IntroductionThe interest in the health of Para athletes continues to increase. Still, there are few studies that have evaluated health parameters beyond injury and illness in this athlete population. ObjectiveTo assess (1) the weekly proportion of elite Para athletes reporting anxiety/depression, low sleep levels (<= 7 hours), and pain over 52 weeks; (2) and to explore whether these health parameters are associated with the risk for a sports injury or illness. DesignA 52-week prospective study, part of the Sports-related Injury and Illness in Paralympic Sport Study (SRIIPSS). SettingA total of 107 Swedish elite Para athletes with physical, visual, and intellectual impairment participated. Main outcome measuresData on self-reported anxiety/depression, sleep levels, pain, and injuries/illnesses were collected weekly. Comparisons of these parameters preceding an injury/illness were made using Friedmans analysis of variance (ANOVA). ResultsThe proportion of athletes reporting weekly anxiety/depression was 34.1%; 60.9% of athletes reported sleeping <= 7 hours and 49.9% reported pain. In exploratory analyses, there were no significant differences between weeks before an injury for any of the variables. There were significant differences in levels of sleep over the weeks, where sleep levels were significantly higher (>10 hours) 4 weeks prior to an illness (p = .016). ConclusionThis cohort of elite Para athletes reported relatively high levels of anxiety/depression, low sleep levels, and pain, which is a concern. High sleep levels and the risk for illness might be an indication of overtraining, which commonly leads to persistent fatigue and an increased susceptibility to infections. Monitoring of the health of elite Para athletes is recommended to be able to improve performance and health in this population.