This is an important question and one I am sure many of you have pondered. I had asked myself that question but I really considered this in much more depth when Professor Steve Peters spoke immediately after me at a Sports Psychiatry event 5 years ago. I attended the event and gave a detailed talk all about the benefits of exercise for mental health. Following on from my talk, Prof Peters posed the question of the title of this blog.
Before delving deeper, I think it is important to say the reasons for the high mental health burden in athletes is multifaceted & complex. Nonetheless, there is consensus in the research that the physical and mental demands placed upon athletes is substantial. To give you an idea of the extent of the problem, a recent meta-analysis found that among current elite athletes, 19% had problematic alcohol use and 34% had anxiety/depression. The reasons for the high mental health burden in athletes explored in this blog focuses on athlete specific factors and does not cover the risk factors that we all have.
So what are some of the specific risk factors that predispose athletes to poor mental health?
Under pressure…..
The pressure to perform and associated scrutiny is a huge factor for elite athletes. The internal pressure to “win” is often substantial in fact, it is essential to motivate athletes to perform. Beyond this, the pressure to perform from sponsors, teammates, fans, the media and the public generally (especially on social media) all produce a pressure cooker which is very unique to this population. Of course, for many athletes, this pressure is the sauce that makes them tick and motivates them to perform to higher levels. However, when resilience is compromised (for any reason), these substantial pressures can tip an athlete into a mental health crisis.
Injury and unable to compete
One factor I have seen extensively in my time as a physiotherapist that is a major cause of distress and poor mental health is pain and/or injury. There have been many times when I have been rehabilitating athletes where I have been struck by their anxiety/concern to be match fit. Closely linked are those injuries that can threaten or actually cause retirement. Transitioning into retirement is already a struggle for many athletes even under the best circumstances.
Concussion
There has been a rapid rise in concerns about the impact of concussion in sport especially when it comes to contact sports. For instance, there has been a rapid increase in media coverage of the impact of concussion in rugby, boxing and football. There is a robust evidence base showing concussion is associated with an increased risk of poor mental health, especially depression and anxiety disorders.
Over training
Over training (but especially when injured and mistiming their return) is another key risk factor. In my experience, often the athlete is unaware or the last to know they are over training. It requires an astute team to spot for signs of over training. Unfortunately, this issue often only arises as people seek an explanation to a substantial decline in their performance.
Team sports offer more protection
I think it is interesting that the type and context of sport also appears to make a difference. For instance, individual sports (e.g. tennis) seem to have a higher burden of mental ill health than team sports. The reasons for this are closely tied to the social support that one gets from the togetherness from team sports (assuming a health team).
Time away from families and travelling
Elite athletes typically spend a large amount of time travelling and away from their families. This lack of social support is also a key risk factor. Additionally, when travelling for sport, the athletes’ lives are micromanaged to a considerable extent – think all eat at the same time, report to training at a certain time and bed time at a certain time. This quite large degree of intense micromanagement for an event (think Olympics) and then transitioning to a less structured setting can be really tricky for athletes.
Stigma
Finally, but importantly, stigma is a major factor and this can explain a substantial amount of the low help seeking among professional athletes. There has been some fantastic efforts to address stigma, but clearly we have a long way to go. Stigma can take MANY different forms, but if you start to think about the Psyche of competitive athletes such as win at all costs, show no weakness against your competitors, it is easy to understand why an athlete may want to not disclose their struggles.
So what can be done about this issue?
I think we have seen monumental shifts in the acceptance and awareness of mental health in sport. Clearly, we have a huge amount to go to ensure that all who need help are able to access it. One positive step was the recent International Olympic Committee guidelines on managing the mental health of elite athletes. This is a very comprehensive review, but they make some excellent recommendations including:
Ensuring mental health services are culturally sensitive.
Integrating athletic trainers, coaches, and other members of the athlete's support network into mental healthcare teams to enhance accessibility and effectiveness.
There is a need to overcome stigma around mental health in sports and understanding sport subculture's impact on mental well-being are essential.
The design of athlete accommodations, societal impacts of sport sponsorships, and empowerment of coaches and athletes in creating supportive environments are key considerations for promoting mental wellness.
Clearly, people that work with elite athletes need to be clued up on the science of the risk factors and warning signs of how to manage an athlete who is struggling with their mental health. Early intervention and prevention should be paramount.
Therefore, I have developed an online course to equip physical activity/rehabilitation professionals with the skills and knowledge to support people in crisis. Check out the online course here.
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