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Prevalence of depression and anxiety in top-level male and female football players. BACKGROUND: Scientific studies on the prevalence of mental health problems in elite athletes are rare, and most have had considerable methodological limitations, such as low response rate and heterogeneous samples. AIMS: To evaluate the prevalence of depression and anxiety in top-level football players in comparison to the general population, and to analyse potential risk factors. METHODS: Players of all first league (FL) and of four U-21 football teams in Switzerland were asked to answer a questionnaire on player's characteristics, the Centre of Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder (GAD-7) scale. RESULTS: All 10 women's FL teams, 9 of 10 men's FL teams and 4 male U-21 teams (n=471 football players) took part in the study. The CES-D score indicated a mild to moderate depression in 33 (7.6%) players and a major depression in 13 (3.0%) players. The GAD-7 score indicated an at least moderate anxiety disorder in 6 (1.4%) players. Compared to the general population, the prevalence of depression was similar and the prevalence of anxiety disorders was significantly (χ2=16.7; p<0.001) lower in football players. Significant differences were observed with regard to player characteristics, such as age, gender, player position, level of play and current injury. CONCLUSIONS: Swiss FL football players had the same prevalence of depression as the general population, while male U-21 players had a higher prevalence of depression. It is important to raise awareness and knowledge of athletes' mental health problems in coaches and team physicians, and to provide adequate treatment to athletes.