Associations between lifestyle patterns during COVID-19 pandemic and mental health in athletes from 14 countries. An analysis by sex and sport level

OBJECTIVE: This study examined the association of sleep quality, eating behaviors, physical activity (PA), and financial security with mental health among elite and amateur male and female athletes during the COVID-19 pandemic. METHOD: A total of 1385 athletes (41.2% women) from 14 countries participated in this global cross-sectional study, with 40.3% identified as elite athletes and 59.7% as amateur athletes. Data on perceived mental health, sleep quality, PA, eating behaviors, and financial security were gathered through an online survey conducted during the second year of the COVID-19 pandemic. Multiple linear regression analysis assessed the association of these variables with depression, anxiety, stress, and global psychological distress across sex and competitive levels. RESULTS: Poorer sleep quality was the most consistent correlate of higher mental health symptom scores across the regression models, although is association was not uniform across all outcoms and subgroups, PA showed a more variable pattern. In the total sample, higher PA was associated with lower depression, anxiety, stress and global distress scores in both women and men. PA was not significantly associated with mental health outcomes among elite women and was only associated with stress among elite men. PA was associated with global distress and anxiety in amateur women, as well as with global distress, depression and stress in amateur men, but not with all outcomes. Eating behaviors showed less consistent associations, emerging mainly among men in the total sample and between amateur men for specific outcomes. Financial security was associated with lower symptom scores in the total sample for both women and men, but subgroup analyses showed a more differentiated pattern, with more consistent associations among elite women and more limited associations among elite men and amateur athletes. CONCLUSION: During the COVID-19 pandemic, athletes' mental health symptoms were associated with several behavioral and contextual factors, particularly sleep quality, while PA, eating behaviors, and financial security showed more subgroup-specific patterns.