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The COVID-19 pandemic significantly affected elite athletes, leading to increased mental health issues such as stress, anxiety, and depression. Sex differences in mental health may exist among athletes during the COVID-19 crisis. This study aimed to perform a systematic review and meta-analysis to examine sex differences in mental health symptoms among elite athletes during the COVID-19 pandemic. We systematically searched the databases including Pubmed, EMBASE, and manually checked previous systematic reviews for relevant studies in March 2024. Authors were also contacted for sex-specific data. Studies were included if they compared mental health symptoms between male and female elite athletes during the COVID-19 pandemic. We used a random-effects model to summarize the rate ratio (RR) between female and male athletes across studies. Risk of bias in studies was assessed using a 9-item tool. We included 18 studies in this review. The results indicated that female athletes reported higher levels of anxiety (RR 1.24, 95% CI = 1.08 to 1.43) and depression (RR 1.36, 95% CI = 1.15 to 1.61) than male athletes during the pandemic. They also had a higher risk of stress or distress (RR 1.27, 95% CI = 0.99 to 1.63) than their male counterparts. No significant differences were found regarding alcohol use or misuse between female and male athletes (RR 1.01, 95% CI = 0.75 to 1.37). Limited evidence was available for eating disorders, gambling, substance use, and sleep problems. In conclusion, female and male athletes differed in mental health symptoms during the COVID-19 pandemic. Female athletes were more likely to report anxiety, depression, and distress. Incorporating mental health resources may be particularly important for women’s sports, which have smaller financial margins and greater career uncertainty than men’s sports.

新型冠状病毒肺炎（COVID-19）疫情对精英运动员造成了显著冲击，引发了应激、焦虑、抑郁等愈发频发的心理健康问题。新冠疫情期间，运动员群体的心理健康状况或存在性别差异。本研究旨在通过系统综述与元分析（meta-analysis），探究新冠疫情期间精英运动员群体心理健康症状的性别差异。本研究于2024年3月系统检索PubMed、EMBASE等数据库，并手动筛查既往系统综述以获取相关研究；同时联系作者获取分性别统计的原始数据。纳入本次综述的研究需满足：对比新冠疫情期间男女精英运动员的心理健康症状差异。本研究采用随机效应模型，合并各研究中女性与男性运动员的比率比（rate ratio, RR）以开展综合分析，并采用9条目偏倚风险评估工具对纳入研究的偏倚风险进行评价。本综述共纳入18项相关研究。结果显示，疫情期间女性精英运动员的焦虑症状（RR=1.24，95%置信区间CI：1.08~1.43）与抑郁症状（RR=1.36，95%CI：1.15~1.61）严重程度均显著高于男性运动员；其应激或心理困扰风险也高于男性（RR=1.27，95%CI：0.99~1.63）。男女运动员在酒精使用与滥用方面未发现显著差异（RR=1.01，95%CI：0.75~1.37）；针对进食障碍、赌博行为、物质使用与睡眠问题的相关研究证据较为有限。综上，新冠疫情期间男女精英运动员的心理健康症状存在显著差异：女性运动员更易报告焦虑、抑郁与心理困扰症状。相较于男子体育赛事，女子体育赛事的财务盈余更少、职业发展不确定性更高，因此针对性配置心理健康资源对女子运动员群体尤为关键。