Plus everything you need to know about mental health in sports  

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Mental health has been in the spotlight for many years now.

Particularly amongst teens, discussion of a ‘mental health crisis’ is common, referring to skyrocketing rates of mental health problems in youth and adolescents. 

In fact, the problem is now so bad that in 2021 the American Academy of Pediatrics, the Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association, declared a national emergency in child and adolescent mental health.

While athletes are generally known for their health and vitality, it would seem that student athletes are not immune to the mental health crisis. 

In this article, we will discuss some of the specific considerations for prioritizing mental health with athletes.

We will run through what mental health issues show up in sports, why mental health is often overlooked in athletes, plus how involvement in sports affects mental health.

Finally, we will explore 4 strategies that can be used by coaches, parents, and individual athletes, to prioritize mental health.

Let's start by taking a look at mental health in sports.

Mental Health In Sports

While mental health considerations in athletes do overlap with those of the general public, there are some factors specifically related to sports that need attention.

Athletes, particularly at the elite level, are exposed to several unique stressors that the non-athletes often don’t have to deal with. Some notable examples include:

• Physically and emotionally demanding training regimes, often undertaken in conjunction with a full academic load.
• Competition related stress and pressure, including public scrutiny of performance and physical appearance.
• Dealing with injury.
• Group dynamics in team sports, including hazing and bullying.
• Reduced family and social support during travel and relocation.

With this context in mind, it is not surprising that mental health conditions can manifest differently in athletes than in the general population. The most prevalent mental health conditions for competitive athletes are detailed below.

Depression

Research indicates that depression in college aged athletes occurs at about the same rate as in non-athlete peers—approximately 25%. Depression can initially show up in athletes as a decline in performance, dedication, and focus, rather than low mood. Personality factors common amongst athletes, like high levels of perfectionism and conscientiousness, can actually increase the risk of depression. Athletes are particularly prone to experiencing depression following an injury.   

Anxiety

Detection of anxiety in athletes can be challenging, because ‘state anxiety’ (like being nervous at competition) is entirely normal—it can even enhance athletic performance. Two specific triggers of anxiety for athletes are fear of failure, and being judged negatively by teammates, coaching staff, and the public. As with depression, injury raises the risk of experiencing prolonged anxiety. For athletes, the focus of anxiety treatment is often to reduce the overflow of state anxiety into daily life.  

Disordered Eating

Eating disorders are more common amongst athletes than in the general population. This is particularly true for sports where leanness or a low body weight can provide a competitive advantage. Because of the increased prevalence of disordered eating in athletes, it is recommended that regular screening be undertaken to identify and address concerns as early as possible. The most common ways disordered eating shows up is through excessive calorie restriction and/or compulsive exercising, to the extent that it negatively impacts health and wellbeing.  

Overtraining

Sometimes referred to as ‘underperformance training syndrome’, overtraining is an issue that can affect athletes' mental health. Overtraining occurs when excessive training loads, with inadequate rest and recovery, lead to a persistent decline in athletic performance. While the focus on overtraining is understandably usually on physical performance, it is well documented that it also results in negative changes in mood, such as fatigue, depression, anger, confusion, and tension.    

Substance Abuse

There is a bit of a mixed picture with substance abuse in student-aged athletes. Excessive alcohol use amongst teenage athletes is similar to non-athlete peers. Rates of marijuana, cocaine, and tobacco use are lower in athletes, but the misuse of opioids is higher. Factors contributing to this problem are a lack of awareness of the risks of opioid abuse amongst athletes, an increased likelihood that athletes will be prescribed opioid painkillers, and a cultural acceptance of opioid use in sports (more prominent in some sports than others).

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Why Mental Health Is Overlooked In Athletes

While several high-profile athletes have spoken out about their personal experiences with mental health issues in recent years, some entrenched cultural beliefs and myths still contribute to mental health being overlooked in athletes.

Amongst the general public, athletes—particularly those participating at elite levels—are often looked upon as possessing superhero-like powers. The confident, larger than life persona, and mentally tough attitude associated with high-level sports performance, promotes the belief that athletes don’t suffer from mental health problems. 

We now know from research that this is simply not true. Athletes are just as susceptible to mental health issues as the rest of the population. 

Problem is, while public health campaigns have focused for decades on encouraging the general public to seek out help for mental health issues, the same hasn’t been true in sports. 

Some of the main reasons mental health is overlooked in athletes include:

• Mixed messages from coaching staff, and even parents. This can be summed up by the phrase, “We care about you, but are you better yet?”. 
• A lack of education and understanding about the timeframes and treatment required for mental health issues. While there are well established guidelines for treatment and recovery periods for physical injury, the same can not be said of mental health issues.
• Difficulty distinguishing mental health conditions from aspects of performance and training. For example, stress, nervous tension, and worry are to be expected before competition, but should not permeate daily life on a continual basis. Depression can easily be mistakenly attributed to overtraining, leading to a delay in treatment.
• Athletes may be reluctant to speak up and ask for help when they are struggling. Concerns about being sidelined, missing out on selection, or being perceived as weak and ‘not having what it takes’ are common worries.
• Concerns about psychiatric medication can lead to a delay in treatment. Worries about medication impacting physical performance, leading to weight gain, or being restricted by anti-doping authorities are common. 

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Fortunately, there is ongoing work being done in this area by various national and international sporting bodies. While the developments are encouraging, individual athletes, coaches, and parents still need to remain vigilant about identifying and addressing mental health concerns in athletes. 

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How Sports Affect Mental Health

The impact of sports on mental health and personal development is an interesting topic. 

It is widely accepted that physical activity and exercise have a positive impact on mental health. People who exercise regularly tend to experience fewer days of poor mental health, have more positive mood states, and enjoy better health overall.

Particularly for adolescents, involvement in organized sports can also be a tremendously beneficial activity for social and emotional development. 

Youth athletes build an important support network of peers, are exposed to positive mentors, and learn about goal setting, competition, and skill acquisition. Participation in sports can be foundational to a young person’s development of a sense of confidence, self-esteem, and emotional self-efficacy.

Furthermore, research indicates that illicit drug use amongst student athletes is generally lower than in the general population.

So if involvement in sports has all these positive effects on mental health, why do student athletes still experience mental health problems at around the same rate as the general population?

Well, the first part of the answer to this question comes back to the point made earlier—athletes, even at the elite level, are still people. They experience the same human emotions as the rest of us, and deal with the same life stressors that impact on mental wellbeing.

The second part of the answer, is that some of the positive mental effects of sports are balanced out with stressors not experienced by the general public. The stress and pressure of competition and training, expectations around maintaining particular physical characteristics, being subject to public scrutiny, and exposure to unhealthy team dynamics, are just some of the factors that can negatively affect athletes' mental health.

If we are serious about prioritizing mental health with athletes, we need to look at the particular issues that negatively impact mental health, then develop individual strategies to address them.

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4 Ways To Make Athlete Mental Health A Priority

Now that we've covered all the important points about mental health in sports, it’s time to look at some practical ways to prioritize mental well-being. 

Here are our four top strategies that can be used by coaches, athletic trainers, individuals, and parents, to support the mental health of athletes

1. Develop An Individual Mental Health Plan For Each Athlete

Just like each athlete has an individual plan for physical training and nutrition, each athlete needs an individual plan for mental health. 

The particular risk factors around mental health will vary greatly between each athlete. Things such as specific demands of the sport, pre-existing mental health issues, personality factors, and social and family situations all need to be taken into account.

Rather than waiting until mental health becomes a problem, plan ahead. Identify risk factors, engage in preventative work, and arrange key mental health support staff early on. 

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2. Proactively Manage Hazing and Bullying

Toxic hazing and bullying can wreak havoc on the mental health of athletes. It is up to everyone involved in sports to proactively address this issue. 

Viewing hazing and bullying as an inevitable part of being involved in sports, or allowing ‘just a little bit’ of either, can easily get out of hand. A zero-tolerance policy is the best approach.

Education for staff, parents, and athletes, plus clear ground rules around acceptable behavior are essential to managing hazing and bullying. Involved adults can also take the initiative in setting up positive team bonding experiences. This helps to ‘fill the void’ that often leads to problems, plus sets an example of healthy group dynamics.  

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3. Promote Education and Awareness About Mental Health

While a lot of general education about mental health does apply to athletes, there are additional sports-specific factors that need to be covered. Increasing awareness of these issues is the first step in responding to them more effectively. 

Athletes need to know that it is ok to talk about mental health and that they won’t be penalized or disadvantaged by asking for help. Framing mental health education as a way to achieve and maintain peak performance can increase interest and engagement.

Mental health education is just as important for parents and support staff as it is for athletes. It needs to be viewed as a continual process, not a ‘one off’ education session that tries to cover everything in one sitting. 

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4. Increase Support During High Risk Periods

We know that there are particular times when athletes are at higher risk of experiencing mental health problems. Providing additional support during these periods can help athletes move through challenging times, and prevent smaller issues from escalating into bigger ones.

Injury is the biggest risk period for mental health problems in athletes. Athletic teams should have well thought out, evidence-based protocols for dealing with injury, that incorporate psychological support into a treatment plan.

Other high risk periods can be the lead-up to and aftermath of significant competitions, transitions out of sport or into different divisions, being the subject of public criticism, and social and family stressors. 

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Mental Health Is A Team Responsibility

If there is one overall lesson about mental health in athletes, it is that looking after the mental health of competitors is a team responsibility.

Everyone on the team—competitors, coaches, and parents—needs to have a good level of knowledge about the unique psychological stressors in sports. 

This knowledge needs to be used to develop individual mental health support plans for each athlete. Plans should include specific areas of concern and risk, plus early identification of mental health support staff that will be utilized when needed.

Finally, a team culture where mental health concerns can be discussed openly, without fear of being penalized or disadvantaged must be created.

For a deep dive on the topic of mental health in student athletes, including practical advice, checklists, and screening tools, check out the NCAA Mental Health Best Practices. 

If you are an athlete experiencing mental health issues, or a concerned parent or coach, please contact a mental health professional as soon as possible. A primary care physician, sports psychologist, or counselor can provide support, advice, and treatment for any mental health concerns. They will also gladly work in collaboration with key members of the athletic team.

For more mental health resources, please see below.

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Resources

In a mental health emergency, please call 911 or visit your local Urgent Care Clinic. 

The resources below may also be helpful:

2.1.1

The caring, local experts at 211 are available 24/7. The 211 network is made up of over 200 agencies throughout the United States, who are experts in local resources and can connect you with the help you need. 211 is free and as the name suggests, can be contacted simply by dialing 211.

National Suicide Prevention Lifeline

The Lifeline provides 24/7, free and confidential emotional support to people in suicidal crisis or emotional distress. A bunch of resources are available on their website and you can call on 1-800-273-8255. 

Teen Line

The mission of Teen Line is to provide support, resources, and hope to youth through a hotline of professionally trained teen counselors. Through the hotline, teens can access personal peer-to-peer support from highly trained teens supervised by adult mental health professionals. The service is free of charge and can be accessed by phone, email, or text. 

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Related Articles:

• Mentality is Everything
• The Power of Routines
• How to Use Critical Thinking in Sports
• Preparation and Focus

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