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Considerable attention has focused on the risks of contact sports like rugby union (1), yet the benefits, rewards and opportunities have received less robust analysis. It is for that reason, Griffin et al.’s recent scoping review is a welcome preliminary contribution to our understanding of risk in rugby. There are, however, some concerns that deserve discussion to ensure that cursory readers are not unintentionally misguided by inaccurate claims.
Claims on mental health and wellbeing
In their paper, Griffin and colleagues examine the evidence for three contexts of rugby; Contact, non-contact and wheelchair. For mental health, Griffin et al. have stated:
There is a generally positive relationship between most (emphasis added) forms of rugby union and both (emphasis added) mental health and wellbeing, especially in wheelchair rugby, though further research is required outside of the wheelchair rugby setting.
They also assert, "Despite relatively fewer studies, the relationship between rugby union and both mental health and well-being is generally positive, especially in non-professional settings" (emphasis added).
For the contact rugby context, Griffin et al. cite three studies (3, 4, 5). Each of which evidences elevated levels of common mental health disorders for contact rugby participants in the elite game. No evidence is presented for sevens at any level, the adult amateur community game or youth contact game....
For the contact rugby context, Griffin et al. cite three studies (3, 4, 5). Each of which evidences elevated levels of common mental health disorders for contact rugby participants in the elite game. No evidence is presented for sevens at any level, the adult amateur community game or youth contact game.
For non-contact rugby there is no evidence found or presented. For wheelchair rugby, one study found participation in wheelchair rugby for those with tetraplegia is a positive impact on mental health.
Therefore, there is insufficient evidence to claim that most forms of rugby have a generally positive relationship to mental health. The evidence in this scoping review suggests that based on one study, wheelchair rugby has a positive relationship to mental health. Furthermore, contact rugby, based on limited evidence of the professional context, has a detrimental impact on mental health.
The authors also claim that “any form of rugby union can involve moderate-to vigorous physical activity (MVPA), which … confers a wide range of physical, mental and social well-being benefits”. However, rugby’s high concussion rate needs to be accounted for before accepting any such claim, particularly with the deleterious mental health effects associated with concussion. In a study published in 2020 of 416 New Zealand high school rugby players “69% of players had sustained [at least one] suspected concussion” (7) during their rugby playing at school. So, any MVPA-related mental health benefits derived from rugby would need to be placed in context with the recent finding about brain injuries to school children (and possible mental health consequences), including
This is particularly important given the widespread dissemination of this article's findings, including to the general public via blogs, infographics and animations; sometimes with the BJSM Approved logo. Indeed, Griffin et al recognise the importance of this work for informed decision making, commenting “A wide range of stakeholders as well as existing and potential participants can use this information to make a more informed decision about participating in and promoting rugby union as a health-enhancing activity” (2).
As examples, some of these pieces include statements such as, "Those who play any form of rugby (outside of the professional setting) could benefit from a range of mental health and wellbeing benefits...". Another claim on an infographic states "Data suggests that participating in rugby union has beneficial effects on numerous proxy measures for mental health and wellbeing, especially in wheelchair and non-professional settings". Given the importance a scoping review like this is for allowing people to make informed and balanced decisions on participation, it is vital that the statements accurately portray not only the benefits (evidenced and perceived) but also the uncertainties and known risks of participation.
The way forward
In this instance, the authors of the paper should look to moderate their claims to be more reflective of the evidence within their scoping review. They should also, as responsible members of the sports medicine community, make every effort to ensure their work is not misrepresented to the public, which may include retracting and amending the various dissemination tools currently being promoted.
1. Pollock, A. M., White, A. J., & Kirkwood, G. (2017). Evidence in support of the call to ban the tackle and harmful contact in school rugby: a response to World Rugby. British journal of sports medicine, 51(15), 1113-1117.
Griffin, S. A., Perera, N. K. P., Murray, A., Hartley, C., Fawkner, S. G., Kemp, S. P., ... & Kelly, P. (2020). The relationships between rugby union, and health and well-being: a scoping review. British Journal of Sports Medicine.
Gouttebarge V, Kerkhoffs G, Lambert M. Prevalence and determinants of symptoms of common mental disorders in retired professional rugby union players. Eur J Sport Sci 2016;16:595–602 PubMed .
Gouttebarge V, Hopley P, Kerkhoffs G, et al. Symptoms of common mental disorders in professional rugby: an international observational descriptive study. Int J Sports Med 2017;38:864–70 PubMed .
Gouttebarge V, Hopley P, Kerkhoffs G, et al. A 12-month prospective cohort study of symptoms of common mental disorders among professional rugby players. Eur J Sport Sci 2018;18:1004–12 PubMed .
Silveira SL, Ledoux T, Cottingham M, et al. Association among practice frequency on depression and stress among competitive US male wheelchair rugby athletes with tetraplegia. Spinal Cord 2017;55:957–62 PubMed .
Salmon, D. M., Mcgowan, J., Sullivan, S. J., Murphy, I., Walters, S., Whatman, C., ... & Romanchuk, J. (2020). What they know and who they are telling: Concussion knowledge and disclosure behaviour in New Zealand adolescent rugby union players. Journal of sports sciences, 1-10.