Volumen 1 (2018): Edición 1 (May 2018)

Both football (also called association football or soccer) and mental health disorders have a global impact on the lives of billions of people. Football has been used to approach and support subjects with or at risk of mental health disorders. However, it is not clear if football itself has any beneficial effect on the mental health of players, fans or spectators. Consequently, the aim of the current systematic review was to examine if playing or watching football impacts on the frequency of mental health problems in people who are involved in playing or watching the game.

We performed a systematic review on the relationship between football and mental health disorders. A total of 662 abstracts were screened initially. We identified 17 relevant papers assessing the prevalence of mental health disorders in current and previous football players, referees or spectators.

The prevalence and 12 months incidence of mental health problems in active and retired professional players and referees were similar to or higher than those found in the general population, possibly as response to osteoarthritis, severe injuries, career dissatisfaction, low social support and poor employment status after retirement. Studies in adolescent amateurs and spectators indicate that playing and watching football games may negatively affect subjective mental health, even though qualitative studies indicate mental health benefits of playing or watching football.

Players, referees and spectators are unlikely to present with fewer mental health problems than other members of society as a result of their involvement with football. It appears that some of the infrastructure that supports resilience in mental health such as a sense of inclusion, shared purpose and positive peer identification might be developed by playing in or supporting a team. Strategies that may use the assumed positive aspects of football need to be validated before implementation of large projects.

There is almost no data on antidepressant prescribing in older adults treated with polypharmacy, although this population represents approximately 50% of older patients. These patients are frequently excluded from double-blind randomized controlled trials, meta-analyses and existing treatment guidelines. The main aim of this paper was to identify data on antidepressant prescribing in depressed older adults on polypharmacy using a systematic review.

Randomized controlled clinical trials (RCTs) and other clinical trials in Medline/PubMed without language limitation (-2017) were searched to identify those with older depressed patients on polypharmacy. Only elderly patients (>65 years as mean) were included. Only approved antidepressants were included.

The systematic search identified 26 different clinical trials, although only one clinical open label trial with sertraline met the final inclusion criteria. This sertraline trial indicated the absence of clinically important drug-drug interactions and confirmed the effectiveness and safety of sertraline in routine clinical practice. Heterogeneity in this trial was high in almost all the categories except attrition and reporting bias.

Sertraline has the highest evidence level in older adults with depression on polypharmacy. According to the results of this review and due to a low number of appropriate trials, a basic understanding of psychopharmacology is the possible approach to avoid serious problematic drug combinations in these patients. Newer RCTs are also urgently needed. This is the first systematic review including patients treated with polypharmacy, and therefore, its results are important in the field of evidence-based medicine.

Globally, Moslems are the second largest religious group. During the month of Ramadan from dawn to sundown, healthy Moslems are required to refrain from eating, drinking, smoking, sexual activity and harmful behaviour towards others and themselves. Thus Ramadan may change individual physical states and social interactions. Both might affect mental health within society. Consequently, this systematic review looks at the various effects of Ramadan on mental health.

A literature search on Ramadan and mental health initially identified 294 papers. We finally selected all 22 relevant papers covering Ramadan and mental health from which study data were extracted.

Relevant papers focussed on the general population and healthy volunteers, on subjects practising sports, on subjects with severe physical disorders, on subjects at risk of eating disorders and on subjects with mental health disorders. The effects of Ramadan on mental well-being were mixed. Positive and negative effects were usually minor, except in subjects with schizophrenia and metabolic syndrome, and in subjects with bipolar disorder who suffered a substantial increase of relapses.

Ramadan fasting is safe in most conditions and disorders, but caution is required in subjects with schizophrenia and bipolar disorder. The research on mental health and Ramadan would profit from larger studies with more representative samples to help understand the intra-individual and social factors that affect the mental health and well-being in patients and in society. The scientific potential of such studies may have been overlooked in the psychiatric community.