |
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Greenhaus scale |
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Social Support Questionnaire |
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Gouttebarge |
2016 |
Former elite rugby |
cross- |
Distress Screener |
•Prevalence of symptoms of CMD among retired professional players |
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et al. |
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players (n = 295) |
sectional |
General Health Questionnaire |
ranged from 15% for smoking and 25% for distress to 62% for adverse |
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analysis |
nutrition behavior. |
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•There were associations between a higher number of life events and |
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Measurement Information |
distress, sleeping disturbance, anxiety/depression, and adverse |
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System (PROMIS) |
nutrition behavior, and also for a higher level of career dissatisfaction |
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Social Athletic Readjustment |
and distress, and adverse nutrition behavior. |
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Rating Scale |
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Greenhaus scale |
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Jones et al. |
2018 |
Former cricket |
cross- |
NA |
•Anxiety and depression were more prevalent in former elite cricketers |
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players 50+ |
sectional |
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than a normal population. |
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(n=113) |
analysis |
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Population |
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(n=4496) |
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Kilic et al. |
2017 |
Current football |
cross- |
Distress Screener |
•Prevalence (4 weeks) of symptoms of CMD ranged from 8% for |
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players |
sectional |
General Health Questionnaire |
adverse alcohol use to 19% for anxiety/depression among retired |
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(n= 348) |
analysis |
professional football players. |
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Retired football |
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Measurement Information |
•Prevalence (4 weeks) of symptoms of CMD ranged from 7% for |
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players |
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System (PROMIS) |
adverse alcohol use to 16% for anxiety/depression among retired |
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(n= 345) |
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professional handball players. |
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Current handball |
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Social Athletic Readjustment |
•Among retired both, handball and football professional players, a |
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players |
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Rating Scale |
higher number of severe injuries and a higher number of recent |
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(n= 232) |
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adverse LE were especially related to the presence of symptoms of |
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Retired handball |
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CMD |
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players |
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•Professional football and handball players exposed to a higher |
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(n= 230) |
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number of severe injuries and/ or a higher number of recent adverse |
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LE are 20– 50% times more likely to report symptoms of CMD during |
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or after their career by comparison with those less or unexposed. |
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Mackinnon |
2019 |
Former professional |
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cross- |
NA |
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•The study found a higher prevalence of |
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et al. |
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male jockeys |
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sectional |
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depression compared to the reference population. |
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(n=135) |
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analysis |
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Participants from |
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the reference |
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population (n=675) |
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Schuring et |
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2017 |
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Current cricket |
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an |
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Distress Screener |
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•Prevalence was 26% for distress, 21% for sleep disturbance, 24% for |
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al. |
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players (n=78) |
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observational |
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General Health Questionnaire |
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anxiety/depression, and 22% for adverse alcohol use. |
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Former cricket |
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prospective |
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•All stressors (surgery, injury, career dissatisfaction, life events) were |
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players n=38) |
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cohort study |
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Measurement Information |
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associated with an increased risk of symptoms of CMD. |
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System (PROMIS) |
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Social Athletic Readjustment
Rating Scale
Greenhaus scale
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Figure 1. The PRISMA flow diagram
Discussion
According to the studies, the cause of poor mental health in former athletes usually lies in something physical like injury or surgery. Also distress or retirement could be one of the causes (Gouttebarge et al., 2015; Gouttebarge et al., 2017; Schuring et al., 2017). The important thing that can be a limitation is that there were no observations and measurements by medical professionals, but former athletes self- reported their symptoms (Kilic et al., 2017; Mackinnon et al., 2019). There are several causes of poor mental health in former athletes: higher number of severe injuries, recent life events, low social support and career dissatisfaction could be associated with mental health problems (Gouttebarge et al., 2015; Gouttebarge et al., 2016; Kilic et al., 2017; Schuring et al., 2017). The
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osteoarthritis, collision/high contact sport, injuries, concussion, low social support, substance use (illicit drug, tobacco, alcohol consumption, anabolic androgenic steroids), misuse and psychological distress during the career. Using
EQOL Journal (2020) 12(1):
phenomenon that all athlete experience but should be followed by professionals (Henriksen et al., 2019). From all these results the need for bringing more attention to mental health in sport during athletes’ career but
Conclusion
In all 8 studies, there was a prevalence of CMD in former athletes. This review showed prevalence in common mental disorders in former athletes. Studies show that factors associated with involuntary retirement, osteoarthritis, injuries, low social support, substance use, collision/high contact sport, concussion could explain the prevalence of the mental health in former athletes.
Perspectives
The overall study quality in the field of mental health in former elite athletes is poor. In addition, a sample of subjects may not be representative of the findings. In all these studies, former athletes from collective sports were selected for the sample, so the results may be different in an individual sport. Also, the results may vary depending on when the athlete ended his career. Furthermore, most studies were
general population may not give the most accurate results when it comes to elite athletes. More intervention about mental health literacy could be beneficial for a better understanding of this phenomenon at this population. Also, mental health literacy could contribute to developing strategies to improve mental health in former elite athletes.
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How to cite this article:
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Ivanović, M., & Mačak, D. (2020). Occurrence of common mental |
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APA: |
disorders among former elite athletes. Exercise and Quality of |
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Life, 12(1), |
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Ivanović, Marija and Draženka Mačak. "Occurrence of common mental |
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MLA: |
disorders among former elite athletes." Exercise and Quality of |
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Life 12.1 (2020): |
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Ivanović, Marija, and Draženka Mačak. "Occurrence of common mental |
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Chicago: |
disorders among former elite athletes." Exercise and Quality of |
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