Depression and performance outcomes in athletes - A narrative literature review

Abstract

Background. Depression is a common mental disorder that may affect athletes as much as the general population, challenging the long-standing assumption that sport protects against it. Aim. To summarize current evidence on the impact of depression on athletic performance outcomes. Material and methods. A narrative review was conducted using PubMed, Scopus, and Google Scholar, covering studies published between 1994 and 2026 on depression, athletes, and performance. Results. Reported depression prevalence among athletes ranges from 4% to 68%, with female sex, individual-sport participation, and injury history as consistent risk factors. Depression affects performance through biological mechanisms (HPA-axis dysregulation, elevated cortisol, sleep disturbance, inflammation, monoaminergic dysfunction) and psychological mechanisms (reduced motivation, loss of confidence, fear of failure, social withdrawal), increasing fatigue and impairing endurance, recovery, attention, and reaction time. Depression is closely linked to injury risk, overtraining, performance inconsistency, and possible career stagnation. The causal direction remains unresolved. Conclusions. Early recognition and a multidisciplinary approach (screening, psychotherapy, coach support) are essential; further longitudinal, sport-specific research is needed linking depression directly to objective performance outcomes.