Objectives To examine in an elite UK athlete cohort: i) sport injury and mental ill-health incidence rates, and ii) the bi-directional relationship between injury and mental ill-health. Design Retrospective, cohort design. Methods Secondary analyses were conducted on six years of UK Sports Institute athlete medical data. Participants were 1979 elite athletes (53.4% male, Mage=28.6years, SD=7.36), representing 43 Olympic and Paralympic sports. IOC guidelines were followed to calculate the incidence and burden of injuries and mental ill-health. The presence of a mental ill-health episode in the previous 12months or the number of previous injuries were included as risk factors in separate frailty models. Results Injuries to the lumbar/pelvis region had the highest incidence (0.26 per athlete year), whilst knee injuries had the greatest mean burden (5.93 time-loss days per athlete year). Depression had the highest incidence (0.03 diagnoses per athlete year) and mean burden (0.96 time-loss days per athlete year). Athletes who experienced an episode of mental ill-health in the past 12months had an 18% increased risk for subsequent injury (HR=1.18; 95% CI=1.10-1.26, p<.001). Moreover, for each injury sustained in the previous 12months, athletes' risk for experiencing mental ill-health increased by 10% (HR=1.10; 95% CI=1.07-1.13, p<.001). Conclusions These results improve existing knowledge by revealing a bi-directional relationship between injury and mental ill-health in elite athletes, which has important implications for the prevention of injuries and mental ill-health in elite sport.
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