Addressing Mental Health Among Athletes

Famed tennis player Naomi Osaka recently withdrew from the French Open due to concerns about her mental health; the athlete had suffered long depressive episodes and emphasized the unique pressures of being a high-profile athlete that led to her decision. Osaka’s example serves as an important reminder for the world of elite athletic competition, and can hopefully spur discussions concerning the importance of psychological wellbeing and mental health from tennis courts to the typical office environment.

Up until now, efforts to support elite athlete mental health have mostly centered on building literacy and awareness of the signs of disorders. While mental health awareness is necessary, it is not sufficient in addressing the varied and increasing psychologic needs of athletes. As such concerns increase among the population, clinicians can play a paramount role in supporting their patients’ mental health while being more conscious of the specific issue of athlete mental health to provide improved, holistic care.

Facts and Figures

According to the most recent data from Athletes for Hope, an organization that aims to educate and assist athletes with philanthropic pursuits, up to 35% of elite athletes experience a mental health crisis often manifesting as anxiety, depression, burnout, or eating disorders. This number is even higher among more segmented demographics; for instance, up to 48% of female collegiate athletes have reported symptoms of anxiety.

Prior to the COVID-19 pandemic, experts reported college athlete depression levels had reached epidemic proportions. Now, recent data reveals that the crisis has gotten even worse with rates of mental health issues among college athletes between 150% and 250% higher than historically reported. Among current elite athletes, rates of either anxiety or depression alone average 34% – that is almost 15% higher than in the general population.

Factors Contributing to Mental Health Disorders in Athletes

The nature of competition can expose specific psychological issues in athletes. There is growing evidence of a range of factors that contribute to the development or worsening of mental illness in elite athletes specifically, such as sports-related injury and concussion, performance failure, overtraining or overtraining syndrome, as well as the sport type with individual sports conferring higher risks than team sports. Furthermore, athletes are also exposed to the general risk factors for mental health conditions, including major negative life events, low social support, and impaired sleep. Overall, all of these factors may impact the severity and onset of disorder symptoms, however, they can also be used to guide response strategies tailored to individual athlete needs and concerns.

Other athlete-specific variables are important to consider as well, such as psychological response to injury and illness, which have a more profound impact on this group, and the barriers to care they experience that can include the fear of consequences for seeking help due to surrounding stigma. Here, athletic culture and environmental variables also play a role as common behaviors such as hazing, bullying, sexual harassment, and gender identity issues can exacerbate existing personality traits and mental health disorders.

Developing the Athletic Care Network 

To help support this demographic in its struggle with mental illness, the American Medical Society for Sports Medicine has provided evidence-based best practices that aim to assist clinicians with detecting, treating, and preventing mental health concerns in athletes. The article outlines the need for comprehensive psychological care – which includes the joint efforts of physicians, trainers, and mental health providers – to better coordinate multiple aspects of effective athlete care. Creating an athletic care network requires the engagement of clinical or counseling psychologists, psychiatrists, nurses, licensed counselors, and primary care physicians. In such an arrangement, it is necessary for members of the network to establish clear roles and guidelines on order to communicate clearly and optimize athlete care.

Prior analyses have proposed a framework that outlines two other important targets to consider alongside the need for specialist multi-disciplinary teams. Firstly, it is critical to help athletes develop and cultivate a range of self-management skills to support themselves during periods of psychological distress. Secondly, key stakeholders in the athlete’s environment should be equipped with the knowledge and awareness to quickly recognize and respond to mental health concerns.

In the sporting context, the early detection and intervention for mental health symptoms is critical as such approaches can help build cultures that prioritize mental wellbeing alongside physical health. Thus, it is important for clinicians to assist in normalizing help-seeking behaviors and to understand and address the barriers to seeking care that athletes uniquely experience. Providing screening for depression, anxiety, eating disorders, and substance abuse among other common mental illnesses as a part of routine pre-sporting physical examinations can help in normalizing discussions about mental health disorders in this specific environment.  Combined, these efforts can help ensure that athletes at every level receive the intervention, care, and support they need to feel and perform their best.