Factors Contributing to Anxiety in Athletes with Disabilities: A PRISMA-Based Systematic Review

Abstract

Background: Athletes with disabilities are vulnerable to competitive anxiety that may negatively affect performance and psychological well-being. Evidence regarding factors contributing to anxiety in disability sports remains fragmented.
Objective: This systematic review aimed to identify factors contributing to anxiety among athletes with disabilities.
Methods: A PRISMA-based systematic review was conducted using PubMed, ScienceDirect, and Google Scholar databases between March 4 and March 10, 2026. Observational studies published between 2021 and 2026 involving athletes with disabilities and anxiety-related outcomes were included. Five studies involving 482 athletes were analyzed using narrative synthesis. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS). Three studies demonstrated low risk of bias, whereas two showed moderate risk.
Results: Anxiety among athletes with disabilities was influenced by internal and external factors. Internal factors included mental toughness, intrinsic motivation, perceived competence, injury and illness status, sleep quality, and age. Greater mental toughness was associated with lower competitive anxiety (r = −0.498; p < 0.05), whereas injury, illness, and poor sleep quality increased anxiety symptoms (p < 0.05). Athletes participating in individual sports demonstrated significantly higher anxiety levels than those participating in team sports (p = 0.009).
Conclusion: Anxiety in athletes with disabilities is a multidimensional phenomenon influenced by psychological, physical, and environmental factors. Despite moderate-to-high methodological quality, heterogeneity and predominantly cross-sectional designs limited causal interpretation. Multidisciplinary psychological support may help reduce anxiety and optimize athletic performance.