Psychological Balance in High Level Athletes: Gender-Based Differences and Sport-Specific Patterns

OBJECTIVES: Few epidemiological studies have focused on the psychological health of high level athletes. This study aimed to identify the principal psychological problems encountered within French high level athletes, and the variations in their prevalence based on sex and the sport practiced. METHODS: Multivariate analyses were conducted on nationwide data obtained from the athletes' yearly psychological evaluations. RESULTS: A representative sample of 13% of the French athlete population was obtained. 17% of athletes have at least one ongoing or recent disorder, generalized anxiety disorder (GAD) being the most prevalent (6%), followed by non-specific eating disorders (4.2%). Overall, 20.2% of women had at least one psychopathology, against 15.1% in men. This female predominance applied to anxiety and eating disorders, depression, sleep problems and self-harming behaviors. The highest rates of GAD appeared in aesthetic sports (16.7% vs. 6.8% in other sports for men and 38.9% vs. 10.3% for women); the lowest prevalence was found in high risk sports athletes (3.0% vs. 3.5%). Eating disorders are most common among women in racing sports (14% vs. 9%), but for men were found mostly in combat sports (7% vs. 4.8%). DISCUSSION: This study highlights important differences in psychopathology between male and female athletes, demonstrating that the many sex-based differences reported in the general population apply to elite athletes. While the prevalence of psychological problems is no higher than in the general population, the variations in psychopathology in different sports suggest that specific constraints could influence the development of some disorders

Lifetime prevalence (%) of minor or major depression according to the type of sport practiced.

<p>#, significant difference with all other sports (p<0.05). *, significant difference between men and women (p<0.05).</p

Lifetime prevalence (%) of generalized anxiety by type of sport played.

<p>#, significant difference with all other sports (p<0.05). *, significant difference between men and women (p<0.05).</p

Prevalence of at least one psychopathology over the lifetime in athletes with and without socio-environmental risk factors.

<p>Significant difference in the prevalence of psychopathology between athletes with or without the risk factor:</p>‡<p>p<0,05,</p>‡‡<p>, p<0.001.</p><p>Significant difference between men and women:</p><p>*, p<0.05;</p><p>**, p<0.01,</p><p>***, p<0.001.</p

Lifetime prevalence (%) of all sleep problems according to type of sport played.

<p>#, significant difference from all other sports (p<0.05). *, significant difference between men and women (p<0.05).</p

Prevalence of psychological disorders and associated problems (%).

<p>Significant difference between men and women;</p>†<p>, p<0.1,</p><p>*, p<0,05,</p><p>**, p<0.01,</p><p>***, p<0.001 (multivariate analysis, adjusted on age, professional and geographical location).</p

Prolonged response after TPO-RA discontinuation in primary ITP: results of a prospective multicenter study

Sustained response off-treatment (SROT) after thrombopoietin receptor agonist (TPO-RA) discontinuation has been reported in ITP. This prospective multicenter interventional study enrolled adults with persistent or chronic primary ITP and complete response on TPO-RAs. The primary endpoint was the proportion of patients achieving SROT (platelet count &gt; 30x109/L and no bleeding) at W24 with no other ITP-specific medications. Secondary endpoints included the proportion of sustained complete response off-treatment (SCROT, platelet count &gt; 100x109/L and no bleeding) and SROT at W52, bleeding events, and pattern of response to a new course of TPO-RAs. We included 48 patients with median (IQR) age 58.5 years (41-73.5); 30/48 (63%) had chronic ITP at TPO-RA initiation. In the intention-to-treat analysis, 27/48 (56.2%, 95% CI, 41.2-70.5) achieved SROT; 15/48 (31.3%; 95% CI, 18.9-44.5) achieved SCROT at W24, and 25/48 (52.1%; 95% CI, 37.2-66.7) achieved respectively SROT and 14/48 (29.2%; 95% CI, 17.2-42.3) SCROT at W52. No severe bleeding episode occurred in patients who relapsed. Among patients re-challenged with TPO-RA, 11/12 achieved CR. We found no significant clinical predictors of SROT at W24. Single-cell RNA-seq revealed enrichment of a "TNFα signaling via NF-κB" signature in CD8+ T cells of patients with no sustained response after TPO-RA discontinuation, which was further confirmed by a significant overexpression of CD69 on CD8+ T cells at baseline in these patients as compared with those achieving SCROT/SROT. Our results strongly support a strategy based of progressive tapering and discontinuation of TPO-RAs for patients with chronic ITP who achieved a stable CR on treatment. Clinical trial number: NCT0311997