Osteoarthritis is Associated with Symptoms of Common Mental
Disorders Among Former Elite Athletes 

N., Aoki H., Gray J., Kerkhoffs GM., Lambert M., Gouttebarge V.
Knee Surg Sports Traumatol Arthrosc 2016; ahead of print

Take Home Message:
Former elite athletes with osteoarthritis are more likely to have symptoms of
common mental disorders (distress, sleep problems, adverse alcohol use) compared
to those without osteoarthritis.

(OA) is one of the most debilitating joint pathologies worldwide as it leads to
physical pain and disability, which can also impact a patient’s mental health. Former
elite athletes in certain sports are at risk for OA or report symptoms of
mental health disorders. However, it is unclear the extent too which OA among
elite athletes is associated with symptoms of common mental disorders. Therefore,
the authors collected survey data from 602 (28% response rate) former elite
athletes within 5 sports (rugby, football, ice hockey, cricket, and Gaelic
players; ~37 years of age) to assess common mental disorders and history of a
diagnosis of OA. The authors assessed patient-reported distress (
4DSQ), anxiety/depression
GHQ-12), sleep disturbance (PROMIS short form), adverse
alcohol use (
AUDIT-C), and whether they
were diagnosed by a doctor with OA. Overall, 33% of the former elite athletes reported
having a diagnosis of OA. Authors identified that athletes reporting a diagnosis
of OA were nearly 1.5 times more likely to report common mental disorders and
comorbidity (having >2 symptoms of mental health) compared with athletes
who were not diagnosed with OA. Overall, roughly 1 in 3 athletes who reported OA
had symptoms of distress (29%), anxiety/depression (31%), sleep disturbance
(33%), and adverse alcohol use (34%). In comparison, roughly 1 in 4 or 5 athletes
who reported they do not have diagnosed OA had symptoms of distress (19%) anxiety/depression
(25%), sleep disturbance (24%), and adverse alcohol use (23%). Hence, former
elite athletes with OA are 50 to 70% more likely to have symptoms for common
mental disorders than their peers without OA. The authors also noted that the
relationship between OA and mental health disorder differed by sport. For
example, data from former athletes in rugby and ice hockey supported these
findings but data from former football/soccer athletes showed no association
between OA and symptoms for common mental disorders.

is an important study as it confirms that both OA and symptoms of common mental
disorders are prevalent among former elite athletes.  Additionally, OA may be associated to common
mental disorders such as distress, sleep disturbance, and adverse alcohol use
among former elite athletes. These findings illustrate the importance of looking
at potential long-term consequences when making medical decisions that put
athletes at risk for OA. The interaction between OA and mental health issues
occurring is complex, and strategies to prevent symptoms should be discussed,
developed, and implemented. Medical professionals should have discussions with
athletes about the prevention and care of mental health problems that may occur
after sports.

Questions for Discussion:
Have you ever discussed the risks of OA or mental health problems that could
arise following an injury or surgery with your patients? Do you implement
patient reported outcome measures? If so, which ones do you find helpful?

Jane McDevitt, PhD
by: Jeff Driban


Former Male Elite Athletes May Have a Higher Prevalence of Hip and Knee Osteoarthritis

Schuring N, Aoki H, Gray J, Kerkhoffs GM, Lambert M, & Gouttebarge V (2016). Osteoarthritis is associated with symptoms of common mental disorders among former elite athletes. Knee Surgery, Sports Traumatology, Arthroscopy PMID: 27488101