From Slump to Comeback: Psychological Determinants of Performance Decline, Burnout, and Recovery in Competitive Athletes-A Systematic Review.

Background

Psychological determinants are increasingly recognized as central contributors to both performance decline and recovery in competitive sport; however, contemporary evidence integrating injury-related and non-injury performance contexts remains fragmented.

Objective

This systematic review synthesized empirical evidence (2016-2025) examining psychological determinants associated with return to sport (RTS), reinjury risk, burnout, injury incidence, and performance decline among competitive athletes.

Methods

Conducted in accordance with PRISMA 2020 guidelines, a systematic search of PubMed, Scopus, Web of Science, and SPORTDiscus identified peer-reviewed studies published between January 2016 and December 2025. Eligibility criteria were defined using a PICO framework. Prospective cohort studies, longitudinal multi-wave investigations, one randomized controlled trial, matched cohort studies, diary-based designs, and injury-related observational studies were included. Due to heterogeneity in constructs and outcomes, findings were synthesized narratively.

Results

Fourteen studies met the inclusion criteria, including prospective cohort studies, multi-wave longitudinal designs, one randomized controlled trial, one matched cohort study, and a diary-based investigation. Seven independent cohorts examined psychological readiness using the Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI) in athletes with anterior cruciate ligament (ACL) injuries (sample sizes ranging from n = 39 to n = 384), consistently demonstrating that higher readiness predicted successful RTS at 6-24 months, while two prospective studies reported contrasting associations with second ACL injury risk. Four longitudinal studies (n = 93-491) showed that increased burnout and controlled motivation predicted performance decline and dropout trajectories, whereas higher resilience and mental toughness reduced burnout progression. One seasonal longitudinal study (n = 21) linked elevated cognitive anxiety and mood disturbance to increased injury incidence.

Conclusion

Psychological determinants operate across deterioration and restoration pathways. Psychological readiness shows the strongest predictive consistency for RTS, while burnout, motivational climate, and resilience significantly shape long-term performance sustainability and injury-related outcomes.