Mental problems are stigmatised in football – but they certainly exist, as demonstrated by studies carried out in the course of a FIFA research project on mental health at the Hamburg Medical School.

9 November 2009 was a dark day in the annals of German football: it was the day that Robert Enke, goalkeeper for Hannover 96 and the national team, committed suicide. Although Enke suffered from depression, nobody knew about it apart from his closest friends – neither the club and national teams nor the general public. A professional footballer with depression? The general view was that such athletes had nothing to be depressed about, but there had been examples before him of pros who suffered from the illness, such as Sebastian Deisler, one of the most talented German players of his generation, who called time on his career at just 24.

Awareness among professional athletes of the condition has grown since Enke’s tragic death, but given the public scrutiny and the highly competitive environment in which they operate, the pressure on sufferers to hide it remains high. Professor Astrid Junge, Head of Research at the FIFA Medical Assessment and Research Centre (F-MARC), confirms: “Football players, especially the top players, are subject to higher levels of stress, not only physically in training and matches but also in terms of the high expectations of them as well as potential competition and conflicts within the team.” Professional football is a fast-moving business in which, every day, players have to prove themselves and perform at their very best.

How widespread is depression among professional athletes? Are footballers more at risk than the general public due to the pressure they face? Few studies were devoted to the subject in the past, particularly any involving a broad participation that would yield a scientifically sound analysis. FIFA therefore opened up a new research area with the Hamburg Medical School in 2014. The intention behind “Mental Health and Sport” is to remove the stigma surrounding mental health and top athletes and develop basic foundations for treatment and sources of information for team doctors, coaches and players.

The head researcher in the project is Birgit Prinz, three-time FIFA Women’s World Player of the Year and a qualified psychologist. She says: “Mental fitness is just as important for professional footballers’ well-being and performance as physical fitness and technique.”

High levels among U-21 players

Members of all ten top-tier Swiss women’s teams along with nine of the ten men’s top-level teams and four U-21 teams took part in an initial study that was designed to ascertain how widespread depression is among top-level footballers compared to the general public. The anonymous questionnaires revealed that the percentage of male and female players in the top league who suffer from depression is as high as that among the general public, with 7.6% showing indications of mild depression and 3% having to contend with a more severe form. The distribution among the U-21 players was higher, with an average of 2.8 players in each 23-man squad complaining of initial signs of depression.

The study also showed that injured players are more prone to depression than non-injured ones, with strikers particularly affected. Midfielders are the least likely to suffer from the condition.

Fighting the stigma

How high is the risk of a professional female player suffering from depression during and after her career? This issue was tackled in a second study involving 157 players from the top-tier German women’s league. The results were revealing: almost 40% of the participants had wanted to seek psychological help, but only 10% actually received it. Post-career, the first figure reduced to 24%, 90% of whom actually received support privately. These figures clearly show that the stigma still exists, leading to players hiding their psychological problems during their careers.

The reasons given by players for suffering depression in their playing days were conflict with the coach, injuries or personal problems, while in retirement, the causes were a lack of prospects and financial difficulties. The player’s position on the pitch was also a factor, with strikers and goalkeepers most at risk, possibly because they receive the most attention and can be the difference between winning and losing. In addition, fewer players who command a regular place in the team suffer from depression than those on the fringes. Both studies show that coaches play an important role in a player’s psychological state, and it would therefore be beneficial if mental training were included in coach education.

FIFA’s research project is intended to raise awareness of the issue, remove doubt from the minds of those involved and provoke a debate. “We need to dispel the myth that professional footballers are invincible,” says Prinz. Mental problems are not confined to specific groups and can be found in all walks of life, regardless of location or culture. In the words of the project leader: “Mental stress can be prevented, treated and cured.”