Abstract
Introduction: Poor mental health of athletes is major concern in sport. Typically, incidence/prevalence of mental health symptoms in athletes is studied using symptom-specific questionnaires. For symptoms of depression/anxiety, one such self-reporting questionnaire is the 12-item General Health Questionnaire (GHQ-12).
 Objective: The aim of this review was to synthesise and compare studies using the GHQ-12 in athletes to inform future research by identifying trends and gaps in the literature.
 Methods: A systematic search of five electronic databases (Google Scholar, PubMed, PsychINFO, Scopus and Web of Science) was conducted on all published studies up to 1 January 2019. 1) participants were able-bodied athletes; 2) studies measured anxiety/depression using the GHQ-12; 3) studies were full original articles from peer-reviewed journals; 4) studies were published in English.
 Results: 32 studies were included in the review. Prevalence and incidence of symptoms of anxiety/depression ranged from 21-48% and 17-57% respectively. The majority of studies screening anxiety/depression using the GHQ-12 were cross-sectional. Almost 70% of studies used the traditional scoring method. The majority of study populations sampled all-male cohorts comprising football (soccer) players.
 Conclusion: The traditional scoring of 0-0-1-1 should be used with the cut-off set at ≥3. Also, the mean GHQ-12 score should be reported. Potential risk factors for symptoms of anxiety/depression (i.e. recent adverse life events, injury and illness, social support, pressure to perform and career transitioning) and a lack of prospective studies were identified. Future research should also broaden the spectrum of athlete populations used and try to improve response rates.
Highlights
Poor mental health of current and retired athletes is a major concern in sport.[1,2,3,4,5,6,7] Typically, the incidence/prevalence of mental health symptoms in athletes is studied using symptom-specific questionnaires
While a number of reviews on the mental health of elite athletes are available in the literature, [2,3,4,5] no review currently exists which focuses on anxiety and depression using the General Health Questionnaire (GHQ)-12
To improve anxiety/depression prevalence and incidence comparisons, we suggest that the recommended cut-off for the GHQ-12 for athletes be set at ≥3
Summary
Poor mental health of current and retired athletes is a major concern in sport.[1,2,3,4,5,6,7] Typically, the incidence/prevalence of mental health symptoms in athletes is studied using symptom-specific questionnaires. A score of ≥2 indicates symptoms of anxiety/depression.[9,11] Goldberg suggested that to obtain an optimal trade-off between sensitivity and specificity, the mean score of the group could be used as a threshold.[15] The less frequently used Likert-type scale scoring (0-1-2-3) can be used. While a number of reviews on the mental health of elite athletes are available in the literature, [2,3,4,5] no review currently exists which focuses on anxiety and depression using the GHQ-12. The aim of this review was to synthesise and compare studies using the GHQ-12 in athletes in order to inform future research by identifying trends and gaps in the literature
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