Musculoskeletal injuries are common in overhead sports. Repetitive use of the upper limb in specific movements can lead to the development of pain and significant functional impairments, affecting athletic performance and quality of life. Psychological factors, such as anxiety and depression, can influence athletes' performance and overall well-being, particularly in those experiencing musculoskeletal pain. Shoulder pain is a common issue among swimmers due to the high demands of repetitive overhead movements, potentially impacting their mental health. Identifying whether athletes with shoulder pain present higher levels of anxiety and depression can provide valuable insights for developing comprehensive rehabilitation strategies that address both physical and psychological aspects. The Hospital Anxiety and Depression Scale (HADS) is a widely used tool for assessing anxiety and depression symptoms in clinical and research settings. However, the relationship between shoulder pain and psychological distress in competitive swimmers remains unclear.

To assess whether athletes with shoulder pain present higher scores for anxiety and depression based on the HADS.

This is a cross-sectional observational study, which was approved by the Ethics Research Committee. We included competitive swimmers, both with and without musculoskeletal pain, of both sexes, aged between 12 and 60 years, with at least one year of competitive experience and a training regimen of at least twice a week. Anxiety and depression were assessed using the HADS, which consists of 14 questions divided into two subscales. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 23.0. Data normality was assessed using the Shapiro-Wilk test. Between groups comparisons for normally distributed data were conducted using Student’s t-test, while the Mann-Whitney U test was used for non-normally distributed data. Effect size (Cohen’s d) was calculated for between-group differences.

A total of 49 competitive swimmers were included in the study, with a mean age of 30,82 ± 14,34, 7,18 ± 6,41 years of sports practice, and 22 (44,9%) were women. No statistically significant differences were found between the groups for anxiety and depression. For the total HADS score the mean difference was 0.41 ((95% confidence interval [CI]: -3.094, 3.92, p = 0.81); Effect size (Cohen’s d) = 1.74). For the anxiety subscale the mean difference was (0.85 ((95% CI: -1.34, 2.98, p = 0.44); Effect size (Cohen’s d) = 1.83). For the depression subscale the mean difference was -0.43 ((95% CI: -2.22 to 1.35;p = 0.62); Effect size (Cohen’s d) = 0.014).

The results indicate no statistically significant difference in anxiety and depression scores between athletes with and without shoulder pain.

The results of this study suggest that the anxiety and depression scores are not different between swimmers with and without shoulder pain. However, different results may be found using other measurement instruments to assess the anxiety and depression scores.