Para-athletes (PA) may have specific mental health (MH) challenges that, together with the demands of high-level sport performance, could put them at risk for MH disorders. However, research in this population is limited. PURPOSE: To investigate factors associated with MH in South African PA. METHODS: In this descriptive, cross-sectional study, 124 athletes (93 males; 31 females) with a mean age 26.7 (±9.2) competing in the 2019 National Champs were recruited. Demographic, medical history and sleep-related variables were included in bivariate analyses to assess their association with MH. Between-group differences were analysed using the Mann-Whitney U or T-tests. Variables significantly associated in the bivariate analyses were included in multiple regression analyses for mental health. Mental health was measured with the State/Trait Anxiety Inventory (STAI) and the Kessler Psychological Distress Scale (K-10 Questionnaire). Sleep quality, sleepiness and chronotype were measured with the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness scale and Morningness-Eveningness Questionnaire (MEQ-SA). RESULTS: The model explained 40% of the variance in MH (F=12.04, p<0.001). Compared to athletes with ‘good’ sleep quality, K-10 and STAI scores were significantly higher (indicating poorer MH) in athletes with ‘poor’ sleep quality (U =2.6, p<0.001; t(116.8)=-4.30, p<0.001). ‘Poor’ sleep quality (B:0.8; 95%CI 0.4 to 1.3), moderate to severe daytime sleepiness (B:4.2; 95%CI 1.1 to 7.3) intermediate (B:3.5 95%CI 0.4 to 6.6) and evening chronotypes (B:12.0 95%CI 5.0 to 19.1), the presence of allergies (B:3.9 95%CI 0.1 to 7.6) and male gender (B:3.3 95%CI 0.1 to 6.5) were most strongly associated with high STAI scores.  CONCLUSIONS: This study identified novel factors associated with adverse MH in elite PA. As some of these factors are modifiable, further research towards prevention strategies is warranted.