Research suggests that elite female-athletes report elevated levels of mental ill-health, particularly, anxiety, depression and disordered eating, in comparison to male-athletes. However, to date, there has been no systematic review or meta-analysis that has quantified the prevalence of clinically significant symptoms of these disorders in elite female-athletes. We searched three electronic databases from inception to May 2025. Eligible articles had to include: a sample of elite female athletes; quantitative data on clinically significant symptoms of anxiety, depression, and/or disordered eating; and prevalence data. Through the systematic search process, we identified 4321 potentially relevant articles. Following screening against the eligibility criteria, we included 122 articles in the systematic review and meta-analyses. We performed three proportional meta-analyses for studies investigating clinically significant symptoms of anxiety, depression, and disordered eating. 19.4, 18.7 and 18.6% of elite female-athletes reported clinically significant symptoms of anxiety (n = 37 studies), depression (n = 56 studies) and disordered eating (n = 57 studies) respectively. By comparison, research into anxiety, depression and eating disorders in women in the general population suggests global prevalence rates of 7.3%, 7.8% and 5.7% respectively, suggesting substantial prevalence of clinically significant mental ill-health symptoms in elite female-athletes. As such, sporting organisations should be aware of the extent of these challenges, with robust systems in place to support prevention, management, intervention and recovery from mental ill-health in elite female-athlete populations.
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