Mental Health In Elite Athletes Research Articles

Psychiatric Disorders in Elite Athletes

Previous literature has described the importance of increased knowledge about the mental health of elite athletes. This systematic literature review aimed to investigate clinically diagnosed psychiatric disorders in elite athletes, including possible connections between being an elite athlete and psychiatric disorders. The databases EMBASE, MEDLINE, SPORTDiscus and Psychinfo have been systematically searched from January 1975 to December 2022. Two authors have conducted title-, abstract- and full-text screening as well as quality assessment independently. The search identified 12,490 records up until December 2022. After a removal of duplicates and double screening, 11 studies consisting of 4,492 elite athletes were included. The mean age of the included athletes was 18.6 years, and most studies included were Scandinavian. Most studies investigated multiple types of sport simultaneously. Findings revealed that eating disorder was the most studied psychiatric disorder in this population, while depression and anxiety were more sparsely investigated. Furthermore, female athletes had a higher occurrence of both eating disorders, depression, and anxiety than male athletes. Additional studies based on diagnostic interviews need to be conducted to investigate possible associations between elite athletes and psychiatric disorders.

Differences in Exercise Stress, Job Satisfaction, Intention to Quit Exercise, and Quality of Life According to the Psychological Abuse Experiences of Elite Male Athletes.

This study aimed to further understand psychological abuse in sports and contribute to the development of elite sports and athletes' persistent performance by identifying the causal effects of psychological abuse on elite athletes' exercise stress, job satisfaction, intention to quit exercise, and quality of life (QOL). Data were collected from 363 elite South Korean male athletes (ages ≥ 20 years) from August to September 2023. The independent variable for comparative analysis was the presence or absence of psychological abuse in elite male athletes by coaches. The participants were divided into two groups: a non-abuse-experienced group (Group 1) and an abuse-experienced group (Group 2). Participants' demographic and athletic background information (e.g., career and sport) were also collected. This study showed that the three factors (exercise stress, intention to quit exercise, and QOL) were higher in Group 2 than in Group 1. These findings provide a meaningful analysis of the impact of psychological abuse on the mental health, persistence, and overall QOL of elite male athletes that can be used to develop countermeasures and policies against psychological abuse that threatens the mental health of elite athletes.

Factors contributing to elite athletes’ mental health in the junior-to-senior transition: A mixed methods study

The goals of this study were to examine factors that may affect the mental health of elite athletes during their junior-to-senior transition and to explore the types and frequency of facilitators and challenges athletes encounter during this transition. Using a cross-sectional, embedded QUAN(qual) mixed methods study design, we surveyed two samples for the study goals. All participants completed demographic data (e.g., gender, age, sports). Sample one (N = 394, Mage = 18.46 years, SD = 2.2) consisted of current transitioning athletes which completed questionnaires on stress, anxiety, depression, well-being, self-compassion, and social support. Mediation and moderation analyses revealed that stress leads to resource depletion, and that self-compassion can be an important resource for young athletes to draw upon to maintain their mental health. Regarding social support results were less conclusive. Sample two (N = 371, Mage = 27.70 years, SD = 8.3) consisted of athletes that have passed the transition. They responded to open questions about helpful strategies and challenges faced during their junior-to-senior transition, which were analyzed using thematic content analysis. Results showed that during the junior-to-senior transition, external resources were more frequently mentioned than internal resources when it came to facilitators. Furthermore, external challenges were perceived as hindering more frequently than internal challenges. These findings can guide practitioners by providing potential starting points for improving the mental health of transitioning elite athletes, as well as information on helpful strategies and barriers during the transition.

Mental health symptoms in German elite athletes: a network analysis

IntroductionElite athletes are exposed to a variety of sport-specific stressors that may put them at particular risk for mental health symptoms and disorders. The aim of the present study was to assess data on mental health of elite athletes and investigate associations and interconnections among different variables using network analysis.MethodsA cross-sectional study was conducted from December 2021 to December 2022. The sample consisted of 275 German elite athletes (167 females) aged ≥18 years. Next to sociodemographic, medical and sport-related data, psychometric data such as psychological distress, symptoms of generalized anxiety, depression, and somatic symptom disorder have been gathered through questionnaires and analyzed by means of network analysis.ResultsOver 95.0% of the athletes showed elevated distress and 28.6% reported symptoms of depression. Results of the network analysis show, among other findings, that symptoms of somatic symptom disorder were associated with severe injuries and substance use. Moreover, elite athletes who reported a better financial situation reported fewer symptoms of depression, generalized anxiety, and somatic symptom disorder. They also reported a lower incidence of mild to moderate injuries and severe injuries, fewer years spent in elite sports, less substance use, and fewer training sessions per week. Conversely, these athletes reported a higher level of distress. Furthermore, sex, financial situation and number of training units per week emerged as significant predictors for mental health symptoms.DiscussionElite athletes showed increased numbers regarding mental health symptoms. Providing appropriate mental health interventions for elite athletes and further analysis of factors that influence the mental health of elite athletes and their interplay seem to be of central importance for the general well-being of elite athletes.

Coping strategies for handling stress and providing mental health in elite athletes: a systematic review.

The combination of stressors unique to the athletic context plus the sensitive developmental phase that elite athletes go through during their peak performance may increase the athletes' vulnerability to mental health decrements. To emphasize the necessity to raise elite athletes' awareness of health risks, it seems to be essential to teach them coping skills to handle stress and to make affected athletes aware of how to recognize, evaluate, and articulate potential risks to their health. This systematic review analyzes coping strategies used by elite athletes to deal with stress and the effect of these strategies on mental health to identify gaps that future research could prioritize. The current review analyzes studies containing quantitative, qualitative, and mixed data and results, all of them focusing on coping strategies to deal with stress and the effect of coping strategies on elite athletes' mental health. Literature search for this systematic review took place between August and October 2023 and included the use of 3 electronic databases: PubMed, PsychINFO, SPORTdiscus. There were initially 5,705 hits from 3 electronic databases, hand search and from a complementary search in Google Scholar. After the screening process and quality appraisal 30 studies were included. The analyzed study results point to a broad spectrum of coping categories, elite athletes make use of to deal with stressful situations. The results of this review underpin the necessity that especially young athletes being confronted with a wide range of stressors, need to be taught mental skills to cope with these stressors. In addition, teaching coaches and teammates about social support seemed to decrease elite athletes' stress reactions, such as anxiety or depressive symptoms. Coping in elite sporting settings is very complex and dynamic. There is evidence of coping being effective to buffer stress, but the interrelationships between stressor, appraisal of the stressor, application of a corresponding coping strategy and its effect especially in terms of mental health outcomes is still unclear because of lacking intervention-based study designs.

Integrating sports psychiatry in the interdisciplinary care of elite sports teams

Abstract: Introduction: Sports psychiatry is a developing field whose focus is the diagnosis, treatment, and management of mental illness in sports team members. Participation in elite sports can compromise mental health as psychiatric symptoms and disorders are often unrecognized until players experience performance failures, injury, or interpersonal concerns. Despite the growing recognition of psychiatric illness in sports, sports psychiatry is yet to be widely practiced in athlete healthcare management. Methods: We conducted a search on relevant publications on sports psychiatry and mental health in elite athletes. Results: Numerous papers detailed mental health statistics in elite athletes as well as outlined the development of sports psychiatry with respect to healthcare management. The papers describe cultural barriers to athlete mental health treatment include stigma, low mental health literacy, adverse mental health treatment experiences, busy schedules, and cultural/religious factors. Modifiable systemic factors include conflicts of interest for team clinicians caused by dual loyalty to sports franchises, and power relations encompassing intra-team hierarchies that prevent both help-seeking behaviors and the disclosure of harassment. Conclusion: The proposed model recommends that sports leagues and tournament organizations hire sports psychiatrists to monitor the standard of care provided within each sports franchise as a quality control initiative to incentivize sports franchises to offer the highest-level of healthcare, combating conflicts of interest and harassment. The conceptual model recommends each sports franchise integrate sports psychiatrists onsite with elite sports team members with the long-term goal of achieving SAMHSA’s full integration model pending available funding and sports culture shifts.

Mental health, eating habits and physical activity levels of elite Iranian athletes during the COVID-19 pandemic.

The COVID-19 pandemic has changed life styles of millions of people worldwide. This study investigated changes in the health, physical activity levels and eating habits of elite athletes during the COVID-19 pandemic lockdown in Iran. 383 (248 female and 135 male) elite athletes (168.82 ± 0.07 cm; 63.92 ± 7.42 kg; the body mass index (BMI): 22.3 ± 0.78 kg/m2) participated in this study. The International Physical Activity Questionnaire (IPAQ), Depression Anxiety Stress Scales (DASS-21) and the Impact of Event Scale-Revised (IES-R) study tools were used to measure levels of physical activity and mental health status, respectively. The Emotional Eater Questionnaire (EEQ) was used to assess food consumption related to emotion. Pearson and Spearman correlation analysis test were used in data analysis. Levels of depression and stress were mild and moderate, while levels of anxiety were severe and very severe in most elite athletes. There were levels of low emotional eating by elite athletes during the COVID-19 pandemic. Physical activity levels were negatively correlated with psychological mood measures (p≤0.05), while there were positive correlations between emotional eating behaviours and psychological mood measures (moderate correlation; p≤0.01) and light physical activity levels (weak correlation; p≤0.05). This study provides the first preliminary evidence showing that the COVID-19 lockdown conditions negatively influenced the eating habits and levels of physical activity and mental health in elite athletes. Regular high intensity physical activity as health strategy in elite athletes and the general population remains a strategy to improve overall health during the COVID-19 pandemic. Additionally, these findings suggest the need to devise strategies to improve the life styles of elite athletes during pandemics such as the Covid-19 pandemic.

Understanding the role of coaches in supporting the mental health of elite athletes.

Elite sport coaches often rely on their discretion when assisting athletes struggling with mental health, with clear guidelines yet to be broadly adopted. This study aimed to explore how coaches perceive their role in athlete mental health and their role clarity. This study employed a descriptive qualitative approach with semi-structured interviews. 17 Australian elite level swimming coaches were interviewed, focusing on their perceived experiences with athlete mental health and any discrepancies between what their role is currently and what they perceive it should be. Thematic analysis was used to analyse results. Analysis revealed that coaches perceive their role to include open communication, actively observing their athletes' mood, and acknowledging their potential mental health knowledge deficits. They also indicated a lack of clarity for when to refer an athlete on to a medical professional. Athletes were perceived as responsible for maintaining self-awareness and help-seeking, whilst the organisational role included providing education and funding. Barriers for supporting athlete mental health included a lack of resources and poor mental health literacy. Coaches suggested a variety of recommendations to ameliorate these barriers including education and redesigning systems of support. Australian swimming coaches would greatly benefit from formal guidelines on how to identify, manage, and support athlete mental health. These guidelines should be established with input from coaches and key staff, in addition to clinical professionals and utilising evidence-based measures, including consideration of boundaries around coaches as non-mental health professionals.

Current trends and perspectives in the exploration of anorexia athletica-clinical challenges and therapeutic considerations.

Elite athletes are exposed to a considerable amount of physical and psychological stress throughout their entire professional life, but the exploration of the consequences of this stressful regimen on mental health is still in its early stages. Eating disorders (EDs), substance use disorders, and behavioral addictions represent only several domains that are worth more investigation in this vulnerable population, in order to find preventative and therapeutic strategies. The exploration of EDs in athletes is important because this population is very vulnerable to the impact that weight and body shape may have on their professional performances, and epidemiological studies support this concern, i.e., the prevalence of EDs in athletes is significantly higher than in the general population. This article is dedicated to the synthesis of available data regarding a specific pathology reported in elite athletes, i.e., anorexia athletica (AA), based on a narrative reviewing methodology. The information about risk factors, pathophysiology, positive and differential diagnosis, epidemiology, structured evaluation, and treatment of AA have been summarized and future research directions have been highlighted. While tentative diagnostic criteria for AA and a self-administered questionnaire exist, its pathophysiology is still insufficiently explored, and the treatment is not based on good-quality trials. According to the retrieved data, more research targeting the physical and mental health of elite athletes, especially those practicing esthetic sports, is needed, in order to implement adequate screening and early intervention programs. Future studies targeting various sub-populations of elite athletes, i.e., esthetic vs. non-esthetic sports, individuals presenting a history of ED vs. those without such a history, and those practicing individual sports vs. team sports are needed to reach the objective of improving the quality of life in this population.

Prevalence of symptoms of depression and generalized anxiety disorder in field hockey players of German first and lower leagues.

While several studies on mental health of elite athletes were published in recent years, few compared the prevalence with the general population and none included field hockey players. To analyze the prevalence of symptoms of depression and generalized anxiety disorder in field hockey players of different skill levels and to compare it to the general population. Male and female hockey players from different leagues were asked to answer questions on player characteristics, the Centre of Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder-7 (GAD-7). One hundred and eighty-seven players (incl. 54 first and 28 second league players) participated in the study (response rate 97.4%). More than a third (n = 64; 35.0%) reported to be affected by an injury/health complaint, but 157 (86.3%) were able to train and play without limitations. The CES-D score indicated depression symptoms in more female (n = 15; 18.3%) than male (n = 5; 4.8%) players (χ2=8.8; p < 0.01). No male and one female player had symptoms of generalized anxiety disorder. Players who played 60 or more matches in the previous 12 months had on average significantly higher depression (t = 2.3; p < 0.05) and generalized anxiety scores (t = 4.2; p < 0.001) than players who played fewer matches. The prevalence of depression and of generalized anxiety symptoms was similar to or lower than in the general population. Although 20 (10.7%) players had depression symptoms, only 4 (2.2%) received psychological counseling or psychotherapy. It is recommended to provide routine screening of mental health problems and low-threshold access to adequate treatment for elite athletes.

Mental health help-seeking preferences and behaviour in elite male rugby players

ObjectivesMental health symptoms and mental illnesses are common in elite athletes. There is an urgent need to develop care systems to support the mental health of elite athletes. Understanding elite...

Depressive symptoms among male professional soccer players in Japan

ObjectivesThe objectives of this study were to (Kuettel & Larsen, 2020) examine depressive symptoms among male professional soccer players in Japan, and (Buck et al., 2018) explore the association of these symptoms with current injuries, history of severe injuries, general anxiety, and adverse life events. DesignCross-sectional online survey. SettingThe survey was conducted during the Japanese Professional Football preseason between February and April 2020 in Japan. ParticipantsSixty-four professional athletes from four teams participated in the survey. The mean age was 26 years (SD 4.5). Main outcome measuresThe outcome measures included the Patient Health Questionnaire, Generalized Anxiety Disorder-7, and select items from the Social Athletic Readjustment Rating Scale. ResultsDepressive symptoms were reported among 9.4% of participants. Two players (3.1%) were found to have generalized anxiety as well as depressive symptoms. Other risk factors were unrelated to depressive symptoms. ConclusionThe occurrence of depressive symptoms among participating professional soccer players from four teams in Japan was lower than the previously reported prevalence estimates among Western players but higher than the general population in Japan of the same age group. The findings suggest clinicians should assess the mental health of elite athletes, and work to mitigate stigma around mental health.

The prevalence of common mental health problems and associated psychosocial issues in elite swimmers

Abstract: Introduction: The mental health of elite athletes has been recognised as of great importance. There have been relatively few studies examining the prevalence of mental health problems in swimmers. None have commented on the range of psychosocial problems associated with mental ill-health. The aim of this study was to identify the prevalence of common mental health problems and psychosocial problems in elite swimmers. Methods: The study was conducted on a national swimming squad competing at the international level. All athletes (n=55) were invited to participate. The response rate was 63.3% (n=36). The study was cross-sectional in design. Data was collected using a battery of psychometric tests yielding information on distress (The Distress Screener), anxiety and depression (PHQ-9, K10), sleep disturbance (PROMIS scale), alcohol consumption (AUDIT-C), smoking behaviour, adverse nutrition behaviour, career satisfaction (Career Satisfaction Scale) and mental toughness (Mental Toughness Index). Results: The prevalence of depression was 14% (n=5). Six percent (n=2) reported suicidal ideation in the last 2 weeks. Fourteen percent met criteria for distress. There were positive correlations between depression and sleep disturbance ( r=.343, p&lt;.05), between anxiety/depression and distress ( r=.380, p&lt;.05), and between depression and distress ( r=.531, p&lt;.01). Career dissatisfaction was identified in 46% of participants and was inversely correlated with mental toughness ( r=.485, p&lt;.01). Low mental toughness and adverse alcohol use were identified in 37% and 23% of participants, respectively. Conclusions: Elite swimmers experience common mental illnesses and associated psychosocial problems. There is a relationship between career dissatisfaction and low mental toughness. Sport governing bodies should assess their own athlete populations and implement programmes to support mental health.

Cumulative lifetime stressor exposure and health in elite athletes: the moderating role of perfectionism

ABSTRACT Although greater lifetime stressor exposure has been associated with physical and mental health issues in the general population, relatively little is known about how lifetime stressors impact the physical and mental health of elite athletes or the factors moderating this association. Given that many elite athletes show signs of perfectionism, and that this trait has been linked with ill-health, it is possible that perfectionism may moderate the lifetime stressor-health relationship. To test this possibility, we examined how cumulative lifetime stressor exposure was associated with general mental and physical health complaints in elite athletes, and the extent to which these associations were moderated by perfectionism. Participants were 110 elite athletes (64 female; Mage = 29.98 years, SD = 10.54) who completed assessments of lifetime stressor exposure, physical health, psychological distress, and perfectionism. As hypothesised, hierarchical regression analyses revealed that experiencing more severe lifetime stressors was related to poorer physical and mental health. Furthermore, self-oriented perfectionism moderated the association between lifetime stressor count and severity and physical health, but not mental health. Overall, these data demonstrate stressor-specific effects among elite athletes and highlight the potential importance of assessing lifetime stressor exposure and perfectionistic tendencies in order to improve athlete health and well-being.

Referencing an evidence-based framework to enhance mental health in elite sport, Mental Health in Elite Athletes: Increased Awareness on early Intervention Framework responding to Athlete Needs

Referencing an evidence-based framework to enhance mental health in elite sport, Mental Health in Elite Athletes: Increased Awareness on early Intervention Framework responding to Athlete Needs

The mental health of elite athletes in developing nations of the greater Oceania region

ABSTRACT Objective The mental health of elite athletes is reportedly similar to that of the general community, but there could be important differences across geographic regions and cultures. This study investigated the mental health and levels of psychological distress of elite athletes from developing nations in the Oceania region via a cross-sectional survey. Method The survey assessed the mental health status, psychological distress, and help-seeking behaviours of athletes from 12 nations of the Oceania region who participated in the Gather, Adjust, Prepare, Sustain (GAPS) program. Results A high proportion of athletes (84%) met cut-off criteria for at least one of the investigated mental health symptoms. Athletes reported being most likely to seek help from their mother, father, or coach. Furthermore, athletes who reported high psychological distress did not differ in anticipated help-seeking behaviour from athletes who reported low psychological distress. Conclusions The findings suggest that mental health symptoms are prevalent among elite athletes from developing nations in the Oceania region. Psychological distress did not predict willingness to seek help, suggesting that education and support frameworks are needed to assist this vulnerable group. Piloting support programs in collaborative aid with nearby developed nations may be warranted and interventions may consider targeted mental health literacy resources and education.

Impact of COVID Lockdown on Mental Health of Elite Athletes – A Status Study

Covid lockdown upset the whole globe to a stunning shock. Never in life we had ever faced such a crisis, complete lockdown, which all lead up in lonely untouchable deaths, sickness, isolation, quarantine finally ended up in disordered mental health. Though there is an increased awareness on health and using need for staying fit, the lockdown restrictions doesn’t pay space for it. If this is the case for the normal, athletes who dedicate their entire life, investing, time, body, mind and soul all into athletic performance have completely dislodged routines. A layman’s eyes may find life of a sports man a fun filled, excited, easy go. But it’s not the true colour. Ambitious, ameturistic life into training has changed to cloudy future feared min set. The purpose of this study was to find out the mental health status of elite athletes during covid lockdown. To conduct the study, data was collected through google form using Kessler Psychological Distress Scale (K-10). Out of the 374 athletes who responded, 218 athletes (58.29%) where in extreme stress almost all the time during covid lockdown. Thus it is concluded that, in this situation coach and sports psychologists have to create awareness about the lockdown, contact athletes and council them. Athletes are the pride of every nation, they need to recover from psychological setbacks. So, it is. The need of the hour to design a best training programme suitable and possible during lockdown to protect their skills and abilities. Even from these minds, our national athletes need to recover from psychological setbacks. So, we need to find the best training method for them and protect their skills.

Mental illness in elite weightlifters

Abstract. Introduction: The mental health of elite athletes is a growing area of research however there remains a paucity of data to support evidence-based screening and prevention programmes as well as holistic yet targeted care. Olympic Weightlifting has long been associated in the media with the use of banned substances at an elite level however little is known about the mental health impact that this might represent and what the wider mental health needs of this group might be. Methods: A systematic search of PsychINFO, MEDLINE, EMCARE, EMBASE and CINAHL databases was conducted from inception up until January 2022. Peer reviewed studies of any methodology looking at mental illness or symptoms amongst current elite level Olympic weightlifters were eligible for inclusion. Results: Four articles met all inclusion criteria. Two cross-sectional studies looked at depression and anxiety and two case studies reported psychosis following long-term use of Mephentermine. Results seemed to broadly align with research looking at elite athletes in other sports however it was not possible to compare results between the two cross-sectional studies due to methodological differences. Conclusion: There is very little published research in this area and it is of varying methodological quality. A narrow subset of mental health symptoms were investigated and most of the data were based on self-reported symptoms rather than diagnostic data. Further research is needed to explore the mental health burden in this group and to inform appropriate support programmes.

Psychological safety in elite sport settings: a psychometric study of the Sport Psychological Safety Inventory.

ObjectivesEffectively supporting the mental health of elite athletes and coaches requires validated tools that assess not only individual-level factors but organisational-level influences. The aim of this study was to develop a bespoke scale assessing perceived psychological safety within high-performance environments.Methods337 elite athletes (M=24.12 years) and 238 elite-level coaches and high-performance support staff (HPSS; M=41.9 years) identified via the Australian Institute of Sport provided data across a range of mental health and well-being domains. Exploratory factor analysis (EFA; n=169 athletes) with parallel analysis identified the Sport Psychological Safety Inventory (SPSI) factor structure. Confirmatory factor analysis (CFA) validated the identified structure in separate validation subsamples of athletes (n=168) and coaches/HPSS (n=238).ResultsEFA identified the 11-item, 3-factor SPSI. Factors assessed domains of the Mentally Healthy Environment, Mental Health Literacy and Low Self-Stigma. All scale items loaded strongly on their specific domain. CFA model fit indices validated scale structure for athletes and coaches/HPSS. Internal consistency and convergent and divergent validity were evident. Logistic regression indicated that incrementally higher Mentally Healthy Environment scores reduced the likelihood of athletes scoring in the ‘moderate’ range of general and athlete-specific distress, with a stronger endorsement of the Low Self-Stigma subscale reducing the likelihood of being identified for athlete-specific distress.ConclusionPsychometric properties of the SPSI support scale utility among athletes and coaches/HPSS in elite sports settings, though further psychometric efforts are needed. This brief measure may support benchmarking efforts across elite sporting contexts to improve mental health culture and broader well-being among athletes and coaches/HPSS.

The paradox of mental health versus mental disease in elite athletes: a scoping review

Aim: To analyze the concepts of mental health and illness as well as the instruments used to measure them in the elite athlete. Methods: The scoping review was conducted using PubMed, SPORTDiscus, PsycINFO, and Scielo. The keywords “Mental Health” AND “Sport” AND “Athlete” were used to find studies in peer-reviewed scientific journals published in English, Spanish, and Portuguese. Studies went through four stages of analysis according to PRISMA guidelines. A total of 179 records were included in this review. Results: Recent studies suggest that health and illness should not be recognized as deviations from the norm, but as a changing construct, varying on a continuum, where, at one extreme, we have health; and, at the other, we have illness even coexisting in an orthogonal way. Between the two extremes, there are degrees of psychological well-being and distress, leading from reduced functioning to effective functioning. This indicates the need for psychological support for both the maintenance and enhancement of mental health. An alarming result was that, although most of the studies investigated mental health, they used primarily instruments focused on illness. This new perspective of health-illness brings the need for the development of new instruments that encompass protective factors and symptom screening. Conclusions: We reinforce the need for a paradigm shift in relation to the mental health of elite athletes understanding it as a changing construct that should be constantly improved and/or maintained. This change led to the need for broader assessment instruments that encompass protective factors and illness symptoms.