Sleep as a Major Determinant for Mental Health Outcomes in Elite Australian Football League (AFL) Athletes

Purpose The link between mental health and sleep is well documented in the general population, with the majority of mental health disorders involving some type of sleep disturbance. There is, however, limited research investigating this relationship in elite athlete populations. The aim of this study was to identify whether sleep and mental health outcomes are associated in elite athletes and, if so, what measures of sleep were the most predictive of mental health outcomes. Methods A comprehensive assessment of sleep was conducted using both objective and subjective methods in 68 Australian Football League athletes (male; mean age, 23.3 +/- 3.4 yr; median, 23; range, 18-32 yr). Rest-activity patterns were recorded using wrist actigraphy for an average of 13.8 +/- 3.6 d (a total of 884 d of data). Subjective sleep data were collected using daily sleep diaries and validated questionnaires. Validated mental health questionnaires were used to assess depression, anxiety, and stress symptoms. Multiple linear regression modeling was used to investigate the relationship between sleep and mental health. Results Using a combination of sleep variables, poor sleep predicted 51% of the variation in clinical depression, 42% of the variation in stress, and 31% in clinical anxiety. Self-reported insomnia symptoms (using the Insomnia Severity Index) were the strongest predictors of poor mental health outcomes, followed by objective sleep monitoring via actigraphy. Sleep diary measures were the weakest predictors of mental health. Conclusions Our results present poor sleep as a major determinant of impaired mental health outcomes in a population that is constantly under pressure to perform at the highest level and may underreport mental health symptoms. These findings support the inclusion of sleep assessments as an initial screening tool as well as a core component of all routine health and rehabilitation programs.