research questions about mental health in sports

• Systematic review update
• Open access
• Published: 21 June 2023

The impact of sports participation on mental health and social outcomes in adults: a systematic review and the ‘Mental Health through Sport’ conceptual model

• Narelle Eather   ORCID: orcid.org/0000-0002-6320-4540 1 , 2 ,
• Levi Wade   ORCID: orcid.org/0000-0002-4007-5336 1 , 3 ,
• Aurélie Pankowiak   ORCID: orcid.org/0000-0003-0178-513X 4 &
• Rochelle Eime   ORCID: orcid.org/0000-0002-8614-2813 4 , 5  

Systematic Reviews volume  12 , Article number:  102 ( 2023 ) Cite this article

67k Accesses

15 Citations

305 Altmetric

Metrics details

Sport is a subset of physical activity that can be particularly beneficial for short-and-long-term physical and mental health, and social outcomes in adults. This study presents the results of an updated systematic review of the mental health and social outcomes of community and elite-level sport participation for adults. The findings have informed the development of the ‘Mental Health through Sport’ conceptual model for adults.

Nine electronic databases were searched, with studies published between 2012 and March 2020 screened for inclusion. Eligible qualitative and quantitative studies reported on the relationship between sport participation and mental health and/or social outcomes in adult populations. Risk of bias (ROB) was determined using the Quality Assessment Tool (quantitative studies) or Critical Appraisal Skills Programme (qualitative studies).

The search strategy located 8528 articles, of which, 29 involving adults 18–84 years were included for analysis. Data was extracted for demographics, methodology, and study outcomes, and results presented according to study design. The evidence indicates that participation in sport (community and elite) is related to better mental health, including improved psychological well-being (for example, higher self-esteem and life satisfaction) and lower psychological ill-being (for example, reduced levels of depression, anxiety, and stress), and improved social outcomes (for example, improved self-control, pro-social behavior, interpersonal communication, and fostering a sense of belonging). Overall, adults participating in team sport had more favorable health outcomes than those participating in individual sport, and those participating in sports more often generally report the greatest benefits; however, some evidence suggests that adults in elite sport may experience higher levels of psychological distress. Low ROB was observed for qualitative studies, but quantitative studies demonstrated inconsistencies in methodological quality.

Conclusions

The findings of this review confirm that participation in sport of any form (team or individual) is beneficial for improving mental health and social outcomes amongst adults. Team sports, however, may provide more potent and additional benefits for mental and social outcomes across adulthood. This review also provides preliminary evidence for the Mental Health through Sport model, though further experimental and longitudinal evidence is needed to establish the mechanisms responsible for sports effect on mental health and moderators of intervention effects. Additional qualitative work is also required to gain a better understanding of the relationship between specific elements of the sporting environment and mental health and social outcomes in adult participants.

Peer Review reports

Introduction

The organizational structure of sport and the performance demands characteristic of sport training and competition provide a unique opportunity for participants to engage in health-enhancing physical activity of varied intensity, duration, and mode; and the opportunity to do so with other people as part of a team and/or club. Participation in individual and team sports have shown to be beneficial to physical, social, psychological, and cognitive health outcomes [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. Often, the social and mental health benefits facilitated through participation in sport exceed those achieved through participation in other leisure-time or recreational activities [ 8 , 9 , 10 ]. Notably, these benefits are observed across different sports and sub-populations (including youth, adults, older adults, males, and females) [ 11 ]. However, the evidence regarding sports participation at the elite level is limited, with available research indicating that elite athletes may be more susceptible to mental health problems, potentially due to the intense mental and physical demands placed on elite athletes [ 12 ].

Participation in sport varies across the lifespan, with children representing the largest cohort to engage in organized community sport [ 13 ]. Across adolescence and into young adulthood, dropout from organized sport is common, and especially for females [ 14 , 15 , 16 ], and adults are shifting from organized sports towards leisure and fitness activities, where individual activities (including swimming, walking, and cycling) are the most popular [ 13 , 17 , 18 , 19 ]. Despite the general decline in sport participation with age [ 13 ], the most recent (pre-COVID) global data highlights that a range of organized team sports (such as, basketball, netball volleyball, and tennis) continue to rank highly amongst adult sport participants, with soccer remaining a popular choice across all regions of the world [ 13 ]. It is encouraging many adults continue to participate in sport and physical activities throughout their lives; however, high rates of dropout in youth sport and non-participation amongst adults means that many individuals may be missing the opportunity to reap the potential health benefits associated with participation in sport.

According to the World Health Organization, mental health refers to a state of well-being and effective functioning in which an individual realizes his or her own abilities, is resilient to the stresses of life, and is able to make a positive contribution to his or her community [ 20 ]. Mental health covers three main components, including psychological, emotional and social health [ 21 ]. Further, psychological health has two distinct indicators, psychological well-being (e.g., self-esteem and quality of life) and psychological ill-being (e.g., pre-clinical psychological states such as psychological difficulties and high levels of stress) [ 22 ]. Emotional well-being describes how an individual feels about themselves (including life satisfaction, interest in life, loneliness, and happiness); and social well–being includes an individual’s contribution to, and integration in society [ 23 ].

Mental illnesses are common among adults and incidence rates have remained consistently high over the past 25 years (~ 10% of people affected globally) [ 24 ]. Recent statistics released by the World Health Organization indicate that depression and anxiety are the most common mental disorders, affecting an estimated 264 million people, ranking as one of the main causes of disability worldwide [ 25 , 26 ]. Specific elements of social health, including high levels of isolation and loneliness among adults, are now also considered a serious public health concern due to the strong connections with ill-health [ 27 ]. Participation in sport has shown to positively impact mental and social health status, with a previous systematic review by Eime et al. (2013) indicated that sports participation was associated with lower levels of perceived stress, and improved vitality, social functioning, mental health, and life satisfaction [ 1 ]. Based on their findings, the authors developed a conceptual model (health through sport) depicting the relationship between determinants of adult sports participation and physical, psychological, and social health benefits of participation. In support of Eime’s review findings, Malm and colleagues (2019) recently described how sport aids in preventing or alleviating mental illness, including depressive symptoms and anxiety or stress-related disease [ 7 ]. Andersen (2019) also highlighted that team sports participation is associated with decreased rates of depression and anxiety [ 11 ]. In general, these reviews report stronger effects for sports participation compared to other types of physical activity, and a dose–response relationship between sports participation and mental health outcomes (i.e., higher volume and/or intensity of participation being associated with greater health benefits) when adults participate in sports they enjoy and choose [ 1 , 7 ]. Sport is typically more social than other forms of physical activity, including enhanced social connectedness, social support, peer bonding, and club support, which may provide some explanation as to why sport appears to be especially beneficial to mental and social health [ 28 ].

Thoits (2011) proposed several potential mechanisms through which social relationships and social support improve physical and psychological well-being [ 29 ]; however, these mechanisms have yet to be explored in the context of sports participation at any level in adults. The identification of the mechanisms responsible for such effects may direct future research in this area and help inform future policy and practice in the delivery of sport to enhance mental health and social outcomes amongst adult participants. Therefore, the primary objective of this review was to examine and synthesize all research findings regarding the relationship between sports participation, mental health and social outcomes at the community and elite level in adults. Based on the review findings, the secondary objective was to develop the ‘Mental Health through Sport’ conceptual model.

This review has been registered in the PROSPERO systematic review database and assigned the identifier: CRD42020185412. The conduct and reporting of this systematic review also follows the Preferred Reporting for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 30 ] (PRISMA flow diagram and PRISMA Checklist available in supplementary files ). This review is an update of a previous review of the same topic [ 31 ], published in 2012.

Identification of studies

Nine electronic databases (CINAHL, Cochrane Library, Google Scholar, Informit, Medline, PsychINFO, Psychology and Behavioural Sciences Collection, Scopus, and SPORTDiscus) were systematically searched for relevant records published from 2012 to March 10, 2020. The following key terms were developed by all members of the research team (and guided by previous reviews) and entered into these databases by author LW: sport* AND health AND value OR benefit* OR effect* OR outcome* OR impact* AND psych* OR depress* OR stress OR anxiety OR happiness OR mood OR ‘quality of life’ OR ‘social health’ OR ‘social relation*’ OR well* OR ‘social connect*’ OR ‘social functioning’ OR ‘life satisfac*’ OR ‘mental health’ OR social OR sociolog* OR affect* OR enjoy* OR fun. Where possible, Medical Subject Headings (MeSH) were also used.

Criteria for inclusion/exclusion

The titles of studies identified using this method were screened by LW. Abstract and full text of the articles were reviewed independently by LW and NE. To be included in the current review, each study needed to meet each of the following criteria: (1) published in English from 2012 to 2020; (2) full-text available online; (3) original research or report published in a peer-reviewed journal; (4) provides data on the psychological or social effects of participation in sport (with sport defined as a subset of exercise that can be undertaken individually or as a part of a team, where participants adhere to a common set of rules or expectations, and a defined goal exists); (5) the population of interest were adults (18 years and older) and were apparently healthy. All papers retrieved in the initial search were assessed for eligibility by title and abstract. In cases where a study could not be included or excluded via their title and abstract, the full text of the article was reviewed independently by two of the authors.

Data extraction

For the included studies, the following data was extracted independently by LW and checked by NE using a customized Google Docs spreadsheet: author name, year of publication, country, study design, aim, type of sport (e.g., tennis, hockey, team, individual), study conditions/comparisons, sample size, where participants were recruited from, mean age of participants, measure of sports participation, measure of physical activity, psychological and/or social outcome/s, measure of psychological and/or social outcome/s, statistical method of analysis, changes in physical activity or sports participation, and the psychological and/or social results.

Risk of bias (ROB) assessment

A risk of bias was performed by LW and AP independently using the ‘Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies’ OR the ‘Quality Assessment of Controlled Intervention Studies’ for the included quantitative studies, and the ‘Critical Appraisal Skills Programme (CASP) Checklist for the included qualitative studies [ 32 , 33 ]. Any discrepancies in the ROB assessments were discussed between the two reviewers, and a consensus reached.

The search yielded 8528 studies, with a total of 29 studies included in the systematic review (Fig.  1 ). Tables  1 and 2 provide a summary of the included studies. The research included adults from 18 to 84 years old, with most of the evidence coming from studies targeting young adults (18–25 years). Study samples ranged from 14 to 131, 962, with the most reported psychological outcomes being self-rated mental health ( n  = 5) and depression ( n  = 5). Most studies did not investigate or report the link between a particular sport and a specific mental health or social outcome; instead, the authors’ focused on comparing the impact of sport to physical activity, and/or individual sports compared to team sports. The results of this review are summarized in the following section, with findings presented by study design (cross-sectional, experimental, and longitudinal).

Flow of studies through the review process

Effects of sports participation on psychological well-being, ill-being, and social outcomes

Cross-sectional evidence.

This review included 14 studies reporting on the cross-sectional relationship between sports participation and psychological and/or social outcomes. Sample sizes range from n  = 414 to n  = 131,962 with a total of n  = 239,394 adults included across the cross-sectional studies.

The cross-sectional evidence generally supports that participation in sport, and especially team sports, is associated with greater mental health and psychological wellbeing in adults compared to non-participants [ 36 , 59 ]; and that higher frequency of sports participation and/or sport played at a higher level of competition, are also linked to lower levels of mental distress in adults . This was not the case for one specific study involving ice hockey players aged 35 and over, with Kitchen and Chowhan (2016) Kitchen and Chowhan (2016) reporting no relationship between participation in ice hockey and either mental health, or perceived life stress [ 54 ]. There is also some evidence to support that previous participation in sports (e.g., during childhood or young adulthood) is linked to better mental health outcomes later in life, including improved mental well-being and lower mental distress [ 59 ], even after controlling for age and current physical activity.

Compared to published community data for adults, elite or high-performance adult athletes demonstrated higher levels of body satisfaction, self-esteem, and overall life satisfaction [ 39 ]; and reported reduced tendency to respond to distress with anger and depression. However, rates of psychological distress were higher in the elite sport cohort (compared to community norms), with nearly 1 in 5 athletes reporting ‘high to very high’ distress, and 1 in 3 reporting poor mental health symptoms at a level warranting treatment by a health professional in one study ( n  = 749) [ 39 ].

Four studies focused on the associations between physical activity and sports participation and mental health outcomes in older adults. Physical activity was associated with greater quality of life [ 56 ], with the relationship strongest for those participating in sport in middle age, and for those who cycled in later life (> 65) [ 56 ]. Group physical activities (e.g., walking groups) and sports (e.g., golf) were also significantly related to excellent self-rated health, low depressive symptoms, high health-related quality of life (HRQoL) and a high frequency of laughter in males and females [ 60 , 61 ]. No participation or irregular participation in sport was associated with symptoms of mild to severe depression in older adults [ 62 ].

Several cross-sectional studies examined whether the effects of physical activity varied by type (e.g., total physical activity vs. sports participation). In an analysis of 1446 young adults (mean age = 18), total physical activity, moderate-to-vigorous physical activity, and team sport were independently associated with mental health [ 46 ]. Relative to individual physical activity, after adjusting for covariates and moderate-to-vigorous physical activity (MVPA), only team sport was significantly associated with improved mental health. Similarly, in a cross-sectional analysis of Australian women, Eime, Harvey, Payne (2014) reported that women who engaged in club and team-based sports (tennis or netball) reported better mental health and life satisfaction than those who engaged in individual types of physical activity [ 47 ]. Interestingly, there was no relationship between the amount of physical activity and either of these outcomes, suggesting that other qualities of sports participation contribute to its relationship to mental health and life satisfaction. There was also some evidence to support a relationship between exercise type (ball sports, aerobic activity, weightlifting, and dancing), and mental health amongst young adults (mean age 22 years) [ 48 ], with ball sports and dancing related to fewer symptoms of depression in students with high stress; and weightlifting related to fewer depressive symptoms in weightlifters exhibiting low stress.

Longitudinal evidence

Eight studies examined the longitudinal relationship between sports participation and either mental health and/or social outcomes. Sample sizes range from n  = 113 to n  = 1679 with a total of n  = 7022 adults included across the longitudinal studies.

Five of the included longitudinal studies focused on the relationship between sports participation in childhood or adolescence and mental health in young adulthood. There is evidence that participation in sport in high-school is protective of future symptoms of anxiety (including panic disorder, generalised anxiety disorder, social phobia, and agoraphobia) [ 42 ]. Specifically, after controlling for covariates (including current physical activity), the number of years of sports participation in high school was shown to be protective of symptoms of panic and agoraphobia in young adulthood, but not protective of symptoms of social phobia or generalized anxiety disorder [ 42 ]. A comparison of individual or team sports participation also revealed that participation in either context was protective of panic disorder symptoms, while only team sport was protective of agoraphobia symptoms, and only individual sport was protective of social phobia symptoms. Furthermore, current and past sports team participation was shown to negatively relate to adult depressive symptoms [ 43 ]; drop out of sport was linked to higher depressive symptoms in adulthood compared to those with maintained participation [ 9 , 22 , 63 ]; and consistent participation in team sports (but not individual sport) in adolescence was linked to higher self-rated mental health, lower perceived stress and depressive symptoms, and lower depression scores in early adulthood [ 53 , 58 ].

Two longitudinal studies [ 35 , 55 ], also investigated the association between team and individual playing context and mental health. Dore and colleagues [ 35 ] reported that compared to individual activities, being active in informal groups (e.g., yoga, running groups) or team sports was associated with better mental health, fewer depressive symptoms and higher social connectedness – and that involvement in team sports was related to better mental health regardless of physical activity volume. Kim and James [ 55 ] discovered that sports participation led to both short and long-term improvements in positive affect and life satisfaction.

A study on social outcomes related to mixed martial-arts (MMA) and Brazilian jiu-jitsu (BJJ) showed that both sports improved practitioners’ self-control and pro-social behavior, with greater improvements seen in the BJJ group [ 62 ]. Notably, while BJJ reduced participants’ reported aggression, there was a slight increase in MMA practitioners, though it is worth mentioning that individuals who sought out MMA had higher levels of baseline aggression.

Experimental evidence

Six of the included studies were experimental or quasi-experimental. Sample sizes ranged from n  = 28 to n  = 55 with a total of n  = 239 adults included across six longitudinal studies. Three studies involved a form of martial arts (such as judo and karate) [ 45 , 51 , 52 ], one involved a variety of team sports (such as netball, soccer, and cricket) [ 34 ], and the remaining two focused on badminton [ 57 ] and handball [ 49 ].

Brinkley and colleagues [ 34 ] reported significant effects on interpersonal communication (but not vitality, social cohesion, quality of life, stress, or interpersonal relationships) for participants ( n  = 40) engaging in a 12-week workplace team sports intervention. Also using a 12-week intervention, Hornstrup et al. [ 49 ] reported a significant improvement in mental energy (but not well-being or anxiety) in young women (mean age = 24; n  = 28) playing in a handball program. Patterns et al. [ 57 ] showed that in comparison to no exercise, participation in an 8-week badminton or running program had no significant improvement on self-esteem, despite improvements in perceived and actual fitness levels.

Three studies examined the effect of martial arts on the mental health of older adults (mean ages 79 [ 52 ], 64 [ 51 ], and 70 [ 45 ] years). Participation in Karate-Do had positive effects on overall mental health, emotional wellbeing, depression and anxiety when compared to other activities (physical, cognitive, mindfulness) and a control group [ 51 , 52 ]. Ciaccioni et al. [ 45 ] found that a Judo program did not affect either the participants’ mental health or their body satisfaction, citing a small sample size, and the limited length of the intervention as possible contributors to the findings.

Qualitative evidence

Three studies interviewed current or former sports players regarding their experiences with sport. Chinkov and Holt [ 41 ] reported that jiu-jitsu practitioners (mean age 35 years) were more self-confident in their lives outside of the gym, including improved self-confidence in their interactions with others because of their training. McGraw and colleagues [ 37 ] interviewed former and current National Football League (NFL) players and their families about its impact on the emotional and mental health of the players. Most of the players reported that their NFL career provided them with social and emotional benefits, as well as improvements to their self-esteem even after retiring. Though, despite these benefits, almost all the players experienced at least one mental health challenge during their career, including depression, anxiety, or difficulty controlling their temper. Some of the players and their families reported that they felt socially isolated from people outside of the national football league.

Through a series of semi-structured interviews and focus groups, Thorpe, Anders [ 40 ] investigated the impact of an Aboriginal male community sporting team on the health of its players. The players reported they felt a sense of belonging when playing in the team, further noting that the social and community aspects were as important as the physical health benefits. Participating in the club strengthened the cultural identity of the players, enhancing their well-being. The players further noted that participation provided them with enjoyment, stress relief, a sense of purpose, peer support, and improved self-esteem. Though they also noted challenges, including the presence of racism, community conflict, and peer-pressure.

Quality of studies

Full details of our risk of bias (ROB) results are provided in Supplementary Material A . Of the three qualitative studies assessed using the Critical Appraisal Skills Program (CASP), all three were deemed to have utilised and reported appropriate methodological standards on at least 8 of the 10 criteria. Twenty studies were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, with all studies clearly reporting the research question/s or objective/s and study population. However, only four studies provided a justification for sample size, and less than half of the studies met quality criteria for items 6, 7, 9, or 10 (and items 12 and 13 were largely not applicable). Of concern, only four of the observational or cohort studies were deemed to have used clearly defined, valid, and reliable exposure measures (independent variables) and implemented them consistently across all study participants. Six studies were assessed using the Quality Assessment of Controlled Intervention Studies, with three studies described as a randomized trial (but none of the three reported a suitable method of randomization, concealment of treatment allocation, or blinding to treatment group assignment). Three studies showed evidence that study groups were similar at baseline for important characteristics and an overall drop-out rate from the study < 20%. Four studies reported high adherence to intervention protocols (with two not reporting) and five demonstrated that.study outcomes were assessed using valid and reliable measures and implemented consistently across all study participants. Importantly, researchers did not report or have access to validated instruments for assessing sport participation or physical activity amongst adults, though most studies provided psychometrics for their mental health outcome measure/s. Only one study reported that the sample size was sufficiently powered to detect a difference in the main outcome between groups (with ≥ 80% power) and that all participants were included in the analysis of results (intention-to-treat analysis). In general, the methodological quality of the six randomised studies was deemed low.

Initially, our discussion will focus on the review findings regarding sports participation and well-being, ill-being, and psychological health. However, the heterogeneity and methodological quality of the included research (especially controlled trials) should be considered during the interpretation of our results. Considering our findings, the Mental Health through Sport conceptual model for adults will then be presented and discussed and study limitations outlined.

Sports participation and psychological well-being

In summary, the evidence presented here indicates that for adults, sports participation is associated with better overall mental health [ 36 , 46 , 47 , 59 ], mood [ 56 ], higher life satisfaction [ 39 , 47 ], self-esteem [ 39 ], body satisfaction [ 39 ], HRQoL [ 60 ], self-rated health [ 61 ], and frequency of laughter [ 61 ]. Sports participation has also shown to be predictive of better psychological wellbeing over time [ 35 , 53 ], higher positive affect [ 55 ], and greater life satisfaction [ 55 ]. Furthermore, higher frequency of sports participation and/or sport played at a higher level of competition, have been linked to lower levels of mental distress, higher levels of body satisfaction, self-esteem, and overall life satisfaction in adults [ 39 ].

Despite considerable heterogeneity of sports type, cross-sectional and experimental research indicate that team-based sports participation, compared to individual sports and informal group physical activity, has a more positive effect on mental energy [ 49 ], physical self-perception [ 57 ], and overall psychological health and well-being in adults, regardless of physical activity volume [ 35 , 46 , 47 ]. And, karate-do benefits the subjective well-being of elderly practitioners [ 51 , 52 ]. Qualitative research in this area has queried participants’ experiences of jiu-jitsu, Australian football, and former and current American footballers. Participants in these sports reported that their participation was beneficial for psychological well-being [ 37 , 40 , 41 ], improved self-esteem [ 37 , 40 , 41 ], and enjoyment [ 37 ].

Sports participation and psychological ill-being

Of the included studies, n  = 19 examined the relationship between participating in sport and psychological ill-being. In summary, there is consistent evidence that sports participation is related to lower depression scores [ 43 , 48 , 61 , 62 ]. There were mixed findings regarding psychological stress, where participation in childhood (retrospectively assessed) was related to lower stress in young adulthood [ 41 ], but no relationship was identified between recreational hockey in adulthood and stress [ 54 ]. Concerning the potential impact of competing at an elite level, there is evidence of higher stress in elite athletes compared to community norms [ 39 ]. Further, there is qualitative evidence that many current or former national football league players experienced at least one mental health challenge, including depression, anxiety, difficulty controlling their temper, during their career [ 37 ].

Evidence from longitudinal research provided consistent evidence that participating in sport in adolescence is protective of symptoms of depression in young adulthood [ 43 , 53 , 58 , 63 ], and further evidence that participating in young adulthood is related to lower depressive symptoms over time (6 months) [ 35 ]. Participation in adolescence was also protective of manifestations of anxiety (panic disorder and agoraphobia) and stress in young adulthood [ 42 ], though participation in young adulthood was not related to a more general measure of anxiety [ 35 ] nor to changes in negative affect [ 55 ]). The findings from experimental research were mixed. Two studies examined the effect of karate-do on markers of psychological ill-being, demonstrating its capacity to reduce anxiety [ 52 ], with some evidence of its effectiveness on depression [ 51 ]. The other studies examined small-sided team-based games but showed no effect on stress or anxiety [ 34 , 49 ]. Most studies did not differentiate between team and individual sports, though one study found that adolescents who participated in team sports (not individual sports) in secondary school has lower depression scores in young adulthood [ 58 ].

Sports participation and social outcomes

Seven of the included studies examined the relationship between sports participation and social outcomes. However, very few studies examined social outcomes or tested a social outcome as a potential mediator of the relationship between sport and mental health. It should also be noted that this body of evidence comes from a wide range of sport types, including martial arts, professional football, and workplace team-sport, as well as different methodologies. Taken as a whole, the evidence shows that participating in sport is beneficial for several social outcomes, including self-control [ 50 ], pro-social behavior [ 50 ], interpersonal communication [ 34 ], and fostering a sense of belonging [ 40 ]. Further, there is evidence that group activity, for example team sport or informal group activity, is related to higher social connectedness over time, though analyses showed that social connectedness was not a mediator for mental health [ 35 ].

There were conflicting findings regarding social effects at the elite level, with current and former NFL players reporting that they felt socially isolated during their career [ 37 ], whilst another study reported no relationship between participation at the elite level and social dysfunction [ 39 ]. Conversely, interviews with a group of indigenous men revealed that they felt as though participating in an all-indigenous Australian football team provided them with a sense of purpose, and they felt as though the social aspect of the game was as important as the physical benefits it provides [ 40 ].

Mental health through sport conceptual model for adults

The ‘Health through Sport’ model provides a depiction of the determinants and benefits of sports participation [ 31 ]. The model recognises that the physical, mental, and social benefits of sports participation vary by the context of sport (e.g., individual vs. team, organized vs. informal). To identify the elements of sport which contribute to its effect on mental health outcomes, we describe the ‘Mental Health through Sport’ model (Fig.  2 ). The model proposes that the social and physical elements of sport each provide independent, and likely synergistic contributions to its overall influence on mental health.

The Mental Health through Sport conceptual model

The model describes two key pathways through which sport may influence mental health: physical activity, and social relationships and support. Several likely moderators of this effect are also provided, including sport type, intensity, frequency, context (team vs. individual), environment (e.g., indoor vs. outdoor), as well as the level of competition (e.g., elite vs. amateur).

The means by which the physical activity component of sport may influence mental health stems from the work of Lubans et al., who propose three key groups of mechanisms: neurobiological, psychosocial, and behavioral [ 64 ]. Processes whereby physical activity may enhance psychological outcomes via changes in the structural and functional composition of the brain are referred to as neurobiological mechanisms [ 65 , 66 ]. Processes whereby physical activity provides opportunities for the development of self-efficacy, opportunity for mastery, changes in self-perceptions, the development of independence, and for interaction with the environment are considered psychosocial mechanisms. Lastly, processes by which physical activity may influence behaviors which ultimately affect psychological health, including changes in sleep duration, self-regulation, and coping skills, are described as behavioral mechanisms.

Playing sport offers the opportunity to form relationships and to develop a social support network, both of which are likely to influence mental health. Thoits [ 29 ] describes 7 key mechanisms by which social relationships and support may influence mental health: social influence/social comparison; social control; role-based purpose and meaning (mattering); self-esteem; sense of control; belonging and companionship; and perceived support availability [ 29 ]. These mechanisms and their presence within a sporting context are elaborated below.

Subjective to the attitudes and behaviors of individuals in a group, social influence and comparison may facilitate protective or harmful effects on mental health. Participants in individual or team sport will be influenced and perhaps steered by the behaviors, expectations, and norms of other players and teams. When individual’s compare their capabilities, attitudes, and values to those of other participants, their own behaviors and subsequent health outcomes may be affected. When others attempt to encourage or discourage an individual to adopt or reject certain health practices, social control is displayed [ 29 ]. This may evolve as strategies between players (or between players and coach) are discussion and implemented. Likewise, teammates may try to motivate each another during a match to work harder, or to engage in specific events or routines off-field (fitness programs, after game celebrations, attending club events) which may impact current and future physical and mental health.

Sport may also provide behavioral guidance, purpose, and meaning to its participants. Role identities (positions within a social structure that come with reciprocal obligations), often formed as a consequence of social ties formed through sport. Particularly in team sports, participants come to understand they form an integral part of the larger whole, and consequently, they hold certain responsibility in ensuring the team’s success. They have a commitment to the team to, train and play, communicate with the team and a potential responsibility to maintain a high level of health, perform to their capacity, and support other players. As a source of behavioral guidance and of purpose and meaning in life, these identities are likely to influence mental health outcomes amongst sport participants.

An individual’s level of self-esteem may be affected by the social relationships and social support provided through sport; with improved perceptions of capability (or value within a team) in the sporting domain likely to have positive impact on global self-esteem and sense of worth [ 64 ]. The unique opportunities provided through participation in sport, also allow individuals to develop new skills, overcome challenges, and develop their sense of self-control or mastery . Working towards and finding creative solutions to challenges in sport facilitates a sense of mastery in participants. This sense of mastery may translate to other areas of life, with individual’s developing the confidence to cope with varied life challenges. For example, developing a sense of mastery regarding capacity to formulate new / creative solutions when taking on an opponent in sport may result in greater confidence to be creative at work. Social relationships and social support provided through sport may also provide participants with a source of belonging and companionship. The development of connections (on and off the field) to others who share common interests, can build a sense of belonging that may mediate improvements in mental health outcomes. Social support is often provided emotionally during expressions of trust and care; instrumentally via tangible assistance; through information such as advice and suggestions; or as appraisal such feedback. All forms of social support provided on and off the field contribute to a more generalised sense of perceived support that may mediate the effect of social interaction on mental health outcomes.

Participation in sport may influence mental health via some combination of the social mechanisms identified by Thoits, and the neurobiological, psychosocial, and behavioral mechanisms stemming from physical activity identified by Lubans [ 29 , 64 ]. The exact mechanisms through which sport may confer psychological benefit is likely to vary between sports, as each sport varies in its physical and social requirements. One must also consider the social effects of sports participation both on and off the field. For instance, membership of a sporting team and/or club may provide a sense of identity and belonging—an effect that persists beyond the immediacy of playing the sport and may have a persistent effect on their psychological health. Furthermore, the potential for team-based activity to provide additional benefit to psychological outcomes may not just be attributable to the differences in social interactions, there are also physiological differences in the requirements for sport both within (team vs. team) and between (team vs. individual) categories that may elicit additional improvements in psychological outcomes. For example, evidence supports that exercise intensity moderates the relationship between physical activity and several psychological outcomes—supporting that sports performed at higher intensity will be more beneficial for psychological health.

Limitations and recommendations

There are several limitations of this review worthy of consideration. Firstly, amongst the included studies there was considerable heterogeneity in study outcomes and study methodology, and self-selection bias (especially in non-experimental studies) is likely to influence study findings and reduce the likelihood that study participants and results are representative of the overall population. Secondly, the predominately observational evidence included in this and Eime’s prior review enabled us to identify the positive relationship between sports participation and social and psychological health (and examine directionality)—but more experimental and longitudinal research is required to determine causality and explore potential mechanisms responsible for the effect of sports participation on participant outcomes. Additional qualitative work would also help researchers gain a better understanding of the relationship between specific elements of the sporting environment and mental health and social outcomes in adult participants. Thirdly, there were no studies identified in the literature where sports participation involved animals (such as equestrian sports) or guns (such as shooting sports). Such studies may present novel and important variables in the assessment of mental health benefits for participants when compared to non-participants or participants in sports not involving animals/guns—further research is needed in this area. Our proposed conceptual model also identifies several pathways through which sport may lead to improvements in mental health—but excludes some potentially negative influences (such as poor coaching behaviors and injury). And our model is not designed to capture all possible mechanisms, creating the likelihood that other mechanisms exist but are not included in this review. Additionally, an interrelationship exits between physical activity, mental health, and social relationships, whereby changes in one area may facilitate changes in the other/s; but for the purpose of this study, we have focused on how the physical and social elements of sport may mediate improvements in psychological outcomes. Consequently, our conceptual model is not all-encompassing, but designed to inform and guide future research investigating the impact of sport participation on mental health.

The findings of this review endorse that participation in sport is beneficial for psychological well-being, indicators of psychological ill-being, and social outcomes in adults. Furthermore, participation in team sports is associated with better psychological and social outcomes compared to individual sports or other physical activities. Our findings support and add to previous review findings [ 1 ]; and have informed the development of our ‘Mental Health through Sport’ conceptual model for adults which presents the potential mechanisms by which participation in sport may affect mental health.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Eime RM, Young JA, Harvey JT, Charity MJ, Payne WR. A systematic review of the psychological and social benefits of participation in sport for adults: informing development of a conceptual model of health through sport. Int J Behav Nutr Phys Act. 2013;10:135.

Article   PubMed   PubMed Central   Google Scholar  

Ishihara T, Nakajima T, Yamatsu K, Okita K, Sagawa M, Morita N. Relationship of participation in specific sports to academic performance in adolescents: a 2-year longitudinal study. Scand J Med Sci Sports. 2020.

Cope E, Bailey R, Pearce G. Why do children take part in, and remain involved in sport?: implications for children’s sport coaches. Int J Coach Sci. 2013;7:55–74.

Google Scholar  

Harrison PA, Narayan G. Differences in behavior, psychological factors, and environmental factors associated with participation in school sports and other activities in adolescence. J Sch Health. 2003;73(3):113–20.

Article   PubMed   Google Scholar  

Allender S, Cowburn G, Foster C. Understanding particpation in sport and physical activity among children and adults: a review of qualitative studies. Health Educ Res. 2006;21(6):826–35.

Adachi P, Willoughby T. It’s not how much you play, but how much you enjoy the game: The longitudinal associations between adolescents’ self-esteem and the frequency versus enjoyment of involvement in sports. J Youth Adolesc. 2014;43(1):137–45.

Malm C, Jakobsson J, Isaksson A. Physical activity and sports-real health benefits: a review with insight into the public health of Sweden. Sports (Basel, Switzerland). 2019;7(5):127.

PubMed   Google Scholar  

Mills K, Dudley D, Collins NJ. Do the benefits of participation in sport and exercise outweigh the negatives? An academic review. Best Pract Res Clin Rheumatol. 2019;33(1):172–87.

Howie EK, Guagliano JM, Milton K, Vella SA, Gomersall SR,Kolbe-Alexander TL, et al. Ten research priorities related to youth sport, physical activity, and health. 2020;17(9):920.

Vella SA, Swann C, Allen MS, Schweickle MJ, Magee CA. Bidirectional associations between sport involvement and mental health in adolescence. Med Sci Sports Exerc. 2017;49(4):687–94.

Andersen MH, Ottesen L, Thing LF. The social and psychological health outcomes of team sport participation in adults: An integrative review of research. Scand J Public Health. 2019;47(8):832–50.

Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG. The mental health of elite athletes: a narrative systematic review. Sports medicine (Auckland, NZ). 2016;46(9):1333–53.

Article   Google Scholar  

Hulteen RM, Smith JJ, Morgan PJ, Barnett LM, Hallal PC, Colyvas K, et al. Global participation in sport and leisure-time physical activities: a systematic review and meta-analysis. Prev Med. 2017;95:14–25.

Eime RM, Harvey J, Charity M, Westerbeek H. Longitudinal Trends in Sport Participation and Retention of Women and Girls. Front Sports Act Living. 2020;2:39.

Brooke HL, Corder K, Griffin SJ, van Sluijs EMF. Physical activity maintenance in the transition to adolescence: a longitudinal study of the roles of sport and lifestyle activities in british youth. PLoS ONE. 2014;9(2): e89028.

Coll CVN, Knuth AG, Bastos JP, Hallal PC, Bertoldi AD. Time trends of physical activity among Brazilian adolescents over a 7-year period. J Adolesc Health. 2014;54:209–13.

Klostermann C, Nagel S. Changes in German sport participation: Historical trends in individual sports. Int Rev Sociol Sport. 2012;49:609–34.

Eime RM, Harvey J, Charity M. Sport participation settings: where and “how” do Australians play sport? BMC Public Health. 2020;20(1):1344.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Lim SY, Warner S, Dixon M, Berg B, Kim C, Newhouse-Bailey M. Sport Participation Across National Contexts: A Multilevel Investigation of Individual and Systemic Influences on Adult Sport Participation. Eur Sport Manag Q. 2011;11(3):197–224.

World Health Organisation. Mental Health Action Plan 2013–2020. Geneva: World Health Orgnaisation; 2013.

Keyes C. Bridging Occupational, Organizational and Public Health. Netherlands: Springer Dordrecht; 2014.

Ryff C, Love G, Urry H, Muller D, Rosenkranz M, Friedman E, et al. Psychological well-being and ill-being: Do they have distinct or mirrored biological correlates? Psychother Psychosom. 2006;75:85–95.

Australian Government. Social and emotional wellbeing: Development of a children’s headline indicator information paper. Canberra: Australian Institute of Health and Welfare; 2013.

Global Burden of Disease Injury IP. Collaborators, Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789–858.

World Health Organisation. Mental disorders: Fact sheet 2019 [Available from: https://www.who.int/news-room/fact-sheets/detail/mental-disorders .

Mental Health [Internet]. 2018 [cited 12 March 2021]. Available from: https://ourworldindata.org/mental-health ' [Online Resource].

Newman MG, Zainal NH. The value of maintaining social connections for mental health in older people. The Lancet Public Health. 2020;5(1):e12–3.

Eime RM, Harvey JT, Brown WJ, Payne WR. Does sports club participation contribute to health-related quality of life? Med Sci Sports Exerc. 2010;42(5):1022–8.

Thoits PA. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145–61.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. PLoS Med. 2021;18(3): e1003583.

Eime RM, Young JA, Harvey JT, Charity MJ, Payne WR. A systematic review of the psychological and social benefits of participation in sport for adults: informing development of a conceptual model of health through sport. Int J Behav Nutr Phys Act. 2013;10(1):135.

Critical Appraisal Skills Programme. CASP Qualitative Studies Checklist2019 1/12/2021]. Available from: https://casp-uk.b-cdn.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist-2018.pdf .

National Institutes from Health. Quality assessment tool for observational cohort and cross-sectional studies 2014 [Available from: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools .

Brinkley A, McDermott H, Grenfell-Essam R. It’s time to start changing the game: a 12-week workplace team sport intervention study. Sports Med Open. 2017;3(1):30–41.

Doré I, O’Loughlin JL, Schnitzer ME, Datta GD, Fournier L. The longitudinal association between the context of physical activity and mental health in early adulthood. Ment Health Phys Act. 2018;14:121–30.

Marlier M, Van Dyck D, Cardon G, De Bourdeaudhuij I, Babiak K, Willem A. Interrelation of sport participation, physical activity, social capital and mental health in disadvantaged communities: A sem-analysis. PLoS ONE [Internet]. 2015; 10(10):[e0140196 p.]. Available from: http://ezproxy.newcastle.edu.au/login?url=http://ezproxy.newcastle.edu.au/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med12&AN=26451731 .

McGraw SA, Deubert CR, Lynch HF, Nozzolillo A, Taylor L, Cohen I. Life on an emotional roller coaster: NFL players and their family members’ perspectives on player mental health. J Clin Sport Psychol. 2018;12(3):404–31.

Mickelsson T. Modern unexplored martial arts – what can mixed martial arts and Brazilian Jiu-Jitsu do for youth development?. Eur J Sport Sci. 2020;20(3):386–93. https://doi.org/10.1080/17461391.2019.1629180 .

Purcell R, Rice S, Butterworth M, Clements M. Rates and Correlates of Mental Health Symptoms in Currently Competing Elite Athletes from the Australian National High-Performance Sports System. Sports Med. 2020.

Thorpe A, Anders W, Rowley K. The community network: an Aboriginal community football club bringing people together. Aust J Prim Health. 2014;20(4):356–64.

Appelqvist-Schmidlechner K, Vaara J, Hakkinen A, Vasankari T, Makinen J, Mantysaari M, et al. Relationships between youth sports participation and mental health in young adulthood among Finnish males. Am J Health Promot. 2018;32(7):1502–9.

Ashdown-Franks G, Sabiston CM, Solomon-Krakus S, O’Loughlin JL. Sport participation in high school and anxiety symptoms in young adulthood. Ment Health Phys Act. 2017;12:19–24.

Brunet J, Sabiston CM, Chaiton M, Barnett TA, O’Loughlin E, Low NC, et al. The association between past and current physical activity and depressive symptoms in young adults: a 10-year prospective study. Ann Epidemiol. 2013;23(1):25–30.

Chinkov AE, Holt NL. Implicit transfer of life skills through participation in Brazilian Jiu-jitsu. J Appl Sport Psychol. 2016;28(2):139–53. https://doi.org/10.1080/10413200.2015.1086447 .

Ciaccioni S, Capranica L, Forte R, Chaabene H, Pesce C, Condello G. Effects of a judo training on functional fitness, anthropometric, and psychological variables in old novice practitioners. J Aging Phys Act. 2019;27(6):831–42.

Doré I, O’Loughlin JL, Beauchamp G, Martineau M, Fournier L. Volume and social context of physical activity in association with mental health, anxiety and depression among youth. Prev Med. 2016;91:344–50.

Eime R, Harvey J, Payne W. Dose-response of women’s health-related quality of life (HRQoL) and life satisfaction to physical activity. J Phys Act Health. 2014;11(2):330–8.

Gerber M, Brand S, Elliot C, Holsboer-Trachsler E, Pühse U. Aerobic exercise, ball sports, dancing, and weight Lifting as moderators of the relationship between Stress and depressive symptoms: an exploratory cross-sectional study with Swiss university students. Percept Mot Skills. 2014;119(3):679–97.

Hornstrup T, Wikman JM, Fristrup B, Póvoas S, Helge EW, Nielsen SH, et al. Fitness and health benefits of team handball training for young untrained women—a cross-disciplinary RCT on physiological adaptations and motivational aspects. J Sport Health Sci. 2018;7(2):139–48.

Mickelsson T. Modern unexplored martial arts–what can mixed martial arts and Brazilian Jiu-Jiutsu do for youth development? Eur J Sport Sci. 2019.

Jansen P, Dahmen-Zimmer K. Effects of cognitive, motor, and karate training on cognitive functioning and emotional well-being of elderly people. Front Psychol. 2012;3:40.

Jansen P, Dahmen-Zimmer K, Kudielka BM, Schulz A. Effects of karate training versus mindfulness training on emotional well-being and cognitive performance in later life. Res Aging. 2017;39(10):1118–44.

Jewett R, Sabiston CM, Brunet J, O’Loughlin EK, Scarapicchia T, O’Loughlin J. School sport participation during adolescence and mental health in early adulthood. J Adolesc Health. 2014;55(5):640–4.

Kitchen P, Chowhan J. Forecheck, backcheck, health check: the benefits of playing recreational ice hockey for adults in Canada. J Sports Sci. 2016;34(21):2121–9.

Kim J, James JD. Sport and happiness: Understanding the relations among sport consumption activities, long-and short-term subjective well-being, and psychological need fulfillment. J Sport Manage. 2019.

Koolhaas CH, Dhana K, Van Rooij FJA, Schoufour JD, Hofman A, Franco OH. Physical activity types and health-related quality of life among middle-aged and elderly adults: the Rotterdam study. J Nutr Health Aging. 2018;22(2):246–53.

Article   CAS   PubMed   Google Scholar  

Patterson S, Pattison J, Legg H, Gibson AM, Brown N. The impact of badminton on health markers in untrained females. J Sports Sci. 2017;35(11):1098–106.

Sabiston CM, Jewett R, Ashdown-Franks G, Belanger M, Brunet J, O’Loughlin E, et al. Number of years of team and individual sport participation during adolescence and depressive symptoms in early adulthood. J Sport Exerc Psychol. 2016;38(1):105–10.

Sorenson SC, Romano R, Scholefield RM, Martin BE, Gordon JE, Azen SP, et al. Holistic life-span health outcomes among elite intercollegiate student-athletes. J Athl Train. 2014;49(5):684–95.

Stenner B, Mosewich AD, Buckley JD, Buckley ES. Associations between markers of health and playing golf in an Australian population. BMJ Open Sport Exerc Med. 2019;5(1).

Tsuji T, Kanamori S, Saito M, Watanabe R, Miyaguni Y, Kondo K. Specific types of sports and exercise group participation and socio-psychological health in older people. J Sports Sci. 2020;38(4):422–9.

Yamakita M, Kanamori S, Kondo N, Kondo K. Correlates of regular participation in sports groups among Japanese older adults: JAGES cross–sectional study. PLoS ONE. 2015;10(10):e0141638.

Howie EK, McVeigh JA, Smith AJ, Straker LM. Organized sport trajectories from childhood to adolescence and health associations. Med Sci Sports Exerc. 2016;48(7):1331–9.

Chinkov AE, Holt NL. Implicit transfer of life skills through participation in Brazilian Jiu-Jitsu. J Appl Sport Psychol. 2016;28(2):139–53.

Lubans D, Richards J, Hillman C, Faulkner G, Beauchamp M, Nilsson M, et al. Physical activity for cognitive and mental health in youth: a systematic review of mechanisms. Pediatrics. 2016;138(3):e20161642.

Lin TW, Kuo YM. Exercise benefits brain function: the monoamine connection. Brain Sci. 2013;3(1):39–53.

Dishman RK, O’Connor PJ. Lessons in exercise neurobiology: the case of endorphins. Ment Health Phys Act. 2009;2(1):4–9.

Download references

Acknowledgements

We would like to acknowledge the work of the original systematic review conducted by Eime, R. M., Young, J. A., Harvey, J. T., Charity, M. J., and Payne, W. R. (2013).

No funding associated with this study.

Author information

Authors and affiliations.

Centre for Active Living and Learning, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia

Narelle Eather & Levi Wade

College of Human and Social Futures, School of Education, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia

Narelle Eather

College of Health, Medicine, and Wellbeing, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia

Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, VIC, 3011, Australia

Aurélie Pankowiak & Rochelle Eime

School of Science, Psychology and Sport, Federation University Australia, University Drive, Mount Helen, VIC, 3350, Australia

Rochelle Eime

You can also search for this author in PubMed   Google Scholar

Contributions

All authors contributed to the conducting of this study and reporting the findings. The titles of studies identified were screened by LW, and abstracts and full text articles reviewed independently by LW and NE. For the included studies, data was extracted independently by LW and checked by NE, and the risk of bias assessment was performed by LW and AP independently. All authors have read and approved the final version of the manuscript and agree with the order of presentation of the authors.

Corresponding author

Correspondence to Narelle Eather .

Ethics declarations

Ethics approval and consent to participate.

Not applicable

Consent for publication

Competing interests.

The authors declare they have no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1: supplementary table a..

Risk of bias.

Additional file 2: Supplementary Table B.

PRISMA Checklist.  

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Eather, N., Wade, L., Pankowiak, A. et al. The impact of sports participation on mental health and social outcomes in adults: a systematic review and the ‘Mental Health through Sport’ conceptual model. Syst Rev 12 , 102 (2023). https://doi.org/10.1186/s13643-023-02264-8

Download citation

Received : 30 August 2021

Accepted : 31 May 2023

Published : 21 June 2023

DOI : https://doi.org/10.1186/s13643-023-02264-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Experimental
• Observational
• Psychological health
• Mental health
• Social health

Systematic Reviews

ISSN: 2046-4053

• Submission enquiries: Access here and click Contact Us
• General enquiries: [email protected]

• Open access
• Published: 21 May 2024

The bright side of sports: a systematic review on well-being, positive emotions and performance

• David Peris-Delcampo 1 ,
• Antonio Núñez 2 ,
• Paula Ortiz-Marholz 3 ,
• Aurelio Olmedilla 4 ,
• Enrique Cantón 1 ,
• Javier Ponseti 2 &
• Alejandro Garcia-Mas 2  

BMC Psychology volume  12 , Article number:  284 ( 2024 ) Cite this article

Metrics details

The objective of this study is to conduct a systematic review regarding the relationship between positive psychological factors, such as psychological well-being and pleasant emotions, and sports performance.

This study, carried out through a systematic review using PRISMA guidelines considering the Web of Science, PsycINFO, PubMed and SPORT Discus databases, seeks to highlight the relationship between other more ‘positive’ factors, such as well-being, positive emotions and sports performance.

The keywords will be decided by a Delphi Method in two rounds with sport psychology experts.

Participants

There are no participants in the present research.

The main exclusion criteria were: Non-sport thema, sample younger or older than 20–65 years old, qualitative or other methodology studies, COVID-related, journals not exclusively about Psychology.

Main outcomes measures

We obtained a first sample of 238 papers, and finally, this sample was reduced to the final sample of 11 papers.

The results obtained are intended to be a representation of the ‘bright side’ of sports practice, and as a complement or mediator of the negative variables that have an impact on athletes’ and coaches’ performance.

Conclusions

Clear recognition that acting on intrinsic motivation continues to be the best and most effective way to motivate oneself to obtain the highest levels of performance, a good perception of competence and a source of personal satisfaction.

Peer Review reports

Introduction

In recent decades, research in the psychology of sport and physical exercise has focused on the analysis of psychological variables that could have a disturbing, unfavourable or detrimental role, including emotions that are considered ‘negative’, such as anxiety/stress, sadness or anger, concentrating on their unfavourable relationship with sports performance [ 1 , 2 , 3 , 4 ], sports injuries [ 5 , 6 , 7 ] or, more generally, damage to the athlete’s health [ 8 , 9 , 10 ]. The study of ‘positive’ emotions such as happiness or, more broadly, psychological well-being, has been postponed at this time, although in recent years this has seen an increase that reveals a field of study of great interest to researchers and professionals [ 11 , 12 , 13 ] including physiological, psychological, moral and social beneficial effects of the physical activity in comic book heroes such as Tintin, a team leader, which can serve as a model for promoting healthy lifestyles, or seeking ‘eternal youth’ [ 14 ].

Emotions in relation to their effects on sports practice and performance rarely go in one direction, being either negative or positive—generally positive and negative emotions do not act alone [ 15 ]. Athletes experience different emotions simultaneously, even if they are in opposition and especially if they are of mild or moderate intensity [ 16 ]. The athlete can feel satisfied and happy and at the same time perceive a high level of stress or anxiety before a specific test or competition. Some studies [ 17 ] have shown how sports participation and the perceived value of elite sports positively affect the subjective well-being of the athlete. This also seems to be the case in non-elite sports practice. The review by Mansfield et al. [ 18 ] showed that the published literature suggests that practising sports and dance, in a group or supported by peers, can improve the subjective well-being of the participants, and also identifies negative feelings towards competence and ability, although the quantity and quality of the evidence published is low, requiring better designed studies. All these investigations are also supported by the development of the concept of eudaimonic well-being [ 19 ], which is linked to the development of intrinsic motivation, not only in its aspect of enjoyment but also in its relationship with the perception of competition and overcoming and achieving goals, even if this is accompanied by other unpleasant hedonic emotions or even physical discomfort. Shortly after a person has practised sports, he will remember those feelings of exhaustion and possibly stiffness, linked to feelings of satisfaction and even enjoyment.

Furthermore, the mediating role of parents, coaches and other psychosocial agents can be significant. In this sense, Lemelin et al. [ 20 ], with the aim of investigating the role of autonomy support from parents and coaches in the prediction of well-being and performance of athletes, found that autonomy support from parents and coaches has positive relationships with the well-being of the athlete, but that only coach autonomy support is associated with sports performance. This research suggests that parents and coaches play important but distinct roles in athlete well-being and that coach autonomy support could help athletes achieve high levels of performance.

On the other hand, an analysis of emotions in the sociocultural environment in which they arise and gain meaning is always interesting, both from an individual perspective and from a sports team perspective. Adler et al. [ 21 ] in a study with military teams showed that teams with a strong emotional culture of optimism were better positioned to recover from poor performance, suggesting that organisations that promote an optimistic culture develop more resilient teams. Pekrun et al. [ 22 ] observed with mathematics students that individual success boosts emotional well-being, while placing people in high-performance groups can undermine it, which is of great interest in investigating the effectiveness and adjustment of the individual in sports teams.

There is still little scientific literature in the field of positive emotions and their relationship with sports practice and athlete performance, although their approach has long had its clear supporters [ 23 , 24 ]. It is comforting to observe the significant increase in studies in this field, since some authors (e.g [ 25 , 26 ]). . , point out the need to overcome certain methodological and conceptual problems, paying special attention to the development of specific instruments for the evaluation of well-being in the sports field and evaluation methodologies.

As McCarthy [ 15 ] indicates, positive emotions (hedonically pleasant) can be the catalysts for excellence in sport and deserve a space in our research and in professional intervention to raise the level of athletes’ performance. From a holistic perspective, positive emotions are permanently linked to psychological well-being and research in this field is necessary: firstly because of the leading role they play in human behaviour, cognition and affection, and secondly, because after a few years of international uncertainty due to the COVID-19 pandemic and wars, it seems ‘healthy and intelligent’ to encourage positive emotions for our athletes. An additional reason is that they are known to improve motivational processes, reducing abandonment and negative emotional costs [ 11 ]. In this vein, concepts such as emotional intelligence make sense and can help to identify and properly manage emotions in the sports field and determine their relationship with performance [ 27 ] that facilitates the inclusion of emotional training programmes based on the ‘bright side’ of sports practice [ 28 ].

Based on all of the above, one might wonder how these positive emotions are related to a given event and what role each one of them plays in the athlete’s performance. Do they directly affect performance, or do they affect other psychological variables such as concentration, motivation and self-efficacy? Do they favour the availability and competent performance of the athlete in a competition? How can they be regulated, controlled for their own benefit? How can other psychosocial agents, such as parents or coaches, help to increase the well-being of their athletes?

This work aims to enhance the leading role, not the secondary, of the ‘good and pleasant side’ of sports practice, either with its own entity, or as a complement or mediator of the negative variables that have an impact on the performance of athletes and coaches. Therefore, the objective of this study is to conduct a systematic review regarding the relationship between positive psychological factors, such as psychological well-being and pleasant emotions, and sports performance. For this, the methodological criteria that constitute the systematic review procedure will be followed.

Materials and methods

This study was carried out through a systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews) guidelines considering the Web of Science (WoS) and Psycinfo databases. These two databases were selected using the Delphi method [ 29 ]. It does not include a meta-analysis because there is great data dispersion due to the different methodologies used [ 30 ].

The keywords will be decided by the Delphi Method in two rounds with sport psychology experts. The results obtained are intended to be a representation of the ‘bright side’ of sports practice, and as a complement or mediator of the negative variables that have an impact on athletes’ and coaches’ performance.

It was determined that the main construct was to be psychological well-being, and that it was to be paired with optimism, healthy practice, realisation, positive mood, and performance and sport. The search period was limited to papers published between 2000 and 2023, and the final list of papers was obtained on February 13 , 2023. This research was conducted in two languages—English and Spanish—and was limited to psychological journals and specifically those articles where the sample was formed by athletes.

Each word was searched for in each database, followed by searches involving combinations of the same in pairs and then in trios. In relation to the results obtained, it was decided that the best approach was to group the words connected to positive psychology on the one hand, and on the other, those related to self-realisation/performance/health. In this way, it used parentheses to group words (psychological well-being; or optimism; or positive mood) with the Boolean ‘or’ between them (all three refer to positive psychology); and on the other hand, it grouped those related to performance/health/realisation (realisation; or healthy practice or performance), separating both sets of parentheses by the Boolean ‘and’’. To further filter the search, a keyword included in the title and in the inclusion criteria was added, which was ‘sport’ with the Boolean ‘and’’. In this way, the search achieved results that combined at least one of the three positive psychology terms and one of the other three.

Results (first phase)

The mentioned keywords were cross-matched, obtaining the combination with a sufficient number of papers. From the first research phase, the total number of papers obtained was 238. Then screening was carried out by 4 well-differentiated phases that are summarised in Fig.  1 . These phases helped to reduce the original sample to a more accurate one.

Phases of the selection process for the final sample. Four phases were carried out to select the final sample of articles. The first phase allowed the elimination of duplicates. In the second stage, those that, by title or abstract, did not fit the objectives of the article were eliminated. Previously selected exclusion criteria were applied to the remaining sample. Thus, in phase 4, the final sample of 11 selected articles was obtained

Results (second phase)

The first screening examined the title, and the abstract if needed, excluding the papers that were duplicated, contained errors or someone with formal problems, low N or case studies. This screening allowed the initial sample to be reduced to a more accurate one with 109 papers selected.

Results (third phase)

This was followed by the second screening to examine the abstract and full texts, excluding if necessary papers related to non-sports themes, samples that were too old or too young for our interests, papers using qualitative methodologies, articles related to the COVID period, or others published in non-psychological journals. Furthermore, papers related to ‘negative psychological variables’’ were also excluded.

Results (fourth phase)

At the end of this second screening the remaining number of papers was 11. In this final phase we tried to organise the main characteristics and their main conclusions/results in a comprehensible list (Table  1 ). Moreover, in order to enrich our sample of papers, we decided to include some articles from other sources, mainly those presented in the introduction to sustain the conceptual framework of the concept ‘bright side’ of sports.

The usual position of the researcher of psychological variables that affect sports performance is to look for relationships between ‘negative’ variables, first in the form of basic psychological processes, or distorting cognitive behavioural, unpleasant or evaluable as deficiencies or problems, in a psychology for the ‘risk’ society, which emphasises the rehabilitation that stems from overcoming personal and social pathologies [ 31 ], and, lately, regarding the affectation of the athlete’s mental health [ 32 ]. This fact seems to be true in many cases and situations and to openly contradict the proclaimed psychological benefits of practising sports (among others: Cantón [ 33 ], ; Froment and González [ 34 ]; Jürgens [ 35 ]).

However, it is possible to adopt another approach focused on the ‘positive’ variables, also in relation to the athlete’s performance. This has been the main objective of this systematic review of the existing literature and far from being a novel approach, although a minority one, it fits perfectly with the definition of our area of knowledge in the broad field of health, as has been pointed out for some time [ 36 , 37 ].

After carrying out the aforementioned systematic review, a relatively low number of articles were identified by experts that met the established conditions—according to the PRISMA method [ 37 , 38 , 39 , 40 ]—regarding databases, keywords, and exclusion and inclusion criteria. These precautions were taken to obtain the most accurate results possible, and thus guarantee the quality of the conclusions.

The first clear result that stands out is the great difficulty in finding articles in which sports ‘performance’ is treated as a well-defined study variable adapted to the situation and the athletes studied. In fact, among the results (11 papers), only 3 associate one or several positive psychological variables with performance (which is evaluated in very different ways, combining objective measures with other subjective ones). This result is not surprising, since in several previous studies (e.g. Nuñez et al. [ 41 ]) using a systematic review, this relationship is found to be very weak and nuanced by the role of different mediating factors, such as previous sports experience or the competitive level (e.g. Rascado, et al. [ 42 ]; Reche, Cepero & Rojas [ 43 ]), despite the belief—even among professional and academic circles—that there is a strong relationship between negative variables and poor performance, and vice versa, with respect to the positive variables.

Regarding what has been evidenced in relation to the latter, even with these restrictions in the inclusion and exclusion criteria, and the filters applied to the first findings, a true ‘galaxy’ of variables is obtained, which also belong to different categories and levels of psychological complexity.

A preliminary consideration regarding the current paradigm of sport psychology: although it is true that some recent works have already announced the swing of the pendulum on the objects of study of PD, by returning to the study of traits and dispositions, and even to the personality of athletes [ 43 , 44 , 45 , 46 ], our results fully corroborate this trend. Faced with five variables present in the studies selected at the end of the systematic review, a total of three traits/dispositions were found, which were also the most repeated—optimism being present in four articles, mental toughness present in three, and finally, perfectionism—as the representative concepts of this field of psychology, which lately, as has already been indicated, is significantly represented in the field of research in this area [ 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. In short, the psychological variables that finally appear in the selected articles are: psychological well-being (PWB) [ 53 ]; self-compassion, which has recently been gaining much relevance with respect to the positive attributional resolution of personal behaviours [ 54 ], satisfaction with life (balance between sports practice, its results, and life and personal fulfilment [ 55 ], the existence of approach-achievement goals [ 56 ], and perceived social support [ 57 ]). This last concept is maintained transversally in several theoretical frameworks, such as Sports Commitment [ 58 ].

The most relevant concept, both quantitatively and qualitatively, supported by the fact that it is found in combination with different variables and situations, is not a basic psychological process, but a high-level cognitive construct: psychological well-being, in its eudaimonic aspect, first defined in the general population by Carol Ryff [ 59 , 60 ] and introduced at the beginning of this century in sport (e.g., Romero, Brustad & García-Mas [ 13 ], ; Romero, García-Mas & Brustad [ 61 ]). It is important to note that this concept understands psychological well-being as multifactorial, including autonomy, control of the environment in which the activity takes place, social relationships, etc.), meaning personal fulfilment through a determined activity and the achievement or progress towards goals and one’s own objectives, without having any direct relationship with simpler concepts, such as vitality or fun. In the selected studies, PWB appears in five of them, and is related to several of the other variables/traits.

The most relevant result regarding this variable is its link with motivational aspects, as a central axis that relates to different concepts, hence its connection to sports performance, as a goal of constant improvement that requires resistance, perseverance, management of errors and great confidence in the possibility that achievements can be attained, that is, associated with ideas of optimism, which is reflected in expectations of effectiveness.

If we detail the relationships more specifically, we can first review this relationship with the ‘way of being’, understood as personality traits or behavioural tendencies, depending on whether more or less emphasis is placed on their possibilities for change and learning. In these cases, well-being derives from satisfaction with progress towards the desired goal, for which resistance (mental toughness) and confidence (optimism) are needed. When, in addition, the search for improvement is constant and aiming for excellence, its relationship with perfectionism is clear, although it is a factor that should be explored further due to its potential negative effect, at least in the long term.

The relationship between well-being and satisfaction with life is almost tautological, in the precise sense that what produces well-being is the perception of a relationship or positive balance between effort (or the perception of control, if we use stricter terminology) and the results thereof (or the effectiveness of such control). This direct link is especially important when assessing achievement in personally relevant activities, which, in the case of the subjects evaluated in the papers, specifically concern athletes of a certain level of performance, which makes it a more valuable objective than would surely be found in the general population. And precisely because of this effect of the value of performance for athletes of a certain level, it also allows us to understand how well-being is linked to self-compassion, since as a psychological concept it is very close to that of self-esteem, but with a lower ‘demand’ or a greater ‘generosity’, when we encounter failures, mistakes or even defeats along the way, which offers us greater protection from the risk of abandonment and therefore reinforces persistence, a key element for any successful sports career [ 62 ].

It also has a very direct relationship with approach-achievement goals, since precisely one of the central aspects characterising this eudaimonic well-being and differentiating it from hedonic well-being is specifically its relationship with self-determined and persistent progress towards goals or achievements with incentive value for the person, as is sports performance evidently [ 63 ].

Finally, it is interesting to see how we can also find a facet or link relating to the aspects that are more closely-related to the need for human affiliation, with feeling part of a group or human collective, where we can recognise others and recognise ourselves in the achievements obtained and the social reinforcement of those themselves, as indicated by their relationship with perceived social support. This construct is very labile, in fact it is common to find results in which the pressure of social support is hardly differentiated, for example, from the parents of athletes and/or their coaches [ 64 ]. However, its relevance within this set of psychological variables and traits is proof of its possible conceptual validity.

Analysing the results obtained, the first conclusion is that in no case is an integrated model based solely on ‘positive’ variables or traits obtained, since some ‘negative’ ones appear (anxiety, stress, irrational thoughts), affecting the former.

The second conclusion is that among the positive elements the variable coping strategies (their use, or the perception of their effectiveness) and the traits of optimism, perfectionism and self-compassion prevail, since mental strength or psychological well-being (which also appear as important, but with a more complex nature) are seen to be participated in by the aforementioned traits.

Finally, it must be taken into account that the generation of positive elements, such as resilience, or the learning of coping strategies, are directly affected by the educational style received, or by the culture in which the athlete is immersed. Thus, the applied potential of these findings is great, but it must be calibrated according to the educational and/or cultural features of the specific setting.

Limitations

The limitations of this study are those evident and common in SR methodology using the PRISMA system, since the selection of keywords (and their logical connections used in the search), the databases, and the inclusion/exclusion criteria bias the work in its entirety and, therefore, constrain the generalisation of the results obtained.

Likewise, the conclusions must—based on the above and the results obtained—be made with the greatest concreteness and simplicity possible. Although we have tried to reduce these limitations as much as possible through the use of experts in the first steps of the method, they remain and must be considered in terms of the use of the results.

Future developments

Undoubtedly, progress is needed in research to more precisely elucidate the role of well-being, as it has been proposed here, from a bidirectional perspective: as a motivational element to push towards improvement and the achievement of goals, and as a product or effect of the self-determined and competent behaviour of the person, in relation to different factors, such as that indicated here of ‘perfectionism’ or the potential interference of material and social rewards, which are linked to sports performance—in our case—and that could act as a risk factor so that our achievements, far from being a source of well-being and satisfaction, become an insatiable demand in the search to obtain more and more frequent rewards.

From a practical point of view, an empirical investigation should be conducted to see if these relationships hold from a statistical point of view, either in the classical (correlational) or in the probabilistic (Bayesian Networks) plane.

The results obtained in this study, exclusively researched from the desk, force the authors to develop subsequent empirical and/or experimental studies in two senses: (1) what interrelationships exist between the so called ‘positive’ and ‘negative’ psychological variables and traits in sport, and in what sense are each of them produced; and, (2) from a global, motivational point of view, can currently accepted theoretical frameworks, such as SDT, easily accommodate this duality, which is becoming increasingly evident in applied work?

Finally, these studies should lead to proposals applied to the two fields that have appeared to be relevant: educational and cultural.

Application/transfer of results

A clear application of these results is aimed at guiding the training of sports and physical exercise practitioners, directing it towards strategies for assessing achievements, improvements and failure management, which keep them in line with well-being enhancement, eudaimonic, intrinsic and self-determined, which enhances the quality of their learning and their results and also favours personal health and social relationships.

Data availability

There are no further external data.

Cantón E, Checa I. Los estados emocionales y su relación con las atribuciones y las expectativas de autoeficacia en El deporte. Revista De Psicología Del Deporte. 2012;21(1):171–6.

Google Scholar  

Cantón E, Checa I, Espejo B. (2015). Evidencias de validez convergente y test-criterio en la aplicación del Instrumento de Evaluación de Emociones en la Competición Deportiva. 24(2), 311–313.

Olmedilla A, Martins B, Ponseti-Verdaguer FJ, Ruiz-Barquín R, García-Mas A. It is not just stress: a bayesian Approach to the shape of the Negative Psychological Features Associated with Sport injuries. Healthcare. 2022;10(2):236. https://doi.org/10.3390/healthcare10020236 .

Article   Google Scholar  

Ong NCH, Chua JHE. Effects of psychological interventions on competitive anxiety in sport: a meta-analysis. Psycholy Sport Exerc. 2015;52:101836. https://doi.org/10.1016/j.psychsport.2020.101836 .

Candel MJ, Mompeán R, Olmedilla A, Giménez-Egido JM. Pensamiento catastrofista y evolución del estado de ánimo en futbolistas lesionados (Catastrophic thinking and temporary evolf mood state in injured football players). Retos. 2023;47:710–9.

Li C, Ivarsson A, Lam LT, Sun J. Basic Psychological needs satisfaction and frustration, stress, and sports Injury among University athletes: a Four-Wave prospective survey. Front Psychol. 2019;26:10. https://doi.org/10.3389/fpsyg.2019.00665 .

Wiese-Bjornstal DM. Psychological predictors and consequences of injuries in sport settings. In: Anshel MH, Petrie TA, Steinfelt JA, editors. APA handbook of sport and exercise psychology, volume 1: Sport psychology. Volume 1. Washington: American Psychological Association; 2019. pp. 699–725. https://doi.org/10.1037/0000123035 .

Chapter   Google Scholar  

Godoy PS, Redondo AB, Olmedilla A. (2022). Indicadores De Salud mental en jugadoras de fútbol en función de la edad. J Univers Mov Perform 21(5).

Golding L, Gillingham RG, Perera NKP. The prevalence of depressive symptoms in high-performance athletes: a systematic review. Physician Sportsmed. 2020;48(3):247–58. https://doi.org/10.1080/00913847.2020.1713708 .

Xanthopoulos MS, Benton T, Lewis J, Case JA, Master CL. Mental Health in the Young Athlete. Curr Psychiatry Rep. 2020;22(11):1–15. https://doi.org/10.1007/s11920-020-01185-w .

Cantón E, Checa I, Vellisca-González MY. Bienestar psicológico Y ansiedad competitiva: El Papel De las estrategias de afrontamiento / competitive anxiety and Psychological Well-being: the role of coping strategies. Revista Costarricense De Psicología. 2015;34(2):71–8.

Hahn E. Emotions in sports. In: Hackfort D, Spielberg CD, editors. Anxiety in Sports. Taylor & Francis; 2021. pp. 153–62. ISBN: 9781315781594.

Carrasco A, Brustad R, García-Mas A. Bienestar psicológico Y Su uso en la psicología del ejercicio, la actividad física y El Deporte. Revista Iberoamericana De psicología del ejercicio y El Deporte. 2007;2(2):31–52.

García-Mas A, Olmedilla A, Laffage-Cosnier S, Cruz J, Descamps Y, Vivier C. Forever Young! Tintin’s adventures as an Example of Physical Activity and Sport. Sustainability. 2021;13(4):2349. https://doi.org/10.3390/su13042349 .

McCarthy P. Positive emotion in sport performance: current status and future directions. Int Rev Sport Exerc Psycholy. 2011;4(1):50–69. https://doi.org/10.1080/1750984X.2011.560955 .

Cerin E. Predictors of competitive anxiety direction in male Tae Kwon do practitioners: a multilevel mixed idiographic/nomothetic interactional approach. Psychol Sport Exerc. 2004;5(4):497–516. https://doi.org/10.1016/S1469-0292(03)00041-4 .

Silva A, Monteiro D, Sobreiro P. Effects of sports participation and the perceived value of elite sport on subjective well-being. Sport Soc. 2020;23(7):1202–16. https://doi.org/10.1080/17430437.2019.1613376 .

Mansfield L, Kay T, Meads C, Grigsby-Duffy L, Lane J, John A, et al. Sport and dance interventions for healthy young people (15–24 years) to promote subjective well-being: a systematic review. BMJ Open. 2018;8(7). https://doi.org/10.1136/bmjopen-2017-020959 . e020959.

Ryff CD. Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Personal Soc Psychol. 1989;57(6):1069–81. https://doi.org/10.1037/0022-3514.57.6.1069 .

Lemelin E, Verner-Filion J, Carpentier J, Carbonneau N, Mageau G. Autonomy support in sport contexts: the role of parents and coaches in the promotion of athlete well-being and performance. Sport Exerc Perform Psychol. 2022;11(3):305–19. https://doi.org/10.1037/spy0000287 .

Adler AB, Bliese PD, Barsade SG, Sowden WJ. Hitting the mark: the influence of emotional culture on resilient performance. J Appl Psychol. 2022;107(2):319–27. https://doi.org/10.1037/apl0000897 .

Article   PubMed   Google Scholar  

Pekrun R, Murayama K, Marsh HW, Goetz T, Frenzel AC. Happy fish in little ponds: testing a reference group model of achievement and emotion. J Personal Soc Psychol. 2019;117(1):166–85. https://doi.org/10.1037/pspp0000230 .

Seligman M. Authentic happiness. New York: Free Press/Simon and Schuster; 2002.

Seligman M, Florecer. La Nueva psicología positiva y la búsqueda del bienestar. Editorial Océano; 2016.

Giles S, Fletcher D, Arnold R, Ashfield A, Harrison J. Measuring well-being in Sport performers: where are we now and how do we Progress? Sports Med. 2020;50(7):1255–70. https://doi.org/10.1007/s40279-020-01274-z .

Article   PubMed   PubMed Central   Google Scholar  

Piñeiro-Cossio J, Fernández-Martínez A, Nuviala A, Pérez-Ordás R. Psychological wellbeing in Physical Education and School sports: a systematic review. Int J Environ Res Public Health. 2021;18(3):864. https://doi.org/10.3390/ijerph18030864 .

Gómez-García L, Olmedilla-Zafra A, Peris-Delcampo D. Inteligencia emocional y características psicológicas relevantes en mujeres futbolistas profesionales. Revista De Psicología Aplicada Al Deporte Y El Ejercicio Físico. 2023;15(72). https://doi.org/10.5093/rpadef2022a9 .

Balk YA, Englert C. Recovery self-regulation in sport: Theory, research, and practice. International Journal of Sports Science and Coaching. SAGE Publications Inc.; 2020. https://doi.org/10.1177/1747954119897528 .

King PR Jr, Beehler GP, Donnelly K, Funderburk JS, Wray LO. A practical guide to applying the Delphi Technique in Mental Health Treatment Adaptation: the example of enhanced problem-solving training (E-PST). Prof Psychol Res Pract. 2021;52(4):376–86. https://doi.org/10.1037/pro0000371 .

Glass G. Primary, secondary, and Meta-Analysis of Research. Educational Researcher. 1976;5(10):3. https://doi.org/10.3102/0013189X005010003 .

Gillham J, Seligman M. Footsteps on the road to a positive psychology. Behav Res Ther. 1999;37:163–73. https://doi.org/10.1016/s0005-7967( . 99)00055 – 8.

Castillo J. Salud mental en El Deporte individual: importancia de estrategias de afrontamiento eficaces. Fundación Universitaria Católica Lumen Gentium; 2021.

Cantón E. Deporte, salud, bienestar y calidad de vida. Cuad De Psicología Del Deporte. 2001;1(1):27–38.

Froment F, García-González A. Retos. 2017;33:3–9. https://doi.org/10.47197/retos.v0i33.50969 . Beneficios de la actividad física sobre la autoestima y la calidad de vida de personas mayores (Benefits of physical activity on self-esteem and quality of life of older people).

Jürgens I. Práctica deportiva y percepción de calidad de vida. Revista Int De Med Y Ciencias De La Actividad Física Y Del Deporte. 2006;6(22):62–74.

Carpintero H. (2004). Psicología, Comportamiento Y Salud. El Lugar De La Psicología en Los campos de conocimiento. Infocop Num Extr, 93–101.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C, et al. Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Rev Esp Cardiol. 2001;74(9):790–9.

Royo M, Biblio-Guías. Revisiones sistemáticas: PRISMA 2020: guías oficiales para informar (redactar) una revisión sistemática. Universidad De Navarra. 2020. https://doi.org/10.1016/j.recesp.2021.06.016 .

Urrútia G, Bonfill X. PRISMA declaration: a proposal to improve the publication of systematic reviews and meta-analyses. Medicina Clínica. 2010;135(11):507–11. https://doi.org/10.1016/j.medcli.2010.01.015 .

Núñez A, Ponseti FX, Sesé A, Garcia-Mas A. Anxiety and perceived performance in athletes and musicians: revisiting Martens. Revista De Psicología. Del Deporte/Journal Sport Psychol. 2020;29(1):21–8.

Rascado S, Rial-Boubeta A, Folgar M, Fernández D. Niveles De rendimiento y factores psicológicos en deportistas en formación. Reflexiones para entender la exigencia psicológica del alto rendimiento. Revista Iberoamericana De Psicología Del Ejercicio Y El Deporte. 2014;9(2):373–92.

Reche-García C, Cepero M, Rojas F. Efecto De La Experiencia deportiva en las habilidades psicológicas de esgrimistas del ranking nacional español. Cuad De Psicología Del Deporte. 2010;10(2):33–42.

Kang C, Bennett G, Welty-Peachey J. Five dimensions of brand personality traits in sport. Sport Manage Rev. 2016;19(4):441–53. https://doi.org/10.1016/j.smr.2016.01.004 .

De Vries R. The main dimensions of Sport personality traits: a Lexical Approach. Front Psychol. 2020;23:11. https://doi.org/10.3389/fpsyg.2020.02211 .

Laborde S, Allen M, Katschak K, Mattonet K, Lachner N. Trait personality in sport and exercise psychology: a mapping review and research agenda. Int J Sport Exerc Psychol. 2020;18(6):701–16. https://doi.org/10.1080/1612197X.2019.1570536 .

Stamp E, Crust L, Swann C, Perry J, Clough P, Marchant D. Relationships between mental toughness and psychological wellbeing in undergraduate students. Pers Indiv Differ. 2015;75:170–4. https://doi.org/10.1016/j.paid.2014.11.038 .

Nicholls A, Polman R, Levy A, Backhouse S. Mental toughness, optimism, pessimism, and coping among athletes. Personality Individ Differences. 2008;44(5):1182–92. https://doi.org/10.1016/j.paid.2007.11.011 .

Weissensteiner JR, Abernethy B, Farrow D, Gross J. Distinguishing psychological characteristics of expert cricket batsmen. J Sci Med Sport. 2012;15(1):74–9. https://doi.org/10.1016/j.jsams.2011.07.003 .

García-Naveira A, Díaz-Morales J. Relationship between optimism/dispositional pessimism, performance and age in competitive soccer players. Revista Iberoamericana De Psicología Del Ejercicio Y El Deporte. 2010;5(1):45–59.

Reche C, Gómez-Díaz M, Martínez-Rodríguez A, Tutte V. Optimism as contribution to sports resilience. Revista Iberoamericana De Psicología Del Ejercicio Y El Deporte. 2018;13(1):131–6.

Lizmore MR, Dunn JGH, Causgrove Dunn J. Perfectionistic strivings, perfectionistic concerns, and reactions to poor personal performances among intercollegiate athletes. Psychol Sport Exerc. 2017;33:75–84. https://doi.org/10.1016/j.psychsport.2017.07.010 .

Mansell P. Stress mindset in athletes: investigating the relationships between beliefs, challenge and threat with psychological wellbeing. Psychol Sport Exerc. 2021;57:102020. https://doi.org/10.1016/j.psychsport.2021.102020 .

Reis N, Kowalski K, Mosewich A, Ferguson L. Exploring Self-Compassion and versions of masculinity in men athletes. J Sport Exerc Psychol. 2019;41(6):368–79. https://doi.org/10.1123/jsep.2019-0061 .

Cantón E, Checa I, Budzynska N, Canton E, Esquiva Iy, Budzynska N. (2013). Coping, optimism and satisfaction with life among Spanish and Polish football players: a preliminary study. Revista de Psicología del Deporte. 22(2), 337–43.

Mulvenna M, Adie J, Sage L, Wilson N, Howat D. Approach-achievement goals and motivational context on psycho-physiological functioning and performance among novice basketball players. Psychol Sport Exerc. 2020;51:101714. https://doi.org/10.1016/j.psychsport.2020.101714 .

Malinauskas R, Malinauskiene V. The mediation effect of Perceived Social support and perceived stress on the relationship between Emotional Intelligence and Psychological Wellbeing in male athletes. Jorunal Hum Kinetics. 2018;65(1):291–303. https://doi.org/10.2478/hukin-2018-0017 .

Scanlan T, Carpenter PJ, Simons J, Schmidt G, Keeler B. An introduction to the Sport Commitment Model. J Sport Exerc Psychol. 1993;1(1):1–15. https://doi.org/10.1123/jsep.15.1.1 .

Ryff CD. Eudaimonic well-being, inequality, and health: recent findings and future directions. Int Rev Econ. 2017;64(2):159–78. https://doi.org/10.1007/s12232-017-0277-4 .

Ryff CD, Singer B. The contours of positive human health. Psychol Inq. 1998;9(1):1–28. https://doi.org/10.1207/s15327965pli0901_1 .

Romero-Carrasco A, García-Mas A, Brustad RJ. Estado del arte, y perspectiva actual del concepto de bienestar psicológico en psicología del deporte. Revista Latinoam De Psicología. 2009;41(2):335–47.

James IA, Medea B, Harding M, Glover D, Carraça B. The use of self-compassion techniques in elite footballers: mistakes as opportunities to learn. Cogn Behav Therapist. 2022;15:e43. https://doi.org/10.1017/S1754470X22000411 .

Fernández-Río J, Cecchini JA, Méndez-Giménez A, Terrados N, García M. Understanding olympic champions and their achievement goal orientation, dominance and pursuit and motivational regulations: a case study. Psicothema. 2018;30(1):46–52. https://doi.org/10.7334/psicothema2017.302 .

Ortiz-Marholz P, Chirosa LJ, Martín I, Reigal R, García-Mas A. Compromiso Deportivo a través del clima motivacional creado por madre, padre y entrenador en jóvenes futbolistas. J Sport Psychol. 2016;25(2):245–52.

Ortiz-Marholz P, Gómez-López M, Martín I, Reigal R, García-Mas A, Chirosa LJ. Role played by the coach in the adolescent players’ commitment. Studia Physiol. 2016;58(3):184–98. https://doi.org/10.21909/sp.2016.03.716 .

Download references

This research received no external funding.

Author information

Authors and affiliations.

General Psychology Department, Valencia University, Valencia, 46010, Spain

David Peris-Delcampo & Enrique Cantón

Basic Psychology and Pedagogy Departments, Balearic Islands University, Palma de Mallorca, 07122, Spain

Antonio Núñez, Javier Ponseti & Alejandro Garcia-Mas

Education and Social Sciences Faculty, Andres Bello University, Santiago, 7550000, Chile

Paula Ortiz-Marholz

Personality, Evaluation and Psychological Treatment Deparment, Murcia University, Campus MareNostrum, Murcia, 30100, Spain

Aurelio Olmedilla

You can also search for this author in PubMed   Google Scholar

Contributions

Conceptualization, AGM, EC and ANP.; planification, AO; methodology, ANP, AGM and PO.; software, ANP, DP and PO.; validation, ANP and PO.; formal analysis, DP, PO and ANP; investigation, DP, PO and ANP.; resources, DVP and JP; data curation, AO and DP.; writing—original draft preparation, ANP, DP and AGM; writing—review and editing, EC and JP.; visualization, ANP and PO.; supervision, AGM.; project administration, DP.; funding acquisition, DP and JP. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Antonio Núñez .

Ethics declarations

Ethics approval and consent to participate.

Not applicable.

Informed consent statement

Consent for publication, competing interests.

The authors declare no conflict of interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Peris-Delcampo, D., Núñez, A., Ortiz-Marholz, P. et al. The bright side of sports: a systematic review on well-being, positive emotions and performance. BMC Psychol 12 , 284 (2024). https://doi.org/10.1186/s40359-024-01769-8

Download citation

Received : 04 October 2023

Accepted : 07 May 2024

Published : 21 May 2024

DOI : https://doi.org/10.1186/s40359-024-01769-8

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Positive emotions
• Sports performance

BMC Psychology

ISSN: 2050-7283

• General enquiries: [email protected]

• Access Member Benefits
• Exercise is Medicine

In This Section:

The american college of sports medicine statement on mental health challenges for athletes.

The American College of Sports Medicine (ACSM) recognizes the importance of developing the whole athlete. To achieve peak performance, it is important to be equally attentive to both physical and mental health. Approximately one-in-five adults live with a mental health condition during their lifetime. While physical activity is excellent for brain health, sports participation is not entirely protective against mental health challenges.

University and college level student-athletes face pressures from academics, as well as other possible triggers of stress. These triggers include missed classes due to off-campus sports competitions, being away from home for the first time, social isolation from students other than their teammates and adapting to constant visibility within their campus and communities. Approximately 30% of women and 25% of men who are student-athletes report having anxiety, and only 10% of all college athletes with known mental health conditions seek care from a mental health professional.

Professional and elite athletes also face mental health challenges, and data indicate that approximately 35% of elite athletes suffer from disordered eating, burnout, depression and/or anxiety. Limited privacy, inadequate recovery time and limited control or independence may also add to the stress of a professional or elite athlete.

Today, we use our collective voice to support the mental health of athletes. ACSM applauds the bravery of all athletes who have used the world’s stage to shine a bright light on the importance of mental health and encourages continued action to resolve these challenges. For additional information published by ACSM, including the importance of mental health, the benefits of physical activity for mental health, and interventions for those struggling with mental health, please access the resources below.

An Intervention for Mental Health Literacy and Resilience in Organized Sports

The Role of Exercise in Preventing and Treating Depression

Psychosocial Impacts of Sports-Related Injuries in Adolescent Athletes

The Psychological Burden of Retirement from Sport

Interval Training for Cardiometabolic and Brain Health

Promoting Physical Activity for Mental Well-Being ACSM's Mental Health Resources Collection

• 2024 Election Results
• News Archive
• Certification Task Force
• Advertise with ACSM
• Current Partners
• Partner Development
• American Fitness Index
• National Youth Sports Health & Safety Institute
• Annual Report 2022
• Annual Report 2023
• Honor & Citation Awards
• Student Membership
• Alliance Membership
• Professional-in-Training Membership
• Professional Membership
• Renew Membership
• Regional Chapters
• Member Code of Ethics
• Group Exercise Instructor
• ACSM Personal Trainer Prep
• ACSM Exercise Physiologist Prep
• ACSM Clinical Exercise Physiologist Prep
• Beijing Institute of Sports Medicine
• Wellness Academy
• Frequently Asked Questions
• Recertification FAQs
• Find an ACSM Certified Professional
• Certified Professional of the Year
• Wellcoaches
• Certified Professional Discounts
• Hire ACSM Certified Professionals
• Specialty Certificate Programs
• ceOnline FAQs
• Approved Providers
• Current Sports Medicine Reports
• Exercise and Sport Sciences Reviews
• Exercise, Sport, and Movement
• Health & Fitness Journal
• Medicine & Science in Sports & Exercise
• Translational Journal
• Paper of the Year Awards
• ACSM's Guidelines for Exercise Testing and Prescription
• ACSM's Resources for the Personal Trainer
• ACSM's Resources for the Exercise Physiologist
• ACSM's Clinical Exercise Physiology
• ACSM's Resources for the Group Exercise Instructor
• ACSM's Certification Review
• ACSM's Foundations of Strength Training and Conditioning
• ACSM's Nutrition Exercise Science
• ACSM's Essentials of Youth Fitness
• ACSM's Introduction to Exercise Science
• ACSM's Health/Fitness Facility Standards and Guidelines
• ACSM’s Body Composition Assessment
• ACSM's Complete Guide to Fitness and Health
• Preparticipation Physical Evaluation (PPE) Monograph, 5th Edition
• ACSM's Fitness Assessment Manual
• ACSMs Exercise Testing and Prescription
• Textbook Adoption
• Translated Position Stands
• ACSM Official Statements
• Team Physician Consensus Statements
• Resource Library
• Fitness Faceoff
• Autism and Exercise
• Sudden Cardiac Arrest
• Mental Health
• Physical Activity Guidelines
• Reducing Sedentary Behavior
• Faculty Resources
• EIM Clinical Resources
• Black History Month
• COVID-19 Reopening and Return to Play Resources
• Staying Active at Home
• ACSM's Brown Bag Series (archived)
• Sex Differences
• ACSM Podcast
• Emerging Physician Leaders Pilot Program
• Annual Meeting
• IDEA & ACSM Health & Fitness Summit
• Advanced Team Physician Course
• Sports Medicine Essentials
• Integrative Physiology of Exercise Conference
• ACSM World Heart Games
• International Team Physician Course
• Regional Chapter Meetings
• Meeting Exhibits and Sponsors
• Research & Program Grants
• Howard G. "Skip" Knuttgen Scholar Award
• Travel and Research Awards
• ACSM Research Grant Recipients
• Dedicated Endowments & Funds
• Planned Giving / Discovery Society

Advertisement

The Mental Health of Elite Athletes: A Narrative Systematic Review

• Systematic Review
• Open access
• Published: 20 February 2016
• Volume 46 , pages 1333–1353, ( 2016 )

Cite this article

You have full access to this open access article

• Simon M. Rice 1 , 2 , 3 ,
• Rosemary Purcell 1 , 2 ,
• Stefanie De Silva 1 , 2 ,
• Daveena Mawren 1 ,
• Patrick D. McGorry 1 , 2 , 3 &
• Alexandra G. Parker 1 , 2  

165k Accesses

448 Citations

339 Altmetric

46 Mentions

Explore all metrics

The physical impacts of elite sport participation have been well documented; however, there is comparatively less research on the mental health and psychological wellbeing of elite athletes.

This review appraises the evidence base regarding the mental health and wellbeing of elite-level athletes, including the incidence and/or nature of mental ill-health and substance use.

A systematic search of the PubMed, EMBASE, SPORTDiscus, PsycINFO, Cochrane and Google Scholar databases, up to and including May 2015, was conducted.

The search yielded a total of 2279 records. Following double screening, 60 studies were included. The findings suggested that elite athletes experience a broadly comparable risk of high-prevalence mental disorders (i.e. anxiety, depression) relative to the general population. Evidence regarding other mental health domains (i.e. eating disorders, substance use, stress and coping) is less consistent. These results are prefaced, however, by the outcome of the quality assessment of the included studies, which demonstrated that relatively few studies (25 %) were well reported or methodologically rigorous. Furthermore, there is a lack of intervention-based research on this topic.

The evidence base regarding the mental health and wellbeing of elite athletes is limited by a paucity of high-quality, systematic studies. Nonetheless, the research demonstrates that this population is vulnerable to a range of mental health problems (including substance misuse), which may be related to both sporting factors (e.g. injury, overtraining and burnout) and non-sporting factors. More high-quality epidemiological and intervention studies are needed to inform optimal strategies to identify and respond to player mental health needs.

Similar content being viewed by others

Mental Health in Elite Athletes: A Systematic Review of Suicidal Behaviour as Compared to the General Population

Men, Mental Health and Elite Sport: a Narrative Review

Mental health in the young athlete.

Avoid common mistakes on your manuscript.

1 Introduction

High-quality, systematic studies on the nature and impacts of physical injuries in elite athletes—most notably, head injuries/concussion and limb injuries—have led to advances in how these injuries are optimally managed or, ideally, prevented. There is comparatively less research on, but growing interest in, the mental health and psychological wellbeing of elite-level athletes [ 1 – 3 ]. The prevalence of diagnosable psychiatric disorders in this population remains a matter of debate [ 4 ]; however, notions that elite athletes are devoid of mental health problems have been increasingly scrutinised by sports medicine practitioners [ 5 ].

The intense mental and physical demands placed on elite athletes are a unique aspect of a sporting career, and these may increase their susceptibility to certain mental health problems and risk-taking behaviours [ 9 ]. Furthermore, the peak competitive years for elite athletes [ 10 ] tend to overlap with the peak age for the risk of onset of mental disorders [ 11 , 12 ]. In addition to physical and competition stress, elite athletes face a unique array of ‘workplace’ stressors, including the pressures of increased public scrutiny through mainstream and social media, limited support networks due to relocation, group dynamics in team sports and the potential for injuries to end careers prematurely [ 13 – 17 ]. The ways by which athletes appraise and cope with these stressors can be a powerful determinant of the impact the stressors have on both their mental health and their sporting success [ 18 ].

Athletes tend not to seek support for mental health problems, for reasons such as stigma, lack of understanding about mental health and its potential influence on performance, and the perception of help seeking as a sign of weakness [ 12 , 19 ]. While there have been efforts to disseminate sport-related mental health findings in order to advance the prevention, identification and early treatment of psychopathology in elite athletes, there are suggestions that some sporting governing bodies continue to minimise the significance of mental ill-health in this population [ 19 ]. This has sobering implications if elite athletes within such organisations are not provided with access to timely or adequate mental health care, or do not feel that the culture of the sporting organisation is such that they can even raise their mental health concerns. While it is well established that physical activity has a positive effect on mental health [ 6 , 7 ], a review has found that intense physical activity performed at the elite athlete level might instead compromise mental wellbeing, increasing symptoms of anxiety and depression through overtraining, injury and burnout [ 8 ]. Some, though not all, research suggests that this population has an increased risk of mental health problems, including eating disorders [ 21 ] and suicide [ 22 ]. A recent national survey of elite athletes in Australia found that almost half acknowledged symptoms of at least one of the mental health problems that were assessed, with prevalence rates similar to those reported in the community [ 23 ]. Emerging research suggests that retired elite athletes may be at particularly elevated risk of mental ill-health [ 24 ], corresponding to both low rates of formal athlete mental health screening processes [ 25 ] and player perceptions of inadequate availability of mental health support [ 26 ].

Given the early-stage state of sports psychiatry and its research base, the current delivery of mental health care for elite athletes might not take into account sport-related factors that potentially influence vulnerability to mental health problems, nor diagnostic or treatment issues that may be unique to this population [ 4 , 19 ]. Developing a comprehensive understanding of the mental health and psychological wellbeing specific to elite athletes has the potential to advance models of care and management of this population, which may, in turn, facilitate performance gains. Such an understanding is required to provide guidance for sport practitioners—including coaches, medical staff and sport psychologists—in developing the coping abilities of elite athletes and, in turn, improving their emotional wellbeing [ 20 ].

1.1 Objective

The utility of systematic reviews to synthesise research on discrete topics and identify gaps in knowledge is well established; however, to date, there have been no such reviews of the mental health and psychological wellbeing of elite athletes. The objective of this review was to synthesise the growing evidence base regarding the incidence and nature of mental ill-health (including substance use) and psychological wellbeing among elite-level athletes in order to identify gaps that future research should prioritise, and inform strategies or guidelines to advance the detection and management of mental ill-health in this population.

2.1 Literature Search

A systematic search of five electronic databases (PubMed, EMBASE, SPORTDiscus, PsycINFO, Cochrane) was conducted between January and February 2015, using the relevant database search engines. A subsequent search was conducted using the Google Scholar database in May 2015 to ensure that all recently published articles meeting the inclusion criteria were identified. The search strategy for each database, MeSH descriptors and corresponding number of hits per database are presented in Electronic Supplementary Material Tables S1 and S2.

2.2 Study Inclusion

Three researchers independently assessed the eligibility of each retrieved record on the basis of the title and abstract. If the information was unclear, the full-text article was screened. All included studies were subsequently re-screened (i.e. double screened) by a fourth researcher. The included studies were required to meet the following inclusion criteria: (1) participants were currently competing at the elite level, as able-bodied athletes, where the elite level was defined a priori to be competitive at either the Olympic, international, national or professional level; (2) the study reported quantitative data on a mental health, wellbeing or coping outcome; and (3) the study was published in English. Studies were excluded from the review on the basis of the following criteria: (1) the mean age of the participants was <18 years; (2) participants were competing at a school or collegiate level; (3) the study was undertaken with a heterogeneous sample (i.e. a mixed sample of elite and non-elite athletes) without reporting group findings separately; (4) the study assessed only physiological wellbeing or stress responses without assessing or reporting psychological wellbeing; (5) the study was available in abstract form only (i.e. conference presentations), precluding full quality assessment; and (6) the study described substance use focused on performance enhancement (i.e. doping) as opposed to personal use. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (see Fig.  1 for flow diagram).

Study selection flow diagram

2.3 Data Extraction

A standardised data extraction template was designed. One researcher sourced the required information from the included studies, using this template, including the study type and design, sport population, study aim, sex ratio and key outcomes mapped to study measures and main findings.

2.4 Quality Appraisal

Given the heterogeneity of the included study designs and the lack of randomised, controlled trials identified in the search process (see Sect.  3.2 ), it was not possible to conduct a standard risk-of-bias assessment. In place of this, all studies were appraised for reporting quality based on the established standards outlined below.

3.1 Literature Search

The literature search yielded a total of 2279 records. After screening of the titles and abstracts, 103 studies were identified as likely meeting the inclusion criteria. After double screening, exclusion of qualitative studies and a final manual search of the literature (i.e. screening of references lists), a total of 60 studies were included in the quantitative synthesis (see Fig.  1 for the study selection diagram).

3.2 Study Design

Sixty quantitative studies were included in the review. The study designs varied, though most were either cross-sectional observational studies ( N  = 38; 63.3 %), longitudinal studies ( N  = 11; 18.3 %) or of a mixed-method design ( N  = 8; 13.3 %). In addition, there were one randomised, controlled trial (1.6 %), one meta-analysis and one intervention case study report. Given the heterogeneity of both the study designs and the outcome variables that were assessed, it was not possible to conduct a meta-analysis as part of this review.

3.3 Quality Appraisal

The methodological rigour of the included studies was assessed according to relevant published criteria [ 27 , 28 ]. Quality appraisal of the 60 studies is presented in Electronic Supplementary Material Table S3. Only two studies met all methodological criteria, with one quarter ( N  = 15; 25 %) assessed to be of good reporting quality (i.e. scoring ≥4 out of 5). The mean quality rating was 2.88 (standard deviation 0.87). Over one third of the remaining studies ( N  = 21; 45 %) were assessed to be of moderate quality (scoring 3 out of 5), while 24 studies (40 %) were assessed to be of low quality (scoring 2 out of 5). Almost all included studies ( N  = 59) defined their participants well and either reported use of standardised, validated questionnaires or clearly described the outcomes measured. Fewer than half of the included studies clearly reported ethical review ( N  = 27) and either reported a participant rate of more than 80 % or, in the absence of that, provided a description comparing responders with non-responders ( N  = 25). Over one quarter of the included studies did not report on the participant rate ( N  = 16), and very few used random sampling ( N  = 3).

3.4 Description of Included Studies

Tables  1 , 2 , 3 , 4 , 5 , 6 , 7 provide a summary of the key characteristics and main outcomes of the 60 included studies. For the purposes of reporting and analysis, studies were grouped according to the following major mental health constructs: anger and aggression ( N  = 2) [ 29 , 30 ], anxiety ( N  = 4) [ 31 – 34 ], eating disorder and body image ( N  = 10) [ 21 , 35 – 43 ], general-prevalence studies ( N  = 10) [ 23 , 44 – 52 ], help seeking ( N  = 1) [ 11 ], sleep ( N  = 1) [ 53 ], stress and coping ( N  = 22) [ 64 – 86 ], substance use ( N  = 9) [ 54 – 62 ] and wellbeing ( N  = 1) [ 63 ]. The included studies examined athletes from a broad range of individual sports (e.g. swimming, tennis, wrestling) and team-based sports (e.g. soccer, football, rugby), with some studies including elite athletes from a range of sporting disciplines.

3.4.1 Main Findings

Of the two included studies that focused on anger and aggression (see Table  1 ), one was conducted with rugby players [ 29 ], while the other was a case study of an elite table tennis player [ 30 ]. Anger tended to be experienced relatively frequently by the rugby players, was viewed as facilitative as opposed to debilitative and was positively associated with anxiety. In both studies, cognitive aspects (self-confidence or problem solving) were associated with less expression of anger in competition. No studies were found that evaluated off-field expressions of anger or aggression.

Four studies focused on anxiety in elite athletes (see Table  2 ): two on swimmers [ 32 , 33 ] and two on athletes from mixed sporting populations [ 31 , 34 ]. These studies focused primarily on the performance aspect of symptoms of anxiety (i.e. where athletic performance is evaluated as threatening and is associated with elevated levels of arousal or worry) as opposed to generalised clinical or subclinical experiences of non-competitive anxiety, which are summarised in the general-prevalence studies listed in Table  4 . Athlete interpretation of anxiety states was identified as critical to the impact of anxiety. For example, a focus on performance (as opposed to cooperation and effort) predicted athlete worry [ 31 ], while interpretation of anxiety as facilitative was associated with more adaptive anxiety management strategies (i.e. approach-focused coping) [ 32 ] and performance levels [ 33 ]. Higher levels of athlete anxiety were also found to be related to negative patterns of perfectionism [ 34 ]. Recommendations to elite-level coaches included development of athlete skills in appraisal and interpretation of anxiety states [ 32 ] and the type of training culture facilitated among athletes (i.e. mastery as opposed to performance) [ 31 ].

Of the ten studies examining eating disorders and body image (see Table  3 ), six were conducted with mixed populations [ 21 , 35 – 37 , 40 , 43 ], two with rowers [ 41 , 42 ] and the remaining studies with distance runners [ 38 ] and figure skaters [ 39 ]. With the exception of the three studies that used an interviewer-administered diagnostic interview [ 35 , 40 , 43 ], all studies on eating disorders and body image used self-report data from standardised measures. Of the ten studies, five evaluated either eating disorder or body image issues in comparison with general community samples. The results from these studies were inconsistent. Three reported a higher incidence of eating disorder or body dissatisfaction in elite athletes relative to controls [ 36 ], especially in sports emphasising leanness or lower body weight [ 21 , 35 ]. In contrast, one study found no difference between elite athletes and controls when the sample was restricted to females [ 43 ]. The included meta-analytic study that examined differences in body image reported no differences between athletes and non-athletes, or by sex or body mass index [ 37 ]; however, it must be noted this meta-analysis used homogenous inclusion criteria incorporating a large number of studies reporting data from non-elite athletes. The remaining studies identified athlete-specific risk factors for eating disorders or body image concerns, including sport-specific body-type demands (i.e. leanness) [ 38 – 40 ], age (higher risk in younger athletes) and sex (higher risk in females) [ 41 , 42 ]. One study recruiting only males identified onset-related characteristics of eating disorders as commencement of training at an earlier age, dieting and experience of traumatic events, such as significant injury [ 40 ].

The ten general-prevalence studies on elite athlete mental health (see Table  4 ) reported data from either mixed samples [ 23 , 46 , 50 , 51 ] or specific codes, including football [ 44 ], swimming [ 45 ], weight lifting [ 47 ], equestrian [ 48 ], distance running [ 49 ] and tennis [ 52 ]. Sample sizes for these studies varied on the basis of the population of interest, ranging from N  = 2067 for a national-level study [ 51 ] to N  = 14 for a study of distance runners. Of note, with the exception of one study utilising a structured diagnostic interview [ 45 ] and one study utilising clinician diagnoses [ 51 ], outcomes for general-prevalence studies were based on athlete self-report data from standardised measures. In the studies with larger sample sizes ( N  > 100), combined rates of high-prevalence disorders (i.e. mood or anxiety disorders) were frequently reported. In one large self-report study, up to 46.4 % of Australian athletes ( N  = 224; a mixed sample) met the clinical cut-off for a diagnosable mental health disorder based on standardised scales, with identified rates of depression (27.2 %), eating disorder (22.8 %) and anxiety disorder (social phobia; 14.7 %) [ 23 ]. Similar findings were reported for prevalence rates of depression (34 %) based on diagnostic interviews undertaken with swimmers [ 45 ] and self-reported depression and anxiety (26 %) in European football players [ 44 ], though rates of self-reported depression were lower (15 %) in a mixed sample of German elite athletes [ 50 ]. Markedly lower case rates, based on clinician diagnosis, were reported from a large French study (a mixed sample), with a lifetime prevalence rate for any disorder of 25.1 % and recent diagnosis rates of 8.6 % for anxiety, 4.9 % for eating disorder and 3.6 % for depression (and 0.6 % for suicidal ideation) [ 51 ]. This study did, however, report relatively frequent sleep problems (delayed onset, frequent waking and daytime drowsiness) in 21.5 % of athletes. Major life events, including injury and chronic stress, were associated with higher rates of distress, anxiety and depression [ 23 , 44 , 50 ]. The self-report general-prevalence studies reporting smaller sample sizes ( N  < 100) were relatively heterogeneous in outcomes. While male athletes tended to report lower anxiety than their female counterparts, sex differences in depression were inconsistent [ 46 , 48 ]. Lower ratings of depression and distress were reported in highly achieving athletes [ 47 ] and in older versus younger female athletes [ 52 ], with global mood and anxiety predicting athlete performance [ 49 ].

The studies on elite athlete substance use focused on either alcohol [ 54 , 59 , 60 ], or other drugs [ 55 – 58 , 61 , 62 ] (see Table  5 ). Studies related to alcohol use indicated higher rates of consumption in athletes relative to the general community [ 59 , 60 ]. However, during the playing season, the rates of risky alcohol use may be lower than general community levels [ 54 ]. Studies focusing on illicit drugs suggested relatively low use (7–8 %) in the previous year [ 55 , 56 ] but significantly higher combined lifetime use when athletes were asked if they knew other athletes who used illicit drugs (up to 45 %) [ 62 ]. These studies reported that knowing another athlete who had used drugs was a significant predictor of their own use. In terms of drug-related attitudes, there was a tendency for athletes to overestimate levels of drug use in those competing in sports other than their own [ 56 ]. One intervention study that examined the long-term effects of an illicit drug–testing programme [ 58 ] found that rates of positive tests among athletes declined over an extended period, and the authors attributed this to education, harm minimisation and testing frequency. One study examined athlete knowledge regarding the effects of illicit drug use. Despite potential stigma relating to athletes seeking drug-related information (i.e. fellow players or staff assuming that information seeking equates to actual drug use), a substantial proportion of elite athletes expressed a desire to receive additional information regarding the effects of some classes of recreational drugs [ 61 ].

There were 22 studies examining stress and coping in elite athletes (see Table  6 ), comprising nine longitudinal studies [ 64 – 72 ] and 13 cross-sectional observational studies [ 73 – 85 ]. Injury, errors on the sporting field, fatigue and club/organisational climate were identified as common sources of stress among elite athletes [ 66 , 68 , 69 , 71 , 81 , 86 ]. Four studies emphasised the impact of the coach in setting the organisational climate [ 72 , 82 – 84 ], noting the negative implications of a performance culture over a mastery culture for athletes’ stress. Longitudinal studies found that stress related to injuries, external distractions and fatigue was highest during training periods [ 68 – 71 ], while opponents, officials/umpires and the crowd were the predominant sources of stress for athletes during competition [ 70 ].

The majority of the retrieved studies examined the different strategies employed by elite athletes to cope with the various stressors that were encountered [ 64 – 66 , 70 , 73 – 75 , 79 , 80 , 85 ]. Adaptive, active coping strategies (such as problem solving, use of imagery, seeking social support and planning ahead) were frequently reported [ 66 , 71 , 81 ]; however, there was a tendency for athletes to engage in less adaptive (i.e. avoidance-coping) strategies when faced with unexpected stressors [ 73 , 76 ]. One study [ 79 ] found that coping behaviour varied between sporting types, with athletes in team-based sports more likely to seek social support than individual competitors, and female athletes more likely to engage in strategies focused on managing affect. Coping strategies based on problem solving and behavioural change were found to be the most effective in managing stress [ 64 , 70 , 77 ] and developing resilience [ 74 ]. Emotional reactivity and stressful life events were associated with poor on-field performance and injury [ 66 , 67 , 75 , 82 ].

There were single studies identified for the domains of help seeking [ 11 ], sleep [ 53 ] and wellbeing [ 63 ] (see Table  7 ). The help-seeking study was the only randomised, controlled trial that met the inclusion criteria. While this small study ( N  = 59) found no difference between athletes in the intervention conditions and control conditions with regard to attitudes, intentions and behaviours related to mental health help seeking, significant improvements were noted in depression and anxiety mental health literacy scores, as well as stigma, at 3-month follow-up [ 11 ]. The one study examining sleep reported on a small sample of Australian Rules footballers ( N  = 19) and found that match-related interstate air travel exerted relatively minimal effects on athlete sleep quality [ 53 ]. Finally, the study examining athlete wellbeing identified distinct profiles, with feeling unappreciated, greater perfectionism and lower self-esteem impacting on athlete general wellbeing [ 63 ].

4 Discussion

Researchers have emphasised the limited peer-reviewed literature regarding the mental health and wellbeing of elite athletes [ 9 , 19 ]. This narrative systematic review is the first to synthesise data from the existing knowledge base with the goal of identifying the incidence and/or nature of mental ill-health and substance use in elite athletes. Given the paucity of research in the field [ 19 ], the present review took a broad and inclusive approach to study both outcomes and designs. In doing so, it identified the relatively poor overall quality of study reporting to date and the lack of well-designed, intervention-based research in the area of elite athletes’ mental health and wellbeing. Despite the limitations of the extant literature, a number of key observations and tentative conclusions can be drawn from our data synthesis.

4.1 Elite Athlete Vulnerability to Mental Illness

The data from studies reporting larger samples, although limited in scope, suggest that elite athletes experience a broadly comparable risk of high-prevalence mental disorders (i.e. anxiety, depression) relative to the general population [ 23 ]. That said, there may be subgroups of athletes at elevated risk of mental ill-health, including those in the retirement phase of their careers [ 44 ] or those experiencing performance failure [ 45 ]. As in the general population, major negative life events, including injury [ 23 ], may increase the risk of mental ill-health in elite athletes [ 50 ], though focused quantitative studies with adequate follow-up assessment periods are needed to confirm this. Findings regarding the prevalence of eating disorders and body image concerns relative to the general population were inconsistent. However, there was a tendency for higher vulnerability to these conditions in athletes involved in sports requiring a particularly lean body shape [ 21 , 35 , 38 – 40 ] and in female athletes [ 41 – 43 ]—the latter being consistent with the findings of general population studies [ 87 ]. Objective data, based on the results of medical review and tests, would likely assist in the assessment of eating pathologies and help counter the limitations of self-reporting (i.e. underreporting) [ 88 ]. Low social support was noted as a key risk factor for general mental ill-health, highlighting the importance of both formal and informal support networks for athletes [ 44 , 46 , 66 ]. All of the included general-prevalence studies were cross-sectional in nature. A natural advance for the field will be to assess athletes prospectively and better identify factors within the competitive spheres (i.e. performance or team success) and non-competitive spheres (i.e. approach coping, social support) for managing symptoms of mental ill-health. Given the significant overlap between the competitive years for elite athletes and the peak onset of mental disorders [ 10 – 12 ], future work should also assess low-prevalence disorders, such as psychosis or mania, in order to detect and direct at-risk athletes to early-intervention programmes or services.

4.2 Elite Athlete Substance Use

Contextual factors also appear important for athlete substance use, though more rigorous studies are needed. For example, no research has examined illicit substance dependence in elite athletes. Nonetheless, higher rates of alcohol use may occur in elite athletes relative to the general population, though this may be largely due to a binge pattern of consumption during non-competitive or vacation periods [ 54 ]. Rates of self-reported illicit drug use were relatively low in the previous 12 months (i.e. 8 %) [ 56 ], which may be due to rigorous drug-testing procedures [ 58 ]. Further targeted research in the domain of athlete substance use is warranted, given the frequent harmful effects (e.g. fighting) reported [ 54 ] and the possibility of patterns of misuse developing in the transition to retirement. Given the possible stigma (i.e. assumed use) associated with elite athletes seeking drug information, improvements to specific, targeted and accessible (i.e. internet-based) information may be warranted [ 61 ].

4.3 Athlete Coping

The literature related to athlete coping is more established than that for mental health outcomes. Most studies evaluated coping strategies employed by athletes to manage performance-related and non-performance-related stressors. In this way, coping was general in nature relative to psychosocial stressors (i.e. managing poor performance, injury or content on social media) rather than specific strategies for coping with a diagnosable disorder. Adaptive and maladaptive coping strategies were reported, though there was a lack of studies that sought to improve athlete coping. While a small-scale ( N  = 59), internet-based intervention failed to boost help-seeking-related attitudes, intentions or behaviours, increases were noted in mental health literacy [ 11 ]—an essential component of the help-seeking process. Given that stigma, poor mental health literacy and negative past experiences of mental health help seeking are key barriers for elite athletes [ 12 ], more well-designed studies, drawing on larger samples, are needed. Common athlete-specific stressors noted across studies included injury, poor performance, fatigue and organisational factors, such as the coaching environment and coaching expectations. The consistency of findings related to athlete stressors highlights these areas as potential avenues for targeted skills-based intervention programmes, including problem solving [ 70 ] and resilience training [ 74 ].

Management of athlete-specific stressors was also highlighted in the included studies focusing on athlete performance-related anxiety. Improved coping may be enabled by coaching staff emphasising a supportive training culture whereby athletes can interpret performance-related anxiety as facilitative, developing approach (as opposed to avoidance) strategies [ 31 , 32 ]. Indeed, coaching staff themselves were identified as critical to setting the organisational climate—in turn, impacting on the level of stress experienced by athletes [ 72 , 82 – 84 ]. Given the positive associations between coaches emphasising a mastery climate relative to a performance climate, future mental health intervention-based research should ensure the involvement and support of key coaching staff.

4.4 Study Limitations and Future Directions

As indicated, the overall study quality in this field is poor, and heterogeneous study outcomes prevented the application of meta-analytic techniques. In addition, the nature of participant self-selection may have reduced the representativeness of the findings. While the included studies focused specifically on elite-level competition at the national or international level, differences between the included sports in terms of training, remuneration, media pressure and other salient variables must be considered [ 89 ]. Our study did not include athletes with disabilities—a population in which relatively little is known about mental health outcomes. Furthermore, most studies used self-reporting rather than a diagnostic interview [ 45 ]; therefore, the extent of psychiatric disorders , as opposed to mental health symptoms or probable ‘caseness’, in this population remains largely unknown. While some mental health domains were relatively well represented by the included studies, other domains—particularly athlete anger and aggression, help seeking and sleep—had very few studies. In addition, the included studies generally failed to include assessment of athlete psychological strengths , and only one included study assessed wellbeing-related outcomes. Further, there is a lack of research focusing on the transition from playing or competing in elite sport to retirement. Despite this, the current findings are useful for informing the next generation of studies focusing on elite athlete mental health.

The last two decades have witnessed extraordinary progress in sports medicine, performance coaching and elite athlete nutrition. As comparatively little progress has been made in the area of mental health, there is enormous scope for programmes to boost athlete wellbeing, which would likely flow on to benefits in competitive performance and increase the likelihood of a successful transition to retirement [ 24 , 26 , 49 , 90 ]. Although vulnerability to mental ill-health might well be relatively comparable in elite athletes relative to the general community, there is significant scope for coaches, team psychologists and sport administrators to focus on targeted screening and early detection, monitoring and intervention—especially at key risk periods, such as significant injury [ 91 , 92 ], transition to retirement [ 44 , 93 ] and following performance difficulties [ 45 ]. Specific mental health help-seeking interventions are being developed for collegiate-level athletes, with a randomised, controlled trial currently underway [ 94 ]. The results of this work are likely to be relevant to elite-level athletes. Encouraging progress has been made in the development of mental health guidelines for working with school-aged athletes [ 95 ] and collegiate-level athletes [ 96 – 98 ]. These guidelines show a growing emphasis on the need to provide specific and targeted support for the mental health needs of athletes. They highlight the importance of monitoring changes in specific observable behaviours, appreciating psychological history and the need for a responsive crisis intervention framework specific to athletes. Development of comprehensive, targeted, disorder-specific treatment models are a required next step, and the National Athletic Trainers’ Association statement on preventing, detecting and managing disordered eating provides a useful disorder-specific model [ 99 ]. Psychoeducation should also extend to substance use—in particular, alcohol—given the tendency for hazardous use (bingeing) outside competition periods [ 100 ] and the stigma related to athlete help seeking in this domain [ 61 ].

Development of specific models of psychiatric intervention for elite athletes with significant psychopathology and impairment appears to be warranted [ 3 , 101 ]. Such models should capitalise on an early-intervention framework [ 102 – 104 ], ensuring early detection and prompt access to high-quality, evidence-based interventions. This may include implementing mental health screening programmes alongside physical health checks [ 25 ], in addition to dissemination of mental health awareness support to key support people, including partners, friends, family, coaching staff and administrative staff. For this to occur, collaborative efforts would be required between sports medicine practitioners, psychiatrists, psychologists and other mental health professionals [ 105 ], mindful of overcoming treatment barriers and stigma for athletes at the elite level and balancing the need for treatment with the need for ongoing performance in, or commitment to, their chosen career [ 106 ].

In addition, from a broader public health perspective, better engagement of elite athletes in the domains of positive mental health (and as identifiable role models or ambassadors) may be significant in mental health stigma reduction and in boosting help-seeking behaviours and engagement in services. Importantly, the mental health of hard-to-engage populations, such as young men [ 107 ] and older men [ 108 , 109 ], could be targeted. For this, the research will need to expand from simple cross-sectional designs and develop innovative strategies to improve athlete help seeking. Technology heralds a unique opportunity for this, especially given that the next generation of elite athletes will be digital natives and highly adept at utilising computer-based or internet-based interventions. Finally, given the paucity of high-quality studies reported to date, we encourage sporting bodies to consider public dissemination of any research (subject to ethical conduct) that is being conducted within the field of elite athlete mental health. Such efforts will enable the field to prosper and develop.

5 Conclusion

Elite athletes experience a unique range of stressors that may potentially increase their vulnerability to mental ill-health. Key factors include the psychological impacts of injury, overtraining and burnout; intense public and media scrutiny; and managing ongoing competitive pressures to perform. For the assessment and management of the mental health needs of elite athletes’ to be on a par with their physical needs, more high-quality epidemiological and intervention studies are needed. Ideally, where possible and appropriate, the results of these should be disseminated beyond the organisation or sporting code.

Baron DA, Reardon CL, Baron SH. Clinical sports psychiatry: an international perspective. West Sussex: Wiley; 2013.

McDuff DR. Sports psychiatry: strategies for life balance and peak performance. Arlington, VA: American Psychiatric Pub; 2012.

Glick ID, Kamm R, Morse E. The evolution of sport psychiatry, circa 2009. Sports Med. 2009;39(8):607–13.

Article   PubMed   Google Scholar  

Bär K-J, Markser VZ. Sport specificity of mental disorders: the issue of sport psychiatry. Eur Arch Psychiatry Clin Neurosci. 2013;263(2):205–10.

Article   Google Scholar  

Wolanin A, Gross M, Hong E. Depression in athletes: prevalence and risk factors. Curr Sports Med Rep. 2015;14(1):56–60.

Hamer M, Stamatakis E, Steptoe A. Dose-response relationship between physical activity and mental health: the Scottish Health Survey. Br J Sports Med. 2009;43(14):1111–4.

Article   CAS   PubMed   Google Scholar  

Daley A. Exercise and depression: a review of reviews. J Clin Psychol Med Settings. 2008;15(2):140–7.

Peluso M, Andrade L. Physical activity and mental health: the association between exercise and mood. Clinics. 2005;60(1):61–70.

Hughes L, Leavey G. Setting the bar: athletes and vulnerability to mental illness. Br J Psychiatry. 2012;200(2):95–6.

Allen SV, Hopkins WG. Age of peak competitive performance of elite athletes: a systematic review. Sports Med. 2015;45(10):1431–1441.

Gulliver A, Griffiths KM, Christensen H, et al. Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial. J Med Internet Res. 2012;14(3):e69.

Article   PubMed   PubMed Central   Google Scholar  

Gulliver A, Griffiths KM, Christensen H. Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC Psychiatry. 2012;12(1):157.

Bruner MW, Munroe-Chandler KJ, Spink KS. Entry into elite sport: a preliminary investigation into the transition experiences of rookie athletes. J Appl Sport Psychol. 2008;20(2):236–52.

Fletcher D, Wagstaff CRD. Organizational psychology in elite sport: its emergence, application and future. Psychol Sport Exerc. 2009;10:427–34.

Hanton S, Fletcher D, Coughlan G. Stress in elite sport performers: a comparative study of competitive and organizational stressors. J Sports Sci. 2005;23(10):1129–41.

Noblet AJ, Gifford SM. The sources of stress experienced by professional Australian footballers. J Appl Sport Psychol. 2002;14(1):1–13.

Woodman T, Hardy L. A case study of organizational stress in elite sport. J Appl Sport Psychol. 2001;13:207–38.

Lazarus RS. How emotions influence performance in competitive sports. Sport Psychol. 2000;14(3):229.

Reardon CL, Factor RM. Sport psychiatry: a systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Med. 2010;40(11):961–80.

Nicholls AR, Polman RCJ. Coping in sport: a systematic review. J Sports Sci. 2007;25(1):11–31.

Sundgot-Borgen J, Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. 2004;14(1):25–32.

Baum AL. Suicide in athletes: a review and commentary. Clin Sports Med. 2005;24:853–69.

Gulliver A, Griffiths KM, Mackinnon A, et al. The mental health of Australian elite athletes. J Sci Med Sport. 2015;18(3):255–61.

Gouttebarge V, Aoki H, Kerkhoffs G. Prevalence and determinants of symptoms related to mental disorders in retired male professional footballers. J Sports Med Phys Fit. 2015. Retrieved from: http://www.minervamedica.it/en/journals/sports-med-physical-fitness/article.php?cod=R40Y9999N00A150079 . Accessed 4 Feb 2016.

Gouttebarge V, Sluiter J. Medical examinations undertaken by Dutch professional football clubs. Occup Med. 2014;64(1):13–6.

Article   CAS   Google Scholar  

Gouttebarge V, Aoki H. Lifespan perspective of professional footballers’ health. Asian J Sports Med. 2014;5(4):e23813.

Glasziou P, Irwig L, Bain C, et al. Systematic reviews in health care: a practical guide. Cambridge: Cambridge University Press; 2001.

Brown A, Rice S, Rickwood D, et al. Systematic review of barriers and facilitators to accessing and engaging with mental health care among at-risk young people. Asia Pac Psychiatry. doi: 10.1111/appy.12199 (In Press) .

Robazza C, Bortoli L. Perceived impact of anger and anxiety on sporting performance in rugby players. Psychol Sport Exerc. 2007;8(6):875–96.

Si G, Lee H-C. Is it so hard to change: the case of a Hong Kong Olympic silver medalist. Int J Sport Exerc Psychol. 2008;6(3):319–30.

Abrahamsen FE, Roberts GC, Pensgaard AM. Achievement goals and gender effects on multidimensional anxiety in national elite sport. Psychol Sport Exerc. 2008;9(4):449–64.

Hatzigeorgiadis A, Chroni S. Pre-competition anxiety and in-competition coping in experienced male swimmers. Int J Sports Sci Coach. 2007;2(2):181–9.

Jones G, Hanton S, Swain A. Intensity and interpretation of anxiety symptoms in elite and non-elite sports performers. Pers Individ Differ. 1994;17(5):657–63.

Koivula N, Hassmen P, Fallby J. Self-esteem and perfectionism in elite athletes: effects on competitive anxiety and self-confidence. Pers Individ Differ. 2002;32(5):865–75.

Byrne S, McLean N. Elite athletes: effects of the pressure to be thin. J Sci Med Sport. 2002;5(2):80–94.

Filaire E, Rouveix M, Pannafieux C, et al. Eating attitudes, perfectionism and body-esteem of elite male judoists and cyclists. J Sports Sci Med. 2007;6(1):50–7.

PubMed   PubMed Central   Google Scholar  

Hausenblas HA, Symons Downs D. Comparison of body image between athletes and nonathletes: a meta-analytic review. J Appl Sport Psychol. 2001;13(3):323–39.

Hulley AJ, Hill AJ. Eating disorders and health in elite women distance runners. Int J Eat Disord. 2001;30(3):312–7.

Jonnalagadda SS, Ziegler PJ, Nelson JA. Food preferences, dieting behaviors, and body image perceptions of elite figure skaters. Int J Sport Nutr Exerc Metab. 2004;14(5):594–606.

Sundgot-Borgen J. Risk and trigger factors for the development of eating disorders in female elite athletes. Med Sci Sports Exerc. 1994;26(4):414–9.

Terry PC, Lane AM, Warren L. Eating attitudes, body shape perceptions and mood of elite rowers. J Sci Med Sport. 1999;2(1):67–77.

Terry PC, Waite J. Eating attitudes and body shape perceptions among elite rowers: effects of age, gender and weight. Aust J Sci Med Sport. 1996;28(1):3–6.

CAS   PubMed   Google Scholar  

Torstveit M, Rosenvinge J, Sundgot-Borgen J. Prevalence of eating disorders and the predictive power of risk models in female elite athletes: a controlled study. Scand J Med Sci Sports. 2008;18(1):108–18.

Gouttebarge V, Frings-Dresen M, Sluiter J. Mental and psychosocial health among current and former professional footballers. Occup Med. 2015;65(3):190–6.

Hammond T, Gialloreto C, Kubas H, et al. The prevalence of failure-based depression among elite athletes. Clin J Sport Med. 2013;23(4):273–7.

Kotnik B, Tušak M, Topič MD, et al. Some psychological traits of Slovenian Olympians (Beijing 2008)—a gender comparison. Kinesiologia Slovenica. 2012;18(2):5–18.

Google Scholar  

Mahoney MJ. Psychological predictors of elite and non-elite performance in Olympic weightlifting. Int J Sport Psychol. 1989;20(1):1–12.

Meyers MC, Bourgeois AE. Mood and psychological skills of elite and sub-elite equestrian athletes. J Sport Behav. 1999;22(3):399.

Morgan WP, O’Connor PJ, Ellickson KA, et al. Personality structure, mood states, and performance in elite male distance runners. Int J Sport Psychol. 1988;19(4):247–63.

Nixdorf I, Hautzinger M, Beckmann J. Prevalence of depressive symptoms and correlating variables among German elite athletes. J Clin Sport Psychol. 2013;7(4):313–26.

Schaal K, Tafflet M, Nassif H, et al. Psychological balance in high level athletes: gender-based differences and sport-specific patterns. PLoS One. 2011;6(5):e19007.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Wughalter EH, Gondola JC. Mood states of professional female tennis players. Percept Mot Skills. 1991 Aug;73(1):187–90.

Richmond LK, Dawson B, Stewart G, et al. The effect of interstate travel on the sleep patterns and performance of elite Australian Rules footballers. J Sci Med Sport. 2007;10:252–8.

Dietze PM, Fitzgerald JL, Jenkinson RA. Drinking by professional Australian Football League (AFL) players: prevalence and correlates of risk. Med J Aust. 2008;189(9):479.

PubMed   Google Scholar  

Dunn M, Thomas JO, Swift W, et al. Recreational substance use among elite Australian athletes. Drug Alcohol Rev. 2011;30(1):63–8.

Dunn M, Thomas JO. A risk profile of elite Australian athletes who use illicit drugs. Addict Behav. 2012;37(1):144–7.

Dunn M, Thomas JO, Swift W, et al. Elite athletes’ estimates of the prevalence of illicit drug use: evidence for the false consensus effect. Drug Alcohol Rev. 2012;31(1):27–32.

Harcourt PR, Unglik H, Cook JL. A strategy to reduce illicit drug use is effective in elite Australian football. Br J Sports Med. 2012;46(13):943–45.

O’Brien KS, Blackie JM, Hunter JA. Hazardous drinking in elite New Zealand sportspeople. Alcohol Alcohol. 2005;40(3):239–41.

O’Brien KS, Ali A, Cotter JD, et al. Hazardous drinking in New Zealand sportspeople: level of sporting participation and drinking motives. Alcohol Alcohol. 2007;42(4):376–82.

Thomas JO, Dunn M, Swift W, et al. Illicit drug knowledge and information-seeking behaviours among elite athletes. J Sci MedSport. 2011;14(4):278–82.

Waddington I MD, Roderick M, Naik R. Drug use in English professional football. Br J Sports Med. 2005;39(4):e18 (discussion e18) .

Lundqvist C, Raglin JS. The relationship of basic need satisfaction, motivational climate and personality to well-being and stress patterns among elite athletes: an explorative study. Motiv Emot. 2015;39(2):237–46.

Didymus FF, Fletcher D. Swimmers’ experiences of organizational stress: exploring the role of cognitive appraisal and coping strategies. J Clin Sport Psychol. 2014;8(2):159–83.

Gastin PB, Meyer D, Robinson D. Perceptions of wellness to monitor adaptive responses to training and competition in elite Australian football. J Strength Cond Res. 2013;27:2518–26.

Gutmann MC, Pollock ML, Foster C, et al. Training stress in Olympic speed skaters: a psychological perspective. Phys Sportsmed. 1984;12(12):45–57.

Ivarsson A, Johnson U, Podlog L. Psychological predictors of injury occurrence: a prospective investigation of professional Swedish soccer players. J Sport Rehabil. 2013;22(1):19–26.

Maestu J, Jurimae J, Jurimae T. Psychological and biochemical markers of heavy training stress in highly trained male rowers. Med dello Sport. 2003;56(2):95–101.

Nicholls A, Holt N, Polman R. Stressors, coping, and coping effectiveness among professional rugby union players. Sport Psychol. 2006;20:314–29.

Nicholls AR, Levy AR, Grice A, et al. Stress appraisals, coping, and coping effectiveness among international cross-country runners during training and competition. Eur J Sport Sci. 2009;9(5):285–93.

Nicholls AR, Jones CR, Polman RCJ, et al. Acute sport-related stressors, coping, and emotion among professional rugby union players during training and matches. Scand J Med Sci Sports. 2009;19(1):113–20.

Wippert P-M, Wippert J. Perceived stress and prevalence of traumatic stress symptoms following athletic career termination. J Clin Sport Psychol. 2008;2(1):1–16.

Anshel MH, Si G. Coping styles following acute stress in sport among elite Chinese athletes: a test of trait and transactional coping theories. J Sport Behav. 2008;31(1):3–21.

Belem IC, Malheiros Caruzzo N, Andrade do Nascimento Junior JR, et al. Impact of coping strategies on resilience of elite beach volleyball athletes. BrazJ Kineanthrop HumPerf. 2014;16(4):447–55.

Devantier C. Psychological predictors of injury among professional soccer players. Sport Sci Rev. 2011;20(5/6):5–36.

Dugdale JR, Eklund RC, Gordon S. Expected and unexpected stressors in major international competition: appraisal, coping, and performance. Sport Psychol. 2002;16(1):20.

Kristiansen E, Roberts GC, Abrahamsen FE. Achievement involvement and stress coping in elite wrestling. Scand J Med Sci Sports. 2008;18(4):526–38.

Kristiansen E, Tomten SE, Hanstad DV, et al. Coaching communication issues with elite female athletes: two Norwegian case studies. Scand J Med Sci Sports. 2012;22(6):e156–67.

Johnson U. Coping strategies among long-term injured competitive athletes: a study of 81 men and women in team and individual sports. Scand J Med Sci Sports. 1997;7(6):367–72.

Mahoney MJ, Avener M. Psychology of the elite athlete: an exploratory study. Cognit Ther Res. 1977;1(2):135–41.

Noblet A, Rodwell J, McWilliams J. Predictors of the strain experienced by professional Australian footballers. J Appl Sport Psychol. 2003;15(2):184–93.

Pensgaard A, Ursin H. Stress, control, and coping in elite athletes. Scand J Med Sci Sports. 1998;8(3):183–9.

Pensgaard AM, Roberts GC. The relationship between motivational climate, perceived ability and sources of distress among elite athletes. J Sports Sci. 2000;18(3):191–200.

Pensgaard AM, Roberts GC. Elite athletes’ experiences of the motivational climate: the coach matters. Scand J Med Sci Sports. 2002;12(1):54–9.

Grove JR, Hanrahan SJ. Perceptions of mental training needs by elite field hockey players and their coaches. Sport Psychol. 1988;2(3):222–30.

Kristiansen E, Halvari H, Roberts GC. Organizational and media stress among professional football players: testing an achievement goal theory model. Scand J Med Sci Sports. 2012;22(4):569–79.

Hudson JI, Hiripi E, Pope HG, et al. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61(3):348–58.

Carter JE, Rudd NA. Disordered eating assessment for college student-athletes. Women Sport Phys Activity J. 2005;14(1):62.

Swann C, Moran A, Piggott D. Defining elite athletes: issues in the study of expert performance in sport psychology. Psychol Sport Exerc. 2015;16:3–14.

Lardon MT, Fitzgerald MW. Performance enhancement and the sports psychiatrist. In: Baron D, Reardon C, Baron S, editors. Clinical sports psychiatry: an international perspective. Wiley; 2013.

Walker N, Thatcher J, Lavallee D. Review: psychological responses to injury in competitive sport: a critical review. J R Soc Promot Health. 2007;127(4):174–80.

Wiese-Bjornstal DM. Psychology and socioculture affect injury risk, response, and recovery in high-intensity athletes: a consensus statement. Scand J Med Sci Sports. 2010;20(Suppl 2):103–11.

Roberts C-M, Mullen R, Evans L, et al. An in-depth appraisal of career termination experiences in professional cricket. J Sports Sci. 2015;33(9):935–44.

Eisenberg D. Developing and evaluating a model program for supporting the mental health of student athletes. School of Public Health and Institute for Social Research, University of Michigan; 2014. http://www.ncaa.org/about/resources/research/developing-and-evaluating-model-program-supporting-mental-health-student-athletes . Accessed 4 Feb 2016.

Neal TL, Diamond AB, Goldman S, et al. Interassociation recommendations for developing a plan to recognize and refer student-athletes with psychological concerns at the secondary school level: a consensus statement. J Athl Train. 2015;50(3):231–49.

Neal TL, Diamond AB, Goldman S, et al. Inter-association recommendations for developing a plan to recognize and refer student-athletes with psychological concerns at the collegiate level: An executive summary of a consensus statement. J Athl Train. 2013;48(5):716-20.

Hainline B. Mind, body and sport: understanding and supporting student-athlete mental wellness. Indianapolis: National Collegiate Athletic Association; 2014.

Thompson R, Sherman R. Managing student-athletes’ mental health issues. Indianapolis: National Collegiate Athletic Association; 2007.

Bonci CM, Bonci LJ, Granger LR, et al. National Athletic Trainers’ Association position statement: preventing, detecting, and managing disordered eating in athletes. J Athl Train. 2008;43(1):80–108.

Barnes MJ. Alcohol: impact on sports performance and recovery in male athletes. Sports Med. 2014;44(7):909–19.

Begel D. An overview of sport psychiatry. Am J Psychiatry. 1992;149(5):606–14.

McGorry PD, Purcell R, Hickie IB, et al. Investing in youth mental health is a best buy. Med J Aust. 2007;187(7):S5–7.

McGorry PD, Purcell R, Hickie IB, et al. Clinical staging: a heuristic model for psychiatry and youth mental health. Med J Aust. 2007;187(7 Suppl):S40–2.

Patel V, Flisher AJ, Hetrick S, et al. Mental health of young people: a global public-health challenge. Lancet. 2007;369(9569):1302–13.

Esfandiari A, Broshek DK, Freeman JR. Psychiatric and neuropsychological issues in sports medicine. Clin Sports Med. 2011;30(3):611–27.

Delenardo S, Terrion JL. Suck it up: opinions and attitudes about mental illness stigma and help-seeking behaviour of male varsity football players. Can J Commun Ment Health. 2014;33(3):43–56.

Rickwood D, Deane FP, Wilson CJ, et al. Young people’s help-seeking for mental health problems. Aust E J Adv Mental Health. 2005;4(3):218–51.

Bottorff JL, Seaton CL, Johnson ST, et al. An updated review of interventions that include promotion of physical activity for adult men. Sports Med. 2014;45(6):775–800.

Article   PubMed Central   Google Scholar  

Glick ID, Horsfall JL. Diagnosis and psychiatric treatment of athletes. Clin Sports Med. 2005;24(4):771–81.

Download references

Author information

Authors and affiliations.

Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Melbourne, VIC , 3052, Australia

Simon M. Rice, Rosemary Purcell, Stefanie De Silva, Daveena Mawren, Patrick D. McGorry & Alexandra G. Parker

Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia

Simon M. Rice, Rosemary Purcell, Stefanie De Silva, Patrick D. McGorry & Alexandra G. Parker

Orygen Youth Health Clinical Program, Melbourne, VIC, Australia

Simon M. Rice & Patrick D. McGorry

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Simon M. Rice .

Ethics declarations

Simon Rice is supported by an Early Career Fellowship provided by the Society for Mental Health Research. This paper was, in part, made possible from funding from several sporting bodies, all of whom requested anonymity.

Conflict of interest

Simon Rice, Rosemary Purcell, Stefanie De Silva, Daveena Mawren, Patrick McGorry and Alexandra Parker declare that they have no conflicts of interest that are relevant to the content of this review.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 34 kb)

Rights and permissions.

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and permissions

About this article

Rice, S.M., Purcell, R., De Silva, S. et al. The Mental Health of Elite Athletes: A Narrative Systematic Review. Sports Med 46 , 1333–1353 (2016). https://doi.org/10.1007/s40279-016-0492-2

Download citation

Published : 20 February 2016

Issue Date : September 2016

DOI : https://doi.org/10.1007/s40279-016-0492-2

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Mental Health
• Mental Health Problem
• Eating Disorder
• Elite Athlete
• Mental Health Literacy
• Find a journal
• Publish with us
• Track your research

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• Current issue
• For authors
• New editors
• BMJ Journals More You are viewing from: Google Indexer

You are here

• Volume 54, Issue 4
• Mental health issues and psychological factors in athletes: detection, management, effect on performance and prevention: American Medical Society for Sports Medicine Position Statement—Executive Summary
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• Cindy Chang 1 ,
• http://orcid.org/0000-0002-1478-8068 Margot Putukian 2 , 3 ,
• Giselle Aerni 4 ,
• Alex Diamond 5 ,
• Gene Hong 6 ,
• Yvette Ingram 7 ,
• Claudia L Reardon 8 ,
• Andrew Wolanin 9
• 1 Departments of Orthopaedics and Family & Community Medicine , University of California San Francisco , San Francisco , California , USA
• 2 Athletic Medicine , Princeton University , Princeton , New Jersey , USA
• 3 Department of Internal Medicine & Sports Medicine , Rutgers Robert Wood Johnson Medical School , Piscataway , New Jersey , USA
• 4 Sports Medicine & Family Medicine , WellSpan Health , York , Pennsylvania , USA
• 5 Department of Pediatrics and Orthopaedic Surgery , Vanderbilt University Medical Center , Nashville , Tennessee , USA
• 6 Department of Orthopedics and Family Medicine , Medical University of South Carolina—College of Medicine , Charleston , South Carolina , USA
• 7 Department of Health Science , Lock Haven University of Pennsylvania , Lock Haven , Pennsylvania , USA
• 8 Department of Psychiatry , University of Wisconsin Madison School of Medicine and Public Health , Madison , Wisconsin , USA
• 9 Wolanin Consulting and Assessment Inc, Bala Cynwyd , Philadelphia , Pennsylvania , USA
• Correspondence to Dr Margot Putukian, Athletic Medicine, Princeton University, Princeton, New Jersey, USA; putukian{at}princeton.edu

The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.

• overtraining and burnout
• eating disorder

https://doi.org/10.1136/bjsports-2019-101583

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Introduction

Athlete mental health (MH) is receiving increased attention in the sports medicine community. While participation in athletics has many benefits, the very nature of competition can provoke, augment or expose psychological issues in athletes. Certain personality traits can aid in athletic success, yet these same traits can also be associated with MH disorders. Importantly, the athletic culture may have an impact on performance and psychological health through its effect on existing personality traits and MH disorders. Consensus or position statements have been published by a number of organisations with each society bringing its own focus and perspective. 1–5 Sports medicine physicians are trained through their primary disciplines and sports medicine fellowships to provide comprehensive medical care to athletes, including the management of MH disorders. The team physician is often the coordinator of the athlete’s overall healthcare and may oversee MH screening and treatment, the prescribing of psychiatric medication and consultation with members of the MH care network.

The American Medical Society for Sports Medicine (AMSSM) convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment and prevention of MH issues in competitive athletes. 6 This position statement focuses on the competitive athlete, from the youth and collegiate athlete to the Olympian and professional athlete and how team physicians, athletic trainers and MH care providers can assist with the detection and treatment of psychological issues in athletes. The unique signs and symptoms in athletes, prevalence of MH disorders in the athlete population and utilisation of available screening tools will be reviewed. Specific Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria and the pathophysiology of MH disorders will not be discussed. The discussion of management may include psychosocial approaches and pharmacological treatments, emphasising the selection of the most effective treatments with the fewest side effects of relevance for athletic performance. Last, this paper will present recommendations for prevention, including the identification and possible elimination of risk factors within the athlete environment.

This document provides an Executive Summary of key evidence-based findings. The full position statement provides a comprehensive review ( box 1 ) and is accessible as an online supplementary file . While this statement is directed towards sports medicine physicians, it also may assist other physicians and healthcare professionals in the care of competitive athletes with psychological issues and MH disorders.

Supplemental material

Table of contents—amssm position statement on mental health issues and psychological factors in athletes.

Background and Purpose

How Teams Work

Personality Issues and Athletic Culture

Personality Issues

Sexuality and Gender Issues

Sexual Misconduct

Transition from sport

The Psychological Response to Injury and Illness

Self-medication in response to injury/illness

Select Psychological Challenges/Issues

Eating Disorders/Disordered Eating

Depression and Suicide

Anxiety and Stress

Overtraining

Sleep disorders

Attention-Deficit/Hyperactivity Deficit (ADHD)

The AMSSM Board of Directors appointed cochairs (CJC, MP) to assemble a writing group that was carefully selected to include a balanced panel of sports medicine physicians and other professionals experienced in managing MH issues in athletes, actively engaged in research and with demonstrated leadership in the topic. Important members of the panel included an athletic trainer, a clinical psychologist and a sport psychiatrist. The cochairs generated the outline and the writing group subsequently conducted an in-depth literature review using PubMed, SportDiscus and the Cochrane database for each topic. The writing group engaged in conference calls and written communications to discuss the evidence and compile the manuscript. The panel used the Strength of Recommendation Taxonomy (SORT) to grade level of evidence 7 ( table 1 ).

• View inline

Strength of Recommendation Taxonomy

This AMSSM position statement is novel in several respects in its contribution to the topic, including:

addressing topics not fully explored in previous publications about MH issues in athletes, including key personality issues, demographic and cultural variables and environmental conditions,

discussing the interaction and impact of these variables both positively and negatively on competitive athletes and how to monitor the athletic environment that may precipitate or exacerbate MH issues and

defining the level of evidence and the knowledge gaps in this rapidly expanding field.

Key findings

Sports medicine physicians should be familiar with the psychological, cultural and environmental factors that influence MH in athletes as well as common MH disorders affecting the athletic population. Key findings and level of evidence for each topic are summarised below:

Personality issues

High athletic identity is associated with both positive and negative health and performance outcomes. (SORT B) 8

Personality traits and disorders deemed problematic for athletes may be best addressed via psychotherapy. (SORT C) 9

Sexuality and gender issues

The creation of a strong supportive environment that is welcoming to sexual minorities is key to the MH of the athlete and the sports team. (SORT A) 10 11

Reducing the risk of negative health consequences for the sexual minority athlete starts with education of all stakeholders associated with athletic participation. (SORT C) 12–14

Hazing leads to both short-term and long-term health ramifications that can affect an individual’s athletic success and ability to participate in sport. (SORT C). 15

The prevention and management of hazing requires a global investment from athletes, coaches, administrators and healthcare providers centred on a zero-tolerance policy for any form of maltreatment and a focus on positive team building activities that promote dignity and teamwork as opposed to victimisation. (SORT C) 16

Bullying in athletics can take on many different forms and be the actions of teammates or coaches. Signs and symptoms of being bullied may vary greatly. (SORT C) 17

Preventing bullying is the responsibility of all the stakeholders in athletics. Educational programmes can be found on the NCAA website. (SORT C) 17

Sexual misconduct

Authority figures are more often perpetrators of sexual abuse, but peer athletes are far more likely than coaches to be perpetrators of sexual harassment. (SORT C) 18 19

Populations at higher risk for sexual abuse in youth sports reflect trends in the general population. Those participating at higher levels of competition are also at an increased risk. Sport type, amount of touching or degree of clothing cover during participation do not appear to correlate with higher rates of abuse. (SORT C) 20–23

Transitioning from sport

Athletic departments, national governing bodies and professional leagues should assist athletes who are retiring from their sport with development of a comprehensive preretirement plan addressing issues surrounding their transition out of athletic participation. (SORT A) 24

Long-term psychological effects of career-ending injuries are common for many athletes. (SORT C) 25

Psychological response to injury and illness

Psychological and sociocultural factors have been raised as potential risk factors for injury. Stress consistently demonstrates a relationship with injury risk as well as the ability to rehabilitate from injury and return to sport (SORT B) 25 26

Cognitive, emotional and behavioural responses to injury are important in determining outcome. (SORT C). 27

Limited data exist on the use of self-medication by athletes as a coping mechanism. However, certain demographics of athletes are emerging as higher risk groups for medication misuse and for negative MH and other consequences of their use. (SORT C) 28 29

Targeted interventions that incorporate health and athletic performance considerations tend to be more successful for the athletic population and this includes addressing the underlying issues leading to substance use/self-medication. (SORT C) 30–32

Eating disorder/disordered eating

Annual preparticipation screening for eating disorders in athletes should be routine. (SORT C) 33–39

Eating disorder prevention programmes have benefit in reducing risk for eating disorders. (SORT B) 33–36 39–42

Cognitive behavioural therapy (CBT) and family therapy are recommended as treatments for eating disorders in athletes. (SORT B) 33–36 40 43

Depression and suicide

Athletes have unique risk factors for depression compared with non-athletes. Early recognition and appropriate management of depression in athletes lead to improved clinical and performance outcomes. (SORT C) 44

College student-athletes report depression symptoms at a higher prevalence than previously reported; these rates are comparable to non-athlete college students. (SORT B) 45

Suicide incidence in college student athletes is lower than in college student non-athletes. Football has the highest suicide rate by sport in college athletes. (SORT B) 46

Anxiety/stress

CBT for the treatment of anxiety is the optimal non-pharmacological intervention. CBT is an established and effective treatment method for many clinical populations with different types of anxiety disorders, but there are no randomised controlled trials of CBT interventions specifically within athletes. (SORT B) 47

While selective serotonin reuptake inhibitors may be considered, as-needed anxiolytics are not recommended for athletic performance anxiety. (SORT B) 48 49

A management approach to the athlete with overtraining syndrome should be individually developed and should include evaluation for MH stressors and relative or absolute rest depending on the clinical situation at the time. (SORT C) 50

Monitoring training loads, getting adequate rest periods and maintaining optimal nutrition and hydration status are all important in preventing the development of overtraining syndrome. (SORT C) 51

While not specific for athletes, insomnia-specific CBT is first-line treatment for sustained improvements in sleep in those with insomnia alone or insomnia comorbid with other MH disorders. (SORT A) 52 53

Benzodiazepine sedative hypnotics are not recommended for athletes because of their marked ‘hangover’ effect, which includes a negative impact on reaction time. (SORT A) 54 55

While melatonin has not been shown to improve sleep quality in athletes, short-term use is safe with no decrements in performance. (SORT A). 56 57 Because melatonin is not regulated by the FDA, caution for the presence of impurity is necessary and it should be purchased as a single-ingredient product from a reputable company.

Attention deficit hyperactivity disorder (ADHD)

The optimal management approach for ADHD is individualised and may include behaviour therapies, academic accommodations, pharmacotherapy (eg, atomoxetine, amphetamine salts or methylphenidate formulations) and psychological interventions to manage associated features and comorbid diagnoses. (SORT C) 58–61

The risk of heat illness may be increased in athletes taking ADHD medications. Those taking stimulant medications have elevated core temperatures while exercising, although an increased incidence of exertional heat injury or heatstroke in these groups has not been reported. (SORT C) 62–65

Team physicians should be aware of and educate the athlete on regulations and requirements regarding medication treatment of ADHD. (SORT A) 66–68

Conclusion and future directions

While sports participation provides many benefits to individual health and well-being, athletes are exposed to additional risk factors that may impact their MH. The sports medicine physician and other members of the athletic care network are uniquely positioned to detect MH issues early and intervene appropriately. Providers must have a full understanding of how issues commonly manifest in the athletic population, and importantly, an awareness of the relevant psychological, cultural and environmental influences. The primary goal of this AMSSM position statement is to assist the team physician and other members of the athletic care network with the detection, treatment and prevention of a select range of psychological issues and MH disorders in athletes. An important component of management is an understanding of pharmacological treatment options including those that may be the most effective with the fewest side effects. Critical insight is needed into key personality issues (eg, ‘athlete identity’), demographic and cultural variables (eg, sexual orientation, gender identification) and environmental conditions (eg, hazing, bullying, sexual abuse) that can impact athletes and how interactions among these variables may contribute to MH issues. It is important for the athletic care network to be attuned to risk factors for MH disorders and to monitor athletic environments that may trigger or exacerbate psychological issues in athletes under their care.

Limited evidence is available that specifically addresses MH in athletes, and additional research is needed to define and validate the optimal strategies for the detection, management and prevention of MH disorders in competitive athletes. Recommended priorities are the development of validated assessment tools to improve early identification of MH issues in athletes and establishing effective interventions. We encourage readers to review the entire AMSSM Position Statement on Mental Health Issues and Psychological Factors in Athletes ( online supplementary file 1 ) to gain in-depth information on the highlighted topics.

• Henriksen K ,
• Schinke R ,
• Moesch K , et al
• Kleinert J , et al
• Reardon CL ,
• Hainline B ,
• Aron CM , et al
• Stambulova NB ,
• Si G , et al
• Van Slingerland KJ ,
• Durand-Bush N ,
• Bradley L , et al
• Herring SA ,
• Kibler WB ,
• Putukian M , et al
• Weiss BD , et al
• Brewer BW ,
• Van Raalte JL ,
• Stillman MA Ritvo EC ,
• Greenspan SB ,
• Griffith C ,
• Lucas-Carr CB ,
• National Collegiate Athletic Association
• ↵ Championing LGBTQ issues in K-12 education since 1990 [Internet]. 1 . Available: www.glsen.org/?gclid=Cj0KCQiAnuDTBRDUARIsAL41eDoyihJ_zbftLrBbKOTm036OmP2BP4KCqJOwCu6HkvNpcJwV3MT27AwaAviMEALw_wcB [Accessed 5 Feb 2018 ].
• Diamond AB ,
• Goldman S , et al
• NCAA Sport Science Institute
• Mountjoy M ,
• Brackenridge C ,
• Arrington M , et al
• Brackenridge CH ,
• Bishopp D ,
• Moussalli S , et al
• Fasting K ,
• Kirby S , et al
• Vertommen T ,
• Schipper-van Veldhoven NHMJ ,
• Hartill MJ , et al
• Sundgot-Borgen J
• Kleiber D ,
• Greendorfer S ,
• Blinde E , et al
• Ivarsson A ,
• Johnson U ,
• Andersen MB , et al
• Wiese-Bjornstal DM
• Forsdyke D ,
• Jones M , et al
• ↵ NCAA student-athlete substance use study: executive summary . Available: http://www.ncaa.org/about/resources/research/ncaa-student-athlete-substance-use-study-executive-summary-august-2014 [Accessed 21 Jun 2018 ].
• Martens MP ,
• Dams-O'Connor K ,
• de Andrade AG ,
• Castaldelli-Maia JM , et al
• Brisola-Santos MB ,
• Gallinaro JGdeME ,
• Gil F , et al
• Loucks AB ,
• Manore MM , et al
• Kussman A ,
• De Souza MJ ,
• Joy E , et al
• Sundgot-Borgen J ,
• Burke L , et al
• American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine
• Granger LR , et al
• Loucas CE ,
• Fairburn CG ,
• Whittington C , et al
• Martinsen M ,
• Børresen R , et al
• Cassin SE ,
• Couturier J ,
• Wolanin A ,
• Marks D , et al
• Drezner JA , et al
• Carfagno DG ,
• Meeusen R ,
• Foster C , et al
• Chuang L-P , et al
• Carney CE ,
• Edinger JD ,
• Kuchibhatla M , et al
• Charles RB ,
• Kirkham AJ ,
• Guyatt AR , et al
• Grobler LA ,
• Schwellnus MP ,
• Trichard C , et al
• Buscemi N ,
• Vandermeer B ,
• Hooton N , et al
• Atkinson G ,
• Buckley P ,
• Edwards B , et al
• Putukian M ,
• Kreher JB ,
• Coppel DB , et al
• ↵ Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. American Academy of pediatrics . Pediatrics 2000 ; 105 : 1158 – 70 . doi:10.1542/peds.105.5.1158 OpenUrl Abstract / FREE Full Text
• American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement.
• Pelham WE ,
• Roelands B ,
• Hasegawa H ,
• Watson P , et al
• Roelands B , et al
• McLellan TM ,
• Ducharme MB ,
• Canini F , et al
• ↵ NCAA drug testing program . Available: http://www.ncaa.org/sport-science-institute/ncaa-drug-testing-program [Accessed 8 Aug 2018 ].
• ↵ World anti-doping agency drug testing . Available: https://www.wada-ama.org/ [Accessed 8 Aug 2018 ].
• ↵ United States anti-doping agency website . Available: https://www.usada.org/testing/ [Accessed 8 Aug 2018 ].

CC and MP are joint first authors.

Twitter @Mputukian

Contributors All authors have made substantial contributions to the outline, drafted the work and revised it critically. In addition, all authors approved the final version to be published and are accountable for all aspects of the work.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

Read the full text or download the PDF:

• Frontiers in Psychology
• Movement Science
• Research Topics

Mental health challenges in elite sport: balancing risk with reward

Total Downloads

Total Views and Downloads

About this Research Topic

A growing research base suggests that the high performance environment has the potential to be a risky domain for many elite performers. This evidence has accumulated across disparate topics relating to elite sport including eating disorders among males, post-event depression, stigma towards accessing service ...

Important Note : All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Topic Editors

Topic coordinators, recent articles, submission deadlines.

Submission closed.

Participating Journals

Total views.

• Demographics

No records found

total views article views downloads topic views

Top countries

Top referring sites, about frontiers research topics.

With their unique mixes of varied contributions from Original Research to Review Articles, Research Topics unify the most influential researchers, the latest key findings and historical advances in a hot research area! Find out more on how to host your own Frontiers Research Topic or contribute to one as an author.

• Mission & Values
• About Sport & Performance Psychology
• Membership Benefits
• Membership Types
• Executive Board
• Special Interest Groups
• CMPC Emeriti
• In Memoriam
• Strategic Plan
• Privacy Policy
• Civility and Anti-Harassment Policy
• Contact AASP
• Certification
• Benefits of Certification
• Certification Program Candidate Handbook
• How to Apply
• Application Forms
• Exam/Study Resources
• Registry of Approved Mentors
• Professional Ethics & Standards in Sport Psychology Course: K1
• Diversity & Culture Course: K8
• CMPC Course Options (Outside AASP)
• Recertification
• Certification Program Updates
• Find a Certified Mental Performance Consultant® (CMPC)
• Liability Insurance for Member CMPCs
• Ethics Code
• Contact the CMPC Certification Council
• Publications
• Journal of Applied Sport Psychology
• Journal of Sport Psychology in Action
• Case Studies in Sport and Exercise Psychology
• Journal for Advancing Sport Psychology in Research
• Journal Awards for JASP, JSPA, and CSSEP
• Essential Guide for Mental Performance Consultants
• Directory of Graduate Programs in Applied Sport Psychology
• Annual Conference
• 2024 Call For Abstracts
• 2024 Continuing Education Workshop Submissions
• In-Person Schedule
• Registration
• Hotel & Travel
• Featured CE Workshops
• CEUs for CMPC
• Graduate Program & Career Fair
• Student Abstract Awards / Young Researcher Award
• Student Diversity Travel Grant
• Upcoming Conferences & History
• Knowledge Areas
• Required CE Areas
• Mentoring Through Sticky Situations: Navigating and Guiding Students Through Ethical Challenges
• Dissertation Award
• Distinguished Applied Practitioner Award
• Distinguished International Scientist-Practitioner Award
• Distinguished Scientist-Practitioner Award
• Distinguished Public Communication, Awareness, and Outreach Award
• Dorothy V. Harris Memorial Award
• Early Career Applied Practitioner Award
• Inclusion, Diversity, and Excellence in Advocacy and Social Justice (IDEAS) Student Award
• Kate F. Hays Distinguished Mentor Award
• Ken Ravizza Performance Excellence Award
• Master's Thesis Award
• Outstanding Student Practice Award
• Teaching Excellence Award
• AASP Past Award Recipients
• Research Grants
• Collaborative Research Grants
• Community Outreach Grant
• Gualberto Cremades International Research Grant - AASP Foundation
• Oglesby-Snyder Grant for Equity and Cultural Diversity
• Seed Grants - AASP Foundation
• AASP Past Grant Recipients
• Students Center
• Initiatives
• Video Resources
• Student Delegates
• Regional Conferences
• Student Awards
• Undergraduate Programs in Sport, Exercise, and Performance Psychology
• Graduate Training
• Diversity, Equity, Inclusion, Belonging & Justice (DEIBJ)
• AASP Position Statement on Human Diversity
• Events, Institutes, and Initiatives
• Resources and References
• Grants and Awards
• International
• Past Diversity Lectures
• AASP Foundation
• Foundation Honor Roll
• Donation Form
• Research Crowdfunding
• Media Center
• News Releases and Association Updates
• Media Inquiries
• AASP Members in the News
• Featured Podcast Library
• CMPC Directory
• About Sport & Performance Psychology
• AASP Blog for Athletes, Coaches, and Parents
• CMPC Certification Updates
• Related Organizations

Self-Care, Wellness, and Mental Health Strategies for College Student-Athletes

Published May 21, 2024

Participation in college athletics can be a wonderful pursuit. Various disciplines of research highlight the psychosocial benefits of sport participation. Research has also shown that exercise and physical movement can improve mental functioning (Sharma et al., 2006). However, sport participation can also be a significant source of stress for college student-athletes. On top of the psychosocial demands of pursuing a college degree, student-athletes are faced with additional sources of stress. Lu et al. (2012) identified eight broad categories of athlete-specific stressors: Sport injury, performance demands, coach-athlete relationship, training adaption and burnout, interpersonal relationships, family relationships, and academic requirements (e.g., to maintain eligibility). The research recognizes the subsequent impact on student-athletes’ wellness. According to the NCAA (2023), 35% of female student-athletes feel mentally exhausted, while 44% feel overwhelmed. Research has also shown concerns related to body image and disordered eating (Bar et al., 2016); roughly half of student-athletes experience sleep-related problems (IOC, 2021), and upwards of 33% of elite performers experience symptoms of depression and anxiety (IOC, 2021). Other clinically significant concerns include substance misuse and other addictive behaviors (e.g., gambling), ADHD, and self-harm. Given the stress and demands of being a student-athlete, “mental health” is identified as the number one reason for transferring from their current institution (NCAA, 2022).  Based on the research and subjective experiences of student-athletes, the importance of self-care and wellness becomes paramount. With that said, below are a few quick tips to boost wellness and psychological functioning.  

Win the Off Days. For most, the “relationship” with sport may be your longest relationship aside from that with your parent(s). Sport has inevitably become part of your personality. We also know sport-culture is full of mantras like “Give 110%” and “If you’re not working, somebody else is!” Together, it is easy to understand how some athletes report feelings of guilt and shame for engaging in “self-care” activities. However, the human brain needs variety. Burnout is inevitable if you spend every waking moment training for your sport. I have seen dozens of athletes improve their personal wellness and athletic performance by simply finding balance outside of their sport. You would be amazed at how engaging in a “non-sport” hobby can go! Or be intentional in finding so-called “NARP” (non-athlete real person) friend relationships away from your team. Win the off day! Find a hobby and cultivate your identity outside of the role as a “student-athlete.”  

Don’t Sleep on Sleep. Research has indicated that nearly half of student-athletes have sleep-related issues (IOC, 2021). This serves as a reminder of the importance of prioritizing healthy sleep habits. Early warning signs that you may have a sleep issue would include feeling tired throughout the day or having difficulty staying awake, using coffee and stimulants to stay awake in class, difficulty falling asleep or staying asleep, or engaging in so-called “revenge insomnia” behaviors (e.g., scrolling on your phone at night instead of sleeping). Sound like you? If so, let’s focus on increasing the quality of your sleep by practicing healthy sleep behaviors. Restorative sleep habits include sticking to a regular sleep schedule, limiting caffeine before bedtime, avoiding daytime napping after 2:00 pm, lowering the air temperature of your bedroom(less than 68 degrees), and only using your bed for sleep and not as your spot to complete homework, eat snacks, etc. (NCAA, n.d.). To oversimplify a neuropsychology lesson, when you sleep, cerebrospinal fluid (CSF) flows through the brain, removing toxins that accumulate throughout the day. We literally need sleep to function at an optimal level. We also know poor sleep has been linked to an increased risk of injury. Change your thoughts about sleep and view sleep as part of your training. Your brain needs sleep to help you excel in the classroom and on the field.  

Find and Follow Your Values. In Viktor Frankl’s book “Man’s Search for Meaning” (1946), he states that people have a great capacity for resiliency. The catch is that people need to find meaning in the stress and stressors. Any student-athlete can attest to the multiple sources of stress that are associated with sport participation. It is vital to understand how your personal values are fulfilled by your athletic pursuits. Ask yourself “what do I value?” and be intentional in finding ways to express those values. For example, if you value “relationships” be mindful and pour into your relationships with your teammates. If you value “self-growth” lean into your training. Instead of focusing on the stress of 6:00 am workouts, view them as opportunities to grow and improve at your sport. Identify your values and find micro-ways daily to live and express the things you care about.

Use your support team. As we say at Mississippi State, “We are better together!” One of the perks of being a student-athlete is that you are surrounded by a support team. Most student-athletes have access to medical healthcare, nutrition services, strength & conditioning, mental health clinicians and mental performance coaches, and student-athlete development staff.  Be intentional and use the available resources! If you’re struggling to find a support team, you can find a Certified Mental Performance Consultant® (CMPC) on the AASP website to locate someone near you.

In summary, win the off days (find balance in your life and develop an identity outside of sport), practice healthy sleep and nutrition habits, and use your sport to find and express your personal values. Practice these wellness tips and seek personalized care on campus from your support team!

• Frankl, V. E. (1962). Man's search for meaning: An introduction to logotherapy. Beacon Press
• IOC mental health in Elite Athletes Toolkit - Athlete365. (2021). https://olympics.com/athlete365/mentally-fit/mentallyfit-toolkit-resources/
• Lu, F. J. H., Lee, W. P., Chang, Y.-K., Chou, C.-C., Hsu, Y.-W., Lin, J.-H., & Gill, D. L. (2016). Interaction of athletes’ resilience and coaches’ social support on the stress-burnout relationship: A conjunctive moderation perspective. Psychology of Sport and Exercise, 22 , 202–209. https://doi.org/10.1016/j.psychsport.2015.08.005
• NCAA student-athlete health and wellness study . NCAA.org. (2022.). https://www.ncaa.org/sports/2022/9/8/ncaa-student-athlete-health-and-wellness-study.aspx
• NCAA.org. (2023, December 12). Student-athletes report fewer mental health concerns . https://www.ncaa.org/news/2023/12/13/media-center-student-athletes-report-fewer-mental-health-concerns.aspx
• NCAA Sleep and wellness for collegiate athletes. (n.d.). https://ncaaorg.s3.amazonaws.com/ssi/performance/SSI_SleepWellnessFactSheet.pdf
• Sharma, A., Madaan, V., & Petty, F. D. (2006). Exercise for mental health. Primary care companion to the Journal of clinical psychiatry, 8 (2), 106. https://doi.org/10.4088/pcc.v08n0208a

By Joseph Case Mississippi State University

Dr. Joseph Case serves as the Assistant Athletic Director for Counseling & Sport Psychology (CSP) at Mississippi State University. CSP is a fully athletics-embedded mental health and mental performance coaching department comprised of four full-time clinicians, three part-time contractors, and graduate and undergraduate internship students. Dr. Case is a licensed clinical psychologist and specializes in ADHD and sport & performance psychology. Dr. Case can be found on Twitter/X and Instagram @drjosephcase and @josephccase on TikTok.

Share this article:

Published in:

• Athletes and Other Performers

Return to AASP Blog

Blog Archives

• February 2023
• August 2023
• October 2023
• November 2023
• December 2023
• September 2023
• January 2022
• February 2022
• September 2022
• December 2022
• January 2021
• August 2021
• September 2021
• October 2021
• November 2021
• September 2020
• October 2020
• December 2020
• January 2019
• December 2019
• September 2019
• February 2018
• January 2017
• February 2017
• October 2017
• January 2016
• August 2016
• September 2016
• January 2015
• February 2015
• August 2014

Submit an Article

Members: Submit an Article

AASP Members may submit blog posts by logging in to their member profile.

Association for Applied Sport Psychology 8365 Keystone Crossing, Suite 107 Indianapolis , IN 46240 USA

Phone: (317) 205-9225 Fax: (317) 205-9481 Email: [email protected]

• What is Applied Sport Psychology

• Milano Cortina 2026
• Brisbane 2032
• Olympic Refuge Foundation
• Olympic Games
• Olympic Channel
• Let's Move

How sport can have a positive impact on mental and physical health

It’s not always easy to start a workout, but research shows that sport and exercise are beneficial not only for your physical health, but your mental well-being, too. Let us help!

Health experts and Olympic athletes agree: Your mental and physical health benefit when you get active and participate in sport – whatever that means for you.

From daily exercise to choosing a sport to practice or play, the body and mind are worked in new and different ways each time you move your body.

On June 23rd every year we come together to celebrate that, as part of Olympic Day.

For the 2020 edition, we connected with Olympians around the world for Olympic Day 2020 at-home workouts – and a reminder: We’re stronger together, especially when we stay active!

And those are still available online to help inspire you today.

Sport benefits: Both the physical and mental

While the physical benefits are numerous (more on that below), the UK's National Health Service (NHS) report that people who take part in regular physical activity have up to a 30 percent lower risk of depression.

Additionally, exercise can help lower anxiety, reduce the risk of illness and increase energy levels. Want better sleep? Work up a good sweat!

Exercise can help you fall asleep faster and sleep for longer, research says.

It was in June 2020 that the IOC partnered with the World Health Organization and United Nations to promote the #HEALTHYTogether campaign , which highlights the benefits of physical activity in the face of the pandemic.

Over 50 at-home workouts are searchable across Olympics.com for you, each which help further the idea that moving and challenging the body can only prove beneficial for your physical and mental well-being.

The athletes' perspective: 'I used this strength to survive'

“If I had sat doing nothing, I would have gone crazy,” says Syria's Sanda Aldass , who fled the trauma of civil war in her country, leaving behind her husband and infant child.

Instead, she had judo - and has been selected for the IOC Refugee Olympic Team Tokyo 2020 for the Games in 2021.

“Running around and doing some exercises filled up my time and also kept me in good mental health,” Sanda said of the impact of sport on her life during nine months spent in a refugee camp in the Netherlands in 2015.

The same power of sport goes for Iranian taekwondo athlete Ali Noghandoost.

"When I had to leave my family and my home in Iran, the first things I packed in my bag were my belt, my dobok, my shoes and my mitt for taekwondo," Noghandoost said . "I took some documents that said I was a champion in Iran and in a national team, so I could prove I was a fighter and continue to train in any city I went to."

"Taekwondo did not only help me physically; mentally, it stopped me from thinking about giving up and that we wouldn’t make it. I used this strength to survive," he added.

Noghandoost has worked as a coach for refugees in Croatia, where he has tried to pass the power of sport on to the next generation.

"When you’re living in a refugee camp, it’s a really hard situation, but when you play sport, you can release any negative energy and feel free. It’s a space – a paradise – for them to be themselves."

A member of the IOC Refugee Olympic Team Rio 2016, Yiech Pur Biel says that the team provided a message of hope for those watching around the world.

"We were ambassadors for a message of hope, that anything is possible," Biel said . "A good thing had come out of our situations. The world understood. I am called a refugee, but you never know when someone else might become a refugee, through war or persecution. We wanted to show that we responded positively. So that made me very happy. Through sport, we can unite and make the world better."

Sport as a tool for much - including mental health

Sport is a powerful tool no matter from what angle you look at it, including mental health. The Olympic Refugee Foundation (ORF) has recently launched two different programs that are aimed at helping young refugees dream of a brighter future - through sport.

One of those programs, Game Connect, is a three-year initiative that was launched in August 2020 and aims to "improve the mental health and psychosocial wellbeing of young refugees by improving their access to safe sport," as explained on Olympics.com last year.

We are "embarking on a three-year project to improve the psychosocial wellbeing and mental health of young refugees, working together with well-trained community-based coaches to deliver a Sport for Protection program and activities," explained Karen Mukiibi of Youth Sport Uganda, which has partnered with the ORF.

Related content

Stay Healthy, Stay Strong, Stay Active with the Olympic Day home workout

Paris 2024 – getting children moving more at school for 30 minutes a day

Daily routine: five things to do - 11 April 2020

Olympic Day Workout | #StayActive with Bryan Clay

Olympic Day Workout | #StayActive with Hong Zhang

You may like.

55 research questions about mental health

Last updated

11 March 2024

Reviewed by

Brittany Ferri, PhD, OTR/L

Research in the mental health space helps fill knowledge gaps and create a fuller picture for patients, healthcare professionals, and policymakers. Over time, these efforts result in better quality care and more accessible treatment options for those who need them.

Use this list of mental health research questions to kickstart your next project or assignment and give yourself the best chance of producing successful and fulfilling research.

• Why does mental health research matter?

Mental health research is an essential area of study. It includes any research that focuses on topics related to people’s mental and emotional well-being.

As a complex health topic that, despite the prevalence of mental health conditions, still has an unending number of unanswered questions, the need for thorough research into causes, triggers, and treatment options is clear.

Research into this heavily stigmatized and often misunderstood topic is needed to find better ways to support people struggling with mental health conditions. Understanding what causes them is another crucial area of study, as it enables individuals, companies, and policymakers to make well-informed choices that can help prevent illnesses like anxiety and depression.

• How to choose a strong mental health research topic

As one of the most important parts of beginning a new research project, picking a topic that is intriguing, unique, and in demand is a great way to get the best results from your efforts.

Mental health is a blanket term with many niches and specific areas to explore. But, no matter which direction you choose, follow the tips below to ensure you pick the right topic.

Prioritize your interests and skills

While a big part of research is exploring a new and exciting topic, this exploration is best done within a topic or niche in which you are interested and experienced.

Research is tough, even at the best of times. To combat fatigue and increase your chances of pushing through to the finish line, we recommend choosing a topic that aligns with your personal interests, training, or skill set.

Consider emerging trends

Topical and current research questions are hot commodities because they offer solutions and insights into culturally and socially relevant problems.

Depending on the scope and level of freedom you have with your upcoming research project, choosing a topic that’s trending in your area of study is one way to get support and funding (if you need it).

Not every study can be based on a cutting-edge topic, but this can be a great way to explore a new space and create baseline research data for future studies.

Assess your resources and timeline

Before choosing a super ambitious and exciting research topic, consider your project restrictions.

You’ll need to think about things like your research timeline, access to resources and funding, and expected project scope when deciding how broad your research topic will be. In most cases, it’s better to start small and focus on a specific area of study.

Broad research projects are expensive and labor and resource-intensive. They can take years or even decades to complete. Before biting off more than you can chew, consider your scope and find a research question that fits within it.

Read up on the latest research

Finally, once you have narrowed in on a specific topic, you need to read up on the latest studies and published research. A thorough research assessment is a great way to gain some background context on your chosen topic and stops you from repeating a study design. Using the existing work as your guide, you can explore more specific and niche questions to provide highly beneficial answers and insights.

• Trending research questions for post-secondary students

As a post-secondary student, finding interesting research questions that fit within the scope of your classes or resources can be challenging. But, with a little bit of effort and pre-planning, you can find unique mental health research topics that will meet your class or project requirements.

Examples of research topics for post-secondary students include the following:

How does school-related stress impact a person’s mental health?

To what extent does burnout impact mental health in medical students?

How does chronic school stress impact a student’s physical health?

How does exam season affect the severity of mental health symptoms?

Is mental health counseling effective for students in an acute mental crisis?

• Research questions about anxiety and depression

Anxiety and depression are two of the most commonly spoken about mental health conditions. You might assume that research about these conditions has already been exhausted or that it’s no longer in demand. That’s not the case at all.

According to a 2022 survey by Centers for Disease Control and Prevention (CDC), 12.5% of American adults struggle with regular feelings of worry, nervousness, and anxiety, and 5% struggle with regular feelings of depression. These percentages amount to millions of lives affected, meaning new research into these conditions is essential.

If either of these topics interests you, here are a few trending research questions you could consider:

Does gender play a role in the early diagnosis of anxiety?

How does untreated anxiety impact quality of life?

What are the most common symptoms of anxiety in working professionals aged 20–29?

To what extent do treatment delays impact quality of life in patients with undiagnosed anxiety?

To what extent does stigma affect the quality of care received by people with anxiety?

Here are some examples of research questions about depression:

Does diet play a role in the severity of depression symptoms?

Can people have a genetic predisposition to developing depression?

How common is depression in work-from-home employees?

Does mood journaling help manage depression symptoms?

What role does exercise play in the management of depression symptoms?

• Research questions about personality disorders

Personality disorders are complex mental health conditions tied to a person’s behaviors, sense of self, and how they interact with the world around them. Without a diagnosis and treatment, people with personality disorders are more likely to develop negative coping strategies during periods of stress and adversity, which can impact their quality of life and relationships.

There’s no shortage of specific research questions in this category. Here are some examples of research questions about personality disorders that you could explore:

What environments are more likely to trigger the development of a personality disorder?

What barriers impact access to care for people with personality disorders?

To what extent does undiagnosed borderline personality disorder impact a person’s ability to build relationships?

How does group therapy impact symptom severity in people with schizotypal personality disorder?

What is the treatment compliance rate of people with paranoid personality disorder?

• Research questions about substance use disorders

“Substance use disorders” is a blanket term for treatable behaviors and patterns within a person’s brain that lead them to become dependent on illicit drugs, alcohol, or prescription medications. It’s one of the most stigmatized mental health categories.

The severity of a person’s symptoms and how they impact their ability to participate in their regular daily life can vary significantly from person to person. But, even in less severe cases, people with a substance use disorder display some level of loss of control due to their need to use the substance they are dependent on.

This is an ever-evolving topic where research is in hot demand. Here are some example research questions:

To what extent do meditation practices help with craving management?

How effective are detox centers in treating acute substance use disorder?

Are there genetic factors that increase a person’s chances of developing a substance use disorder?

How prevalent are substance use disorders in immigrant populations?

To what extent do prescription medications play a role in developing substance use disorders?

• Research questions about mental health treatments

Treatments for mental health, pharmaceutical therapies in particular, are a common topic for research and exploration in this space.

Besides the clinical trials required for a drug to receive FDA approval, studies into the efficacy, risks, and patient experiences are essential to better understand mental health therapies.

These types of studies can easily become large in scope, but it’s possible to conduct small cohort research on mental health therapies that can provide helpful insights into the actual experiences of the people receiving these treatments.

Here are some questions you might consider:

What are the long-term effects of electroconvulsive therapy (ECT) for patients with severe depression?

How common is insomnia as a side effect of oral mental health medications?

What are the most common causes of non-compliance for mental health treatments?

How long does it take for patients to report noticeable changes in symptom severity after starting injectable mental health medications?

What issues are most common when weaning a patient off of an anxiety medication?

• Controversial mental health research questions

If you’re interested in exploring more cutting-edge research topics, you might consider one that’s “controversial.”

Depending on your own personal values, you might not think many of these topics are controversial. In the context of the research environment, this depends on the perspectives of your project lead and the desires of your sponsors. These topics may not align with the preferred subject matter.

That being said, that doesn’t make them any less worth exploring. In many cases, it makes them more worthwhile, as they encourage people to ask questions and think critically.

Here are just a few examples of “controversial” mental health research questions:

To what extent do financial crises impact mental health in young adults?

How have climate concerns impacted anxiety levels in young adults?

To what extent do psychotropic drugs help patients struggling with anxiety and depression?

To what extent does political reform impact the mental health of LGBTQ+ people?

What mental health supports should be available for the families of people who opt for medically assisted dying?

• Research questions about socioeconomic factors & mental health

Socioeconomic factors—like where a person grew up, their annual income, the communities they are exposed to, and the amount, type, and quality of mental health resources they have access to—significantly impact overall health.

This is a complex and multifaceted issue. Choosing a research question that addresses these topics can help researchers, experts, and policymakers provide more equitable and accessible care over time.

Examples of questions that tackle socioeconomic factors and mental health include the following:

How does sliding scale pricing for therapy increase retention rates?

What is the average cost to access acute mental health crisis care in [a specific region]?

To what extent does a person’s environment impact their risk of developing a mental health condition?

How does mental health stigma impact early detection of mental health conditions?

To what extent does discrimination affect the mental health of LGBTQ+ people?

• Research questions about the benefits of therapy

Therapy, whether that’s in groups or one-to-one sessions, is one of the most commonly utilized resources for managing mental health conditions. It can help support long-term healing and the development of coping mechanisms.

Yet, despite its popularity, more research is needed to properly understand its benefits and limitations.

Here are some therapy-based questions you could consider to inspire your own research:

In what instances does group therapy benefit people more than solo sessions?

How effective is cognitive behavioral therapy for patients with severe anxiety?

After how many therapy sessions do people report feeling a better sense of self?

Does including meditation reminders during therapy improve patient outcomes?

To what extent has virtual therapy improved access to mental health resources in rural areas?

• Research questions about mental health trends in teens

Adolescents are a particularly interesting group for mental health research due to the prevalence of early-onset mental health symptoms in this age group.

As a time of self-discovery and change, puberty brings plenty of stress, anxiety, and hardships, all of which can contribute to worsening mental health symptoms.

If you’re looking to learn more about how to support this age group with mental health, here are some examples of questions you could explore:

Does parenting style impact anxiety rates in teens?

How early should teenagers receive mental health treatment?

To what extent does cyberbullying impact adolescent mental health?

What are the most common harmful coping mechanisms explored by teens?

How have smartphones affected teenagers’ self-worth and sense of self?

• Research questions about social media and mental health

Social media platforms like TikTok, Instagram, YouTube, Facebook, and X (formerly Twitter) have significantly impacted day-to-day communication. However, despite their numerous benefits and uses, they have also become a significant source of stress, anxiety, and self-worth issues for those who use them.

These platforms have been around for a while now, but research on their impact is still in its infancy. Are you interested in building knowledge about this ever-changing topic? Here are some examples of social media research questions you could consider:

To what extent does TikTok’s mental health content impact people’s perception of their health?

How much non-professional mental health content is created on social media platforms?

How has social media content increased the likelihood of a teen self-identifying themselves with ADHD or autism?

To what extent do social media photoshopped images impact body image and self-worth?

Has social media access increased feelings of anxiety and dread in young adults?

• Mental health research is incredibly important

As you have seen, there are so many unique mental health research questions worth exploring. Which options are piquing your interest?

Whether you are a university student considering your next paper topic or a professional looking to explore a new area of study, mental health is an exciting and ever-changing area of research to get involved with.

Your research will be valuable, no matter how big or small. As a niche area of healthcare still shrouded in stigma, any insights you gain into new ways to support, treat, or identify mental health triggers and trends are a net positive for millions of people worldwide.

Should you be using a customer insights hub?

Do you want to discover previous research faster?

Do you share your research findings with others?

Do you analyze research data?

Start for free today, add your research, and get to key insights faster

Editor’s picks

Last updated: 11 January 2024

Last updated: 15 January 2024

Last updated: 17 January 2024

Last updated: 25 November 2023

Last updated: 12 May 2023

Last updated: 30 April 2024

Last updated: 13 May 2024

Latest articles

Related topics, .css-je19u9{-webkit-align-items:flex-end;-webkit-box-align:flex-end;-ms-flex-align:flex-end;align-items:flex-end;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:row;-ms-flex-direction:row;flex-direction:row;-webkit-box-flex-wrap:wrap;-webkit-flex-wrap:wrap;-ms-flex-wrap:wrap;flex-wrap:wrap;-webkit-box-pack:center;-ms-flex-pack:center;-webkit-justify-content:center;justify-content:center;row-gap:0;text-align:center;max-width:671px;}@media (max-width: 1079px){.css-je19u9{max-width:400px;}.css-je19u9>span{white-space:pre;}}@media (max-width: 799px){.css-je19u9{max-width:400px;}.css-je19u9>span{white-space:pre;}} decide what to .css-1kiodld{max-height:56px;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}@media (max-width: 1079px){.css-1kiodld{display:none;}} build next, decide what to build next.

Users report unexpectedly high data usage, especially during streaming sessions.

Users find it hard to navigate from the home page to relevant playlists in the app.

It would be great to have a sleep timer feature, especially for bedtime listening.

I need better filters to find the songs or artists I’m looking for.

Log in or sign up

Get started for free

More From Forbes

Supportive sports environments reduce depression and anxiety in girls, new report shows.

• Share to Facebook
• Share to Twitter
• Share to Linkedin

NEW YORK, NEW YORK - OCTOBER 16: Billie Jean King speaks at The Women in Sports Foundation 40th ... [+] Annual Salute to Women in Sports Awards Gala, celebrating the most accomplished women in sports and the girls they inspire at Cipriani Wall Street on October 16, 2019 in New York City. (Photo by Theo Wargo/Getty Images for Women In Sports Foundation)

A new study conducted by the Women’s Sport Foundation reveals that girls’ participation in supportive sport environments can significantly lessen mental health issues, including depression and anxiety. The report, Thriving Through Sport: The Transformative Impact on Girls’ Mental Health, examined not only the relationship between sport participation and mental health, but also the types of sport environments that yield the most significant mental health benefits for participants.

Karen Issokson-Silver , Vice President, Research & Education at the Women’s Sports Foundation (WSF), shared that the motivation behind the study stemmed largely from a lack of previous research and the notable increase in youth mental health issues. She noted, “though there was some existing research on the connection between sport participation and mental health, it was limited. The Women’s Sport Foundation wanted to dive deeper into the topic to better understand the relationship between sport and mental health, with a focus on girls. Importantly, we wanted to learn more about how the different conditions within sport settings impact mental health, so we could offer data-driven insights about how to support girls more holistically.”

UNITED STATES - AUGUST 28: Tennis pro Gigi Fernandez watches approvingly as a youngster hits a ... [+] return during a Leadership Day for Girls clinic at the U.S. Open at Flushing Meadows-Corona Park. Fernandez has won two Olympic gold medals. (Photo by Corey Sipkin/NY Daily News Archive via Getty Images)

Key Findings

Overall, the findings of this study strongly suggest that engaging in sports within high-quality environments can reduce depression and anxiety, enhance peer relationships, and provide a sense of purpose and meaning. According to Issokson-Silver, “this new report makes clear that sport is not a nice to have, but a must have. The data shows that sport can play a powerful role in improving mental health.” Several key findings from the study include:

• Mental health disorders are roughly 1.5-2.5x lower for girls who play sports once compared to girls who have never played.
• Moderate-to-high levels of depression symptoms are found in 29% of girls who have never played sports, compared to 17% of girls who currently participate.
• Among girls who have never participated in sports, 21% experience moderate to high levels of anxiety symptoms, compared to 11% of girls currently playing sports.
• Depression symptoms are notably lower (9.3%) in sport environments emphasizing effort, improvement, and teamwork, compared to settings where winning is prioritized and success is measured by outperforming others (24.7%).
• Girls currently playing sports have approximately 1.5 times higher odds of having moderate-to-high scores in peer relationships or feelings of meaning and purpose, compared to girls who have never participated in sports.
• Compared to girls involved solely in non-sport activities, those participating in sports show lower levels of depression and anxiety, as well as higher levels of peer relationships and feelings of meaning and purpose, even when considering factors like the number of activities, years engaged, and hours per week of participation.

LITTLETON, CO - FEBRUARY 24: Former NBA player Keith Van Horn talks with his girl's U13 team at 24 ... [+] Hour Fitness on February 24, 2016 in Littleton, Colorado. Van Horn, the second overall pick in the 1997 NBA Draft, created one of the top basketball organizations in Colorado, Colorado Premier, which recently became part of the Nike EYBL circuit, which features only the top 32 club teams in America. Van Horn retired from the NBA in 2006 as a member of the Dallas Mavericks. (Photo by Brent Lewis/The Denver Post via Getty Images)

When Is The Voice Season 25 Finale All About The Star Studded Event

Sam altman apologizes to scarlett johansson over openai chatbot voice she called ‘eerily similar’ to hers, donald trump jr attends father s hush money trial as melania and ivanka avoid it here are the other trump allies in court, supportive sport environments.

The study also identifies crucial elements within sport settings, such as levels of autonomy and the nature of coach relationships, that contribute to positive outcomes for girls. According to Issokson-Silver, “when girls have the opportunity for “voice and choice,” which means they are encouraged to express themselves, share ideas, interests, and concerns, this goes a long way to boosting their mental health. When sport settings prioritize the development of skills over time and personal goal setting, and when players are encouraged to learn from their mistakes, they thrive. This stands in contrast to sport settings in which the focus is on winning above all and where social comparisons dominate the culture and tone.”

Previous research has highlighted the adverse effects of a win-at-all-costs mindset among coaches. Environments driven by coaches' relentless pursuit of victory often breed narcissistic leadership behaviors, impacting both employees and players negatively. This previous study indicates that when winning becomes the sole focus, leadership adopts harmful practices, prioritizing victory over all other organizational and personal goals. When considering the findings from the WSF’s report, it becomes evident that athletes, including young girls, face heightened risks of mental health issues due to these toxic win-at-all-costs cultures, which may also increase the likelihood of strained relationships with their coaches.

Inglewood, CA - August 19: A player from King/Drew girls flag football goes up for a pass against ... [+] Crenshaw at halftime during the Rams and Raiders preseason game at SoFi Stadium on Saturday, Aug. 19, 2023 in Inglewood, CA. (Jason Armond / Los Angeles Times via Getty Images)

As noted by Issokson-Silver, “strong relationships nurture girls’ confidence and overall well-being. This includes the relationship between coaches and players and the relationships that are fostered between players and their peers. Above all, environments that are inclusive, welcoming, and create a sense of belonging are enormously supportive of positive mental health... when coaches highlight the small wins that happen every day, and not just the outcomes of competition, girls’ confidence is nurtured and reinforced. Coach training around promoting mental health is essential. We want all coaches to be equipped to help girls thrive physically and mentally.”

Policy and Practice

The insights from this study provide important avenues for policy and practice recommendations. According to Issokson-Silver, “all sport programs, regardless of the level of play, should prioritize player well-being, both in terms of physical and mental health... [the] WSF’s advocacy and community impact work is fueling this message by supporting programs through the delivery of grants, leadership training, and capacity building. A good example of that work is WSF’s Sports 4 Life program, a national initiative co-founded by ESPN and now also supported by Gatorade. The program seeks to increase the participation and retention of Black, African American, Hispanic, and Native American girls in sport to improve their physical and mental health and leadership skills. This year, Sports 4 Life is celebrating its 10-year anniversary and the outcomes from this program reflect the powerful data in the new research. We see that when sport programs are done well, girls thrive.”

OAKTON, VA - SEPTEMBER 12: Flint Hill's bench celebrates a score in the 3rd set during Flint ... [+] Hill's defeat of Georgetown Day 3 sets to 0 in girls volleyball at Flint Hill School in Oakton, VA on September 12, 2023. (Photo by John McDonnell/The Washington Post via Getty Images)

Alongside policy adjustments, the landscape of women’s sport has witnessed an expansion in role modeling opportunities in recent years, which will likely increase awareness of and participation in sport. Women's sports have seen a surge in viewership and attendance , likely fueling further increases in girls' participation across various sports for years to come. Today's young girls may find it challenging to recall a time when accessing their favorite teams on linear or streaming TV networks was difficult. With this surge in growth, participation opportunities in sports should consistently prioritize inclusivity, individual development, and encouragement for all participants. The undeniable advantages of high-quality sport experiences necessitate that organizations and leaders focus on cultivating supportive environments for girls in order to fully capitalize on these benefits.

• Editorial Standards
• Reprints & Permissions

Join The Conversation

One Community. Many Voices. Create a free account to share your thoughts. 

Forbes Community Guidelines

Our community is about connecting people through open and thoughtful conversations. We want our readers to share their views and exchange ideas and facts in a safe space.

In order to do so, please follow the posting rules in our site's  Terms of Service.   We've summarized some of those key rules below. Simply put, keep it civil.

Your post will be rejected if we notice that it seems to contain:

• False or intentionally out-of-context or misleading information
• Insults, profanity, incoherent, obscene or inflammatory language or threats of any kind
• Attacks on the identity of other commenters or the article's author
• Content that otherwise violates our site's  terms.

User accounts will be blocked if we notice or believe that users are engaged in:

• Continuous attempts to re-post comments that have been previously moderated/rejected
• Racist, sexist, homophobic or other discriminatory comments
• Attempts or tactics that put the site security at risk
• Actions that otherwise violate our site's  terms.

So, how can you be a power user?

• Stay on topic and share your insights
• Feel free to be clear and thoughtful to get your point across
• ‘Like’ or ‘Dislike’ to show your point of view.
• Protect your community.
• Use the report tool to alert us when someone breaks the rules.

Thanks for reading our community guidelines. Please read the full list of posting rules found in our site's  Terms of Service.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Front Psychol

An empirical study of physical activity and sports affecting mental health of university students

Lu congsheng.

1 School of Education, Shaanxi Normal University, Xi'an, Shaanxi, China

2 Haian Senior School of Jiangsu Province, Nantong, China

Sumaira Kayani

3 Department of Education, Zhejiang Normal University, Jinhua, Zhejiang, China

Amna Khalid

4 College of Medicine, University of Sharjah, Sharjah, United Arab Emirates

Associated Data

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Physical activity (PA) and sports are extremely essential elements for physical and mental health among adolescents. Around 30% of 16 years old and above in Malaysia have mental health issues. For this purpose, 512 university students from Malaysia were surveyed through social media, with 74% response rate. Structural equation model partial least square (SEM-PLS) was used to examine the effect of PA and sports on mental health. The results revealed that both PA ( b = 0.402, p < 0.001) and sports ( b = 0.330, p < 0.001) significantly predict mental health among university students. The model explained 35.8% variance in mental health. The study suggests that PA and sports activity need to be promoted among university students to control prevailing mental health issues in adolescents.

Introduction

Mental health is regarded as the psychological and emotional well-being of a person. It is reflected in the positive functioning in life based on the interaction between social and biological factors ( Chow and Choi, 2019 ; Easterlin et al., 2019 ). The World Health Organization has defined mental health as “a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can make a contribution to his or her community” ( Chow and Choi, 2019 ). However, the study conducted by Pascoe et al. (2020) has highlighted that mental disorders are expected to become a leading reason for causing disability among young people in developed countries. Hence, the promotion of mental health and the prevention of mental disorders is paramount.

Several types of research have indicated that physical activity (PA) and sports play a major role in improving an individual’s mental health at all stages of life ( Biddle et al., 2019 ; Tiaotrakul et al., 2019 ; Tamminen et al., 2020 ; Teychenne et al., 2020 ). PA can be spontaneous (leisure, work, or transport) or organized (physical exercise). Main purpose of physical exercise is to improve the health and physical capacity of an individual. The bio-psychosocial (BPS) model confirms that PA and exercise are among the best coping strategies for mental health problems ( Di Benedetto et al., 2010 ; Di Benedetto, 2015 ; Poirel, 2017 ). Physical training is concentrated towards increasing maximum performance and capacity. On the other hand, physical inactivity is a sedentary behavior in which body movement is absent. Physical inactivity leads to increased risk of poor health, which can affect the well-being of an individual ( Malm et al., 2019 ).

Sports is another important activity that contributes to the mental health of youth. The importance of sports among the students is valuable and goes beyond PA. The stress level of college students is higher than the other age groups, which can adversely affect their mental health. Stress is usually caused by academic pressures, which can lead to terrible effects and further results in future failure. However, sports has played a drastic role in reducing the students’ stress levels and increasing happiness and psychological well-being ( Judge, 2018 ).

Malaysian students have been particularly observed to have poor mental health. The COVID-19 pandemic had a further adverse effect on mental health of individuals leading to stress and depression. It has limited the gatherings for PA and sports. During the pandemic, 30% of Malaysian people aged 16 years or older were having mental health issues ( Kotera et al., 2021 ). Furthermore, the youth increased their internet usage due to the protective measures of COVID-19, such as lockdown and social distancing. As a result of high internet usage, health anxiety of the youth is increased ( Khodabakhsh et al., 2021 ). Due to the increasing concern of mental health issues among Malaysia’s youth and the consequences that would endanger the future of the youth and country, it is critical to formulate effective strategies for controlling the prevalence of mental health issues. In this regard, the following research is conducted to evaluate the effectiveness of PA and sports on mental health. This also provides an opportunity to fill the literature gap by studying how PA and sports can positively influence youth’s mental health in Malaysia, as there is no recent study conducted in this context. The significance of this research lies in aiding the government and educational institutes in developing intervention programs based on PA and sports for improving the mental health of the youth in Malaysia.

Literature review

Mental health is an important area of research where scholars and researchers prioritize enhancing health and achieving equity in health for the entire people throughout the globe ( Castillo et al., 2019 ). Mental health is defined as a state in which the individual can realize his/her capabilities while also coping with the normal stress of life and can work productively. Mental health comprises multiple cognitive and affective components, including happiness, enjoyment and pleasure, and having a purpose, meaning and fulfilment ( Silove et al., 2017 ; Bratman et al., 2019 ). However, a major concern for mental health is mental illness, which reflects the occurrence of cognitive, affective and behavior problems. Therefore, there is an increased attention to research towards preventing mental illness that can adversely affect mental health ( Arango et al., 2018 ; Bratman et al., 2019 ).

Furthermore, the importance of preventing the mental health problems has become critical across the globe during the COVID-19 pandemic. World health organization has reported a great concern regarding mental health and psychological consequences of the pandemic ( Kumar and Nayar, 2021 ). An increased rate in mental illness has been reported in developing countries. Mental health professionals and psychologists have speculated that the pandemic is likely to further impact mental health of the people where the cases of depression, self-harm, suicide would increase. Kotera et al. (2021) have highlighted that the youth, particularly university students, face poor mental health, resulting in a negative attitude. The researchers estimated that around 30% of the people aged 16 years or orders are faced with mental health issues. In addition to this, the research conducted by Khodabakhsh et al. (2021) also demonstrated that the COVID-19 pandemic has a major influence on the mental health of individuals resulting in stress and depression. Furthermore, due to lockdown and other protective protocols, the youth in Malaysia is increasingly using internet where it is expected to increase health anxiety and lover PA.

Physical activity is considered an important predictor of health, especially among the youth ( Júdice et al., 2017 ) and is used as a preventive measure against mental illness. PA is defined as the bodily movement by the skeletal muscles that requires the expenditure of energy. PA is reported to have an antidepressant influence on individuals. Exercise is a subset of the PA which is a planned and structured activity for enhancing physical fitness that involves running or weight training. Furthermore, PA also has psychological benefits that may positively influence mental health ( Kandola et al., 2019 ; Ozemek et al., 2019 ). Based on the BPS model ( Di Benedetto et al., 2010 ; Di Benedetto, 2015 ), numerous empirical studies ( McDowell et al., 2017 ), and systematic reviews ( Mikkelsen et al., 2017 ; Stubbs et al., 2017 ) confirm PA as a predominant predictor of mental health. Therefore, PA is reflected as a key strategy for improving the individual’s mental health and well-being benefits. PA comprises structured, supervised exercise programs, active commuting, domestic activities, and leisure physical activities ( Rebar and Taylor, 2017 ). Regular PA is a key health behavior from the public health perspective due to its remarkable effect on health. PA has the potential to prevent mental health disorders and issues that comprise depression and anxiety. Several studies were conducted on the benefits of PA on mental health during COVID-19 ( Callow et al., 2020 ; Lesser and Nienhuis, 2020 ; Shahidi et al., 2020 ). The studies highlighted the importance of PA during the COVID-19 quarantine, where the activity appears to have an antidepressant and anxiolytic effect. However, these studies did not recruit young people in Malaysia. Therefore, based on the literature analysis and the gap, the following hypothesis is developed based on PA.

H1: Physical activity has a significant and positive influence on the mental health of youth.

Sports is reflected as another preventive strategy for mental health problems. It is defined by athletic games institutionalized in several ways. Sports is a game that involves physical exertion and skills in which an individual or a team competes for entertainment ( Jukic et al., 2020 ). However, the study conducted by Malm et al. (2019) has demonstrated that although sports enhances the physical as well as the psychological health of individuals, it may adversely affect mental health due to the risk of injury, burnout, and eating disorders. The negative impact is commonly observed among the elite players as they are required to perform at maximum to get the desired outcomes. As a result, this can cause a negative effect on the mental health of the elite-level players. On the other hand, Eigenschenk et al. (2019) indicated that outdoor sports can create positive benefits for mental health as it can cure the mental health problems. Furthermore, engagement in sports positively affects general health and psychological ability by increasing well-being, improving quality of life, and enhancing happiness and life satisfaction. Therefore, based on the literature analysis and the gap, the following hypothesis is developed:

H2: Sports has a significant and positive influence on the mental health of youth.

Siefken et al. (2019) evaluated the association between leisure-time PA, anxiety and depression. The study was conducted through a questionnaire survey distributed among the athletes across the globe in which total number of completed surveys was 682. The findings from the research indicated that individuals who met the recommended levels of sports and PA reported lower scores on depression. Furthermore, the lowest depression and anxiety scores were identified among the indoor team athletes. Bell et al. (2019) studied the interrelation between PA, mental well-being and symptoms of mental disorders among young British adolescents. The multivariable regression analysis indicated no strong evidence as to whether PA is connected with better health and well-being. Reigal et al. (2021) examine the interconnection between PA, mood states, and self-rated health in Spain. The results indicated that PA positively effects mental health by improving perception and mood during pandemic lockdown. The review of the literature shows that there is a clear gap in research on relationship between PA, sports and mental health in Malaysian youth. The previous findings reported during lockdown have shown mixed results. Therefore, it is imperative to explore these constructs among Malaysian youth during COVID-19 pandemic. Figure 1 represents the conceptual framework for the present study, aimed at investigating the influence of PA and sports on mental health of the youth in Malaysia.

Conceptual framework.

Methodology

Participants.

The targeted audience for the questionnaire survey are mainly the adolescents in Malaysia; therefore, the questionnaire is provided to the students that are currently studying in Malaysian universities. The approach for gaining access to the target audience was distributing the questionnaire through the social media platforms such as Facebook, Instagram, and others. The use of the internet has enabled in easily obtaining the data from Malaysian adolescents. As for the sample size, the total number of questionnaires was distributed among 700 adolescents, where 512 participants have provided the complete data. Response rate was 74%. That may be because the study was conducted during COVID-19 pandemic situation in the country, and the universities were not opened. The student may have adopted casual attitude due to study from home. Hence, most of the students did not bother responding the survey. Characteristics of participants are given in table below (see Table 1 ).

Characteristics of participants.

Instruments

To investigate the role of PA and sports on mental health, the researchers have designed a survey used in the previous research ( Snedden et al., 2019 ; Appelqvist-Schmidlechner et al., 2020 ).

The measure of mental health contained four items: I’ve been feeling optimistic about the future,” “I’ve been feeling relaxed,” “I’ve been dealing with problems well,” and “I’ve been able to make up my own mind about things.” Initially, there were seven items out of which 3 were eliminated during validation process. The items were rated on a 5-point Likert scale from 1 (none of the time) to 5 (all of the time) ( Appelqvist-Schmidlechner et al., 2020 ).

For PA, self-reported leisure time PA was determined from responses to a single question. Think of the last 3 months and consider all leisure-time PA that lasted at least 20 min per session, and answer: “Which of the following definitions best describes your leisure time PA habits?” Initially, there were 6 response categories which were changed to 4 in the current study: 1 = less than once a week, 2 = no vigorous activities, but light or moderate PA at least once a week, 3 = brisk PA once a week, and 4 = vigorous activity at least four times a week. For further analysis, responses were binned into four categories indicating inactive (response 1), low (response 2), medium (responses 3), and high (response 4) leisure time PA ( Fogelholm et al., 2006 ; Appelqvist-Schmidlechner et al., 2020 ).

Further, Self-assessed sport activity level was measured through four items adapted from previous study ( Snedden et al., 2019 ). The students were asked to report their “athletic activities and daily work out” rated on 5-point Likert scale from 1 (do not perform at all) to 5 (perform daily). All tools were validated before use in Malaysian setting. The results of validation process are given in the results section.

Analysis techniques

The analysis of the gathered data is mainly conducted through statistical analysis with the support of the statistical software, SmartPLS. The process for using the SmartPLS was first to convert the questionnaire data to numerical values and was further coded to SmartPLS for generating results. There are mainly two techniques that are applied from software for revealing the results and findings. The first technique applied with the software is the confirmatory factor analysis, also referred to as CFA. The technique aims to evaluate the validity and reliability of the dataset in which the reliability and convergent validity are assessed along with the evaluation of the discriminant validity. The second technique applied is structural equation modelling, in which the cause and effect of the identified variables are assessed.

Descriptive statistics and correlation among study variables

Table 2 presents descriptive statistics and correlation among study variables. It is shown that there is strong positive association among all study variables. However, the mean level of PA is higher than that of sport activity.

Descriptive statistics and correlation among study variables.

Reliability and validity

In the structural equation model and partial least square (SEM-PLS), it is deemed a prerequisite to determine the reliability and validity of the constructs. In an empirical study, multiple constructs are used to measure the concepts and theories to be tested, and each of the constructs has different components or indicators representing the construct. For instance, the first construct of the study was the measurement of mental health, which has four indicators, and similarly, PA and sports activity are two different constructs with four indicators each. In such a setting, scholars ( Amaro et al., 2015 ; Hair et al., 2017 ) have been using the outer loadings, also known as factor loadings, which indicates the variance being predicted each indicator. As per Hair et al. (2017) , the factor loading value needs to be greater than 0.7 to confirm the significant contribution of the factor that it sufficiently contributes to the construct to measure the concept. However, if the factor loading value remains below the given threshold, the indicator has been dropped from within the construct since its presence does not contribute significantly. Similarly, Table 3 , which depicts the indicators along with the factor loadings, shows that all indicators within the study have factor loading greater than 0.7, suggesting that all indicators contribute sufficiently to the constructs, and all indicators can be retained within the model.

Factor loading, reliability, and validity.

Furthermore, the reliability and validity of the constructs have also been determined within the study. In accordance with the definition of Janadari et al. (2016) , reliability refers to the internal consistency within the responses gathered through the construct, and validity refers to the extent to which a construct measures for what it has been designed to measure. To further explore, the opinion of Akter et al. (2017) can be presented where authors have stated that reliability reveals the effectiveness of the construct that whether the constructs used in the survey are producing consistent results or not? It means does it work in an intended way or not? In addition, the concept of validity is also referred to as convergent validity, which represents the extent to which constructs that must be related are related. Meanwhile, Hair et al. (2017) shed light on the convergent validity as that it tells do indicators within the constructed measure the same thing which it must measure actually.

For reliability of the constructs, two empirical techniques have been used; Cronbach’s alpha and composite reliability. Both techniques are being used to assess the internal consistency within the responses to see if constructs produce similar results. Meanwhile ( Hair et al., 2017 ), state that for constructs to be labelled as reliable, the alpha value needs to be above 0.7 in Cronbach’s alpha and Composite reliability results. However, to determine the compliance of constructs with the convergent validity, average variance extracted (AVE) has been used as a technique. Amaro et al. (2015) deem its prerequisite for assuming convergent validity that the AVE needs to be greater than 0.5. Table 2 reveals that Cronbach’s alpha and value of composite reliability are greater than the suggested threshold of 0.7 indicating that there is internal consistency within the responses, which supports the statement that constructs have produced consistent results and have worked in a way they were designed. Similarly, referring to convergent validity, the AVE for all constructs remains greater than 0.5, which supports the statement that constructs which must have been related are related.

The analysis of CFA reveals that the data used in the following study is reliable and valid to be used for further study, and it would also produce valid and consolidated unbiased results.

Discriminant validity

Discriminant validity is a technique to determine how many constructs are accurate in conceptual measurement. Hence, to confirm the accuracy of these measures, the concept of discriminant validity has been applied, which determines the extent to which the constructs that should not be related must be unrelated. To further explore the concept of discriminant validity, Hair et al. (2017) sheds light that a construct measures a unique concept or theory and, in this way, each of the measurements of the construct should be distinct and must not be related. In this regard, Heterotrait-Monotrait (HTMT) ratio has been used to determine the conceptual accuracy of the constructs and result are illustrated in Table 4 .

Discriminant validity.

In accordance with the study conducted by Hair et al. (2017) , it is deemed a prerequisite that the value of the HTMT ratio needs to be below the threshold of 0.9 to confirm compliance with the discriminant validity. Meanwhile, the value of ratio as illustrated in Table 1 also meets the criteria outlined by the authors, which confirms that there is also discriminant validity.

Model specification

In empirical models, the focus of scholars’ remains with the coefficient of determination which is also referred to as R 2 , indicating the predictive strength of the model. The model of the study is depicted in Figure 1 .

In the current model, the R 2 remains to be 0.358 suggesting that 35.8% variance of mental health has been estimated by PA and sports activity, citing that 74.2% variance remains residual of the empirical model (see Table 5 ). This implies that residual can be estimated, or the predictive power of the existing model can be strengthened by the inclusion of other factors and variables into the model. In addition, the adjusted R 2 is 0.356, which is less than R 2 and supports the statement that inclusion of the factors and variables would further improve the model’s predictive power.

Model specification.

Path coefficients

Table 6 provides the path coefficients, where it is evident that one unit of the change into the PA and sports activity will also bring a change of 0.402 [ P value 0.000] and 0.330 [ P value 0.000], respectively. This suggests a positive and statistically significant impact of PA on the mental health of youth in Malaysia, and this implies that prevalence of PA among the youth can be one of the important factors to keep them away from mental health issues. Similarly, the effect of sports activity on mental health has also been found positive and statistically significant, suggesting that the involvement of the youth in sports can help them overcome mental health issues. As a result, the study’s hypotheses are accepted that PA and sports activity have a significant and positive impact on the youth’s mental health in Malaysia. Therefore, it can be asserted that PA and sports activity needs to be promoted among the university students of Malaysia in order to control prevailing mental health issues within the youth and secure a better future for the generations to come.

Path coefficient.

Contributing to the literature, the current study validates a conceptual model reflecting the association of PA and sports with students’ mental health. The hypothetical model in our study suggests the importance of a theoretical framework predicting mental health in students. Further, our research shows novelty for authenticating BPS model in Malaysian setting.

The findings presented that PA was positively associated with mental health of students. Past research exhibited the similar results regarding the link of PA with mental health of university students in different cultures ( Kayani et al., 2020a , b , 2021 ). BPS model of Di Benedetto also confirms the positive association of exercise and mental health ( Di Benedetto et al., 2010 ; Di Benedetto, 2015 ). Moreover, PA has been shown to have an antidepressant effect, implying that it can be used as a mental health prevention strategy ( Kandola et al., 2019 ). Moreover, Kandola et al. (2019) also argues that PA offers mental health benefits that may positively impact mental health. Furthermore, Clough et al. (2016) claimed that engaging in 15 min of PA every day reduces the risk of sadness and anxiety by 26%. Adopting a regular fitness routine lowers the chances of relapsing. PA generates various favorable changes in the brain, making it a reliable therapeutic for psychiatric illnesses. The generation of endorphins contributes to a sense of relaxation and well-being. These activities also diverge negative emotions and other factors that contribute to depression and stress. That is, PA significantly enhances mental well-being among students.

Furthermore, the study has found sport performance positively predicted mental health. In association with previous research ( Kayani et al., 2020a , b , 2021 ), increased sport and exercise enhances psychological well-being. In addition, sports are represented in another mental health prevention plan, where they are described as athletic games that are organized in various ways. Jukic et al. (2020) stated that sports involve physical effort and talent in which individuals or teams compete against one another for enjoyment. Eigenschenk et al. (2019) has indicated that outdoor activities provide good advantages for mental health through curing mental health issues. By promoting well-being, improving life, and boosting pleasure and life happiness, participation in sports has a favorable influence on overall health and mental ability. In addition, Siefken et al. (2019) conducted a study to see if sports impact mental health and analyze the link between leisure-time physical exercise and depression and anxiety. In sum, the study provides evidence for the importance of PA and sport participation in Malaysian society. Apart from this, the study portrays unidirectional relationships among all study variables. Two way associations are hence recommended to get more insight into the study variables.

Research implications

The study’s findings imply that regular PA and sport performance would contribute positively towards mental well-being. These findings are in agreement with the BPS model ( Di Benedetto, 2015 ) in relating exercise PA with mental health. The current study provides significant piece of knowledge portraying PA and sport as protective factor for mental health issues in the context of Malaysian university students.

The study also contains practical implications. The study has called our attention to the importance of PA and sport in promoting mental well-being among university students. The current research has identified that PA and sport play a valuable role in enhancing mental health of students. Therefore, the results suggest encouraging physical activities and sport performance among university students in mental health promotion and intervention initiatives. The research also recommends that institutions may consider teachers’ professional development in the domain of encouraging PA and sport participation. Future research in other cultures with the combination of other contributing factors affecting mental health may assist to better understanding of the phenomenon. Further intervention studies aiming at the promotion of well-being through a PA and sport could be taken into consideration.

Limitations and future research directions

This research describes several significant practical and theoretical implications, but some limitations need to be addressed in upcoming studies. For instance, this research has tested the model based on empirical evidence, which might be criticized for common method bias. Therefore, we suggest a qualitative approach and an in-depth interview to be conducted in future studies. Another limitation is that the research has been conducted in Malaysia by collecting data online from only one region of the country. This might cause sampling bias, and the results might not be generalized to other parts of the country. To get more generalizable results, samples from other cities and provinces of Malaysia may also be taken for future research. Further, the research is based on self-report measures, which may lead to inflated relationships. Future research could be conducted with experimental designs. Moreover, the sample in the present research is a relatively homogenous group of university students. Taking the heterogeneous sample may generate different findings.

In addition, the teachers, educationists and health practitioners should take the importance of PA and sport to promote mental well-being among university students. A recent study has provided a qualitative approach to develop PA leaders using a contemplative education approach to promote wellness among the elderly ( Tiaotrakul et al., 2019 ). The same approach could also be adopted for training the leaders guiding students to perform PA and sport.

This study reports on research on the effect of PA and sport activity on mental health of Malaysian university student. Underpinning this research was the BPS model of exercise, mental and physical health. This study’s research model was based on the evidence gathered from 512 students enrolled in different disciples of in Malaysian universities. After analyzing data in the structural model using PLS, we found that both PA and sport activity significantly predicted mental health of university students. However, the magnitude of the effect size of PA is more than sport performance. Therefore, our findings revealed that PA and sport performance contribute to sound mental health in Malaysian context. The research suggested that students who participate in PA and sport would have better mental health.

Data availability statement

Ethics statement.

The studies involving human participants were reviewed and approved by Shaanxi Normal University. The patients/participants provided their written informed consent to participate in this study.

Author contributions

LC wrote the original draft. SK helped in method and data analysis. AK did critical analysis and edited the manuscript. All authors contributed to the article and approved the submitted version.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

• Akter S., Fosso Wamba S., Dewan S. (2017). Why PLS-SEM is suitable for complex modelling? An empirical illustration in big data analytics quality . Prod. Plan. Control 28 , 1011–1021. doi: 10.1080/09537287.2016.1267411 [ CrossRef ] [ Google Scholar ]
• Amaro S., Abrantes J. L., Seabra C. (2015). Comparing CB-SEM and PLS-SEM results: an empirical example . The Conference for PLS Users. (Sevilla: University of Twente; ), 1–7. [ Google Scholar ]
• Appelqvist-Schmidlechner K., Vaara J. P., Vasankari T., Häkkinen A., Mäntysaari M., Kyröläinen H. (2020). Relationship between different domains of physical activity and positive mental health among young adult men . BMC Public Health 20 , 1–10. doi: 10.1186/s12889-020-09175-6 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Arango C., Díaz-Caneja C. M., McGorry P. D., Rapoport J., Sommer I. E., Vorstman J. A., et al.. (2018). Preventive strategies for mental health . Lancet Psychiatry 5 , 591–604. doi: 10.1016/S2215-0366(18)30057-9 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bell S. L., Audrey S., Gunnell D., Cooper A., Campbell R. (2019). The relationship between physical activity, mental well-being and symptoms of mental health disorder in adolescents: a cohort study . Int. J. Behav. Nutr. Phys. Act. 16 , 1–12. doi: 10.1186/s12966-019-0901-7 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Biddle S. J., Ciaccioni S., Thomas G., Vergeer I. (2019). Physical activity and mental health in children and adolescents: an updated review of reviews and an analysis of causality . Psychol. Sport Exerc. 42 , 146–155. doi: 10.1016/j.psychsport.2018.08.011 [ CrossRef ] [ Google Scholar ]
• Bratman G. N., Anderson C. B., Berman M. G., Cochran B., De Vries S., Flanders J., et al.. (2019). Nature and mental health: an ecosystem service perspective . Sci. Adv. 5 :eaax0903. doi: 10.1126/sciadv.aax0903, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Callow D. D., Arnold-Nedimala N. A., Jordan L. S., Pena G. S., Won J., Woodard J. L., et al.. (2020). The mental health benefits of physical activity in older adults survive the COVID-19 pandemic . Am. J. Geriatr. Psychiatry 28 , 1046–1057. doi: 10.1016/j.jagp.2020.06.024, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Castillo E. G., Ijadi-Maghsoodi R., Shadravan S., Moore E., Mensah M. O., Docherty M., et al.. (2019). Community interventions to promote mental health and social equity . Curr. Psychiatry Rep. 21 , 1–14. doi: 10.1007/s11920-019-1017-0 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Chow S. K. Y., Choi E. K. Y. (2019). Assessing the mental health, physical activity levels, and resilience of today’s junior college students in self-financing institutions . Int. J. Environ. Res. Public Health 16 :3210. doi: 10.3390/ijerph16173210, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Clough P., Houge Mackenzie S., Mallabon L., Brymer E. (2016). Adventurous physical activity environments: a mainstream intervention for mental health . Sports Medicine 46 , 963–968. [ PubMed ] [ Google Scholar ]
• Di Benedetto M. (2015). A bio-psychosocial model of health status: an integrated approach to physical and mental health . Australia: RMIT University. [ Google Scholar ]
• Di Benedetto M., Len Burns G., Lindner H., Kent S. (2010). A biopsychosocial model for depressive symptoms following acute coronary syndromes . Psychol. Health 25 , 1061–1075. doi: 10.1080/08870440903019535, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Easterlin M. C., Chung P. J., Leng M., Dudovitz R. (2019). Association of team sports participation with long-term mental health outcomes among individuals exposed to adverse childhood experiences . JAMA Pediatr. 173 , 681–688. doi: 10.1001/jamapediatrics.2019.1212, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Eigenschenk B., Thomann A., McClure M., Davies L., Gregory M., Dettweiler U., et al.. (2019). Benefits of outdoor sports for society. A systematic literature review and reflections on evidence . Int. J. Environ. Res. Public Health 16 :937. doi: 10.3390/ijerph16060937, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fogelholm M., Malmberg J., Suni J., Santtila M., Kyrolainen H., Mantysaari M., et al.. (2006). International physical activity questionnaire: validity against fitness . Med. Sci. Sports Exerc. 38 , 753–760. doi: 10.1249/01.mss.0000194075.16960.20 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hair J. F., Jr., Matthews L. M., Matthews R. L., Sarstedt M. (2017). PLS-SEM or CB-SEM: updated guidelines on which method to use . Int. J. Multivar. Data Anal. 1 , 107–123. doi: 10.1504/IJMDA.2017.087624 [ CrossRef ] [ Google Scholar ]
• Janadari M., Sri Ramalu S., Wei C., Abdullah O. (2016). “ Evaluation of measurement and structural model of the reflective model constructs in PLS–SEM ,” in Proceedings of the 6th International Symposium—2016 South Eastern University of Sri Lanka (SEUSL), Oluvil, Sri Lanka.
• Judge J. (2018). Stress, happiness and psychological well-being among college students: role of sports in mental health . Int. J. Phys. Educ. Sports Health 5 , 22–25. [ Google Scholar ]
• Júdice P. B., Silva A. M., Berria J., Petroski E. L., Ekelund U., Sardinha L. B. (2017). Sedentary patterns, physical activity and health-related physical fitness in youth: a cross-sectional study . Int. J. Behav. Nutr. Phys. Act. 14 , 1–10. doi: 10.1186/s12966-017-0481-3 [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Jukic I., Calleja-González J., Cos F., Cuzzolin F., Olmo J., Terrados N., et al.. (2020). Strategies and solutions for team sports athletes in isolation due to COVID-19 . Vol . 8 . MDPI, 56. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kandola A., Ashdown-Franks G., Hendrikse J., Sabiston C. M., Stubbs B. (2019). Physical activity and depression: towards understanding the antidepressant mechanisms of physical activity . Neurosci. Biobehav. Rev. 107 , 525–539. doi: 10.1016/j.neubiorev.2019.09.040, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kayani S., Kiyani T., Kayani S., Morris T., Biasutti M., Wang J. (2021). Physical activity and anxiety of Chinese university students: mediation of self-system . Int. J. Environ. Res. Public Health 18 :4468. doi: 10.3390/ijerph18094468, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kayani S., Wang J., Biasutti M., Zagalaz Sánchez M. L., Kiyani T., Kayani S. (2020a). Mechanism between physical activity and academic anxiety: evidence from Pakistan . Sustainability 12 :3595. doi: 10.3390/su12093595 [ CrossRef ] [ Google Scholar ]
• Kayani S., Wang J., Kayani S., Kiyani T., Qiao Z., Zou X., et al.. (2020b). Self-system mediates the effect of physical activity on students’ anxiety: a study from Canada . Asia Pac. Educ. Res. 30 , 1–15. doi: 10.1007/s40299-020-00530-0 [ CrossRef ] [ Google Scholar ]
• Khodabakhsh S., Ramasamy S., Teng T. Y., Leng C. S. (2021). Impact of internet addiction on health anxiety in Malaysian youth during COVID-19 pandemic . MJMR 5 , 12–18. doi: 10.31674/mjmr.2021.v05i02.003 [ CrossRef ] [ Google Scholar ]
• Kotera Y., Ting S.-H., Neary S. (2021). Mental health of Malaysian university students: UK comparison, and relationship between negative mental health attitudes, self-compassion, and resilience . High. Educ. 81 , 403–419. doi: 10.1007/s10734-020-00547-w [ CrossRef ] [ Google Scholar ]
• Kumar A., Nayar K. R. (2021). COVID 19 and its mental health consequences . Vol . 30 . Taylor & Francis, 1–2. [ PubMed ] [ Google Scholar ]
• Lesser I. A., Nienhuis C. P. (2020). The impact of COVID-19 on physical activity behavior and well-being of Canadians . Int. J. Environ. Res. Public Health 17 :3899. doi: 10.3390/ijerph17113899, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Malm C., Jakobsson J., Isaksson A. (2019). Physical activity and sports—real health benefits: a review with insight into the public health of Sweden . Sports 7 :127. doi: 10.3390/sports7050127, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McDowell C. P., MacDonncha C., Herring M. P. (2017). Brief report: associations of physical activity with anxiety and depression symptoms and status among adolescents . J. Adolesc. 55 , 1–4. doi: 10.1016/j.adolescence.2016.12.004, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mikkelsen K., Stojanovska L., Polenakovic M., Bosevski M., Apostolopoulos V. (2017). Exercise and mental health . Maturitas 106 , 48–56. doi: 10.1016/j.maturitas.2017.09.003 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ozemek C., Lavie C. J., Rognmo Ø. (2019). Global physical activity levels-need for intervention . Prog. Cardiovasc. Dis. 62 , 102–107. doi: 10.1016/j.pcad.2019.02.004 [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pascoe M., Bailey A. P., Craike M., Carter T., Patten R., Stepto N., et al.. (2020). Physical activity and exercise in youth mental health promotion: a scoping review . BMJ Open Sport Exerc. Med. 6 :e000677. doi: 10.1136/bmjsem-2019-000677, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Poirel E. (2017). Bienfaits psychologiques de l'activité physique pour la santé mentale optimale psychological benefits of physical activity for optimal mental health . Sante Ment. Que. 42 , 147–164. doi: 10.7202/1040248ar, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Rebar A. L., Taylor A. (2017). Physical activity and mental health; it is more than just a prescription . Ment. Health Phys. Act. 13 , 77–82. doi: 10.1016/j.mhpa.2017.10.004 [ CrossRef ] [ Google Scholar ]
• Reigal R. E., Páez-Maldonado J. A., Pastrana-Brincones J. L., Morillo-Baro J. P., Hernández-Mendo A., Morales-Sánchez V. (2021). Physical activity is related to mood states, anxiety state and self-rated health in COVID-19 lockdown . Sustainability 13 :5444. doi: 10.3390/su13105444 [ CrossRef ] [ Google Scholar ]
• Shahidi S. H., Williams J. S., Hassani F. (2020). Physical activity during COVID-19 quarantine . Acta Paediatr. 109 , 2147–2148. doi: 10.1111/apa.15420, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Siefken K., Junge A., Laemmle L. (2019). How does sport affect mental health? An investigation into the relationship of leisure-time physical activity with depression and anxiety . Hum. Mov. 20 , 62–74. doi: 10.5114/hm.2019.78539 [ CrossRef ] [ Google Scholar ]
• Silove D., Ventevogel P., Rees S. (2017). The contemporary refugee crisis: an overview of mental health challenges . World Psychiatry 16 , 130–139. doi: 10.1002/wps.20438, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Snedden T. R., Scerpella J., Kliethermes S. A., Norman R. S., Blyholder L., Sanfilippo J., et al.. (2019). Sport and physical activity level impacts health-related quality of life among collegiate students . Am. J. Health Promot. 33 , 675–682. doi: 10.1177/0890117118817715, PMID: [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Stubbs B., Koyanagi A., Hallgren M., Firth J., Richards J., Schuch F., et al.. (2017). Physical activity and anxiety: a perspective from the world health survey . J. Affect. Disord. 208 , 545–552. doi: 10.1016/j.jad.2016.10.028, PMID: [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Tamminen N., Reinikainen J., Appelqvist-Schmidlechner K., Borodulin K., Mäki-Opas T., Solin P. (2020). Associations of physical activity with positive mental health: a population-based study . Ment. Health Phys. Act. 18 :100319. doi: 10.1016/j.mhpa.2020.100319 [ CrossRef ] [ Google Scholar ]
• Teychenne M., White R. L., Richards J., Schuch F. B., Rosenbaum S., Bennie J. A. (2020). Do we need physical activity guidelines for mental health: what does the evidence tell us? Ment. Health Phys. Act. 18 :100315. doi: 10.1016/j.mhpa.2019.100315 [ CrossRef ] [ Google Scholar ]
• Tiaotrakul A., Koeipakvaen T., Sertbudra P. (2019). The development of physical activity leaders using a contemplative education approach to promote wellness among the elderly . PSAKU Int. J. Interdiscip. Res. 8 , 180–190. doi: 10.2139/ssrn.3547090 [ CrossRef ] [ Google Scholar ]

Sport and Competition

Why athletes are turning to sports psychiatrists for success, why more athletes are seeking sports psychiatrists for a competitive edge..

Posted May 18, 2024 | Reviewed by Ray Parker

• Sports psychiatrists build athletes' mental resilience—crucial for handling high-pressure situations.
• They enhance focus through mindfulness and cognitive strategies, boosting athletic performance.
• Effective stress management helps athletes handle performance anxiety and set healthy boundaries.
• Sports psychiatrists support mental health during injury recovery, aiding emotional and psychological healing.

The world of sports is competitive and incredibly time-consuming. Athletes are held to a high standard and have several responsibilities when it comes to preparing for competition and performing well on game day. Many elite athletes have spoken out recently in the news about their mental health struggles and the resources that they wish had been available to them. Nowadays, athletes are seeking a competitive edge to excel in their performance, leading more athletes to see the value in working with mental health professionals.

Sports and performance psychiatrists are psychiatrists with additional training in the diagnosis, treatment, and prevention of mental health conditions in athletes. This subspecialty of psychiatry truly understands the unique psychological pressures and stressors faced by elite athletes. When sports psychiatrists work with teams and organizations, they often provide comprehensive services, such as substance misuse prevention, stress control, crisis intervention, sleep and energy management , injury recovery management, mental preparation, and mental health condition treatments. 1 In addition, sports psychiatrists can also work with individuals

Here are 5 reasons why working with a sports and performance psychiatrist can be the secret weapon to excelling in sports:

1. Increased Mental Toughness and Resilience : Sports psychiatrists help athletes build mental resilience by working with them to optimize their mental health and overall well-being. This ultimately leads to being able to handle high-pressure situations during competition effectively. In addition, when athletes face setbacks, sports psychiatrists can help them bounce back and return to play more effectively. Building resilience is essential to the mental component of training.

2. Enhanced Focus and Concentration : Sports psychiatrists are able to teach techniques that ultimately lead to more effective concentration and focus, enabling athletes to excel in their sport. These skills can include mindfulness , meditation , and cognitive behavioral strategies. To unlock peak performance , athletes must be able to stay present and focus on the game in front of them.

3. Effective Stress Management: Being an athlete comes with many demands and expectations, yet there is often not mandatory mental training like there is for physical training in several sporting teams. Sports psychiatrists can help athletes navigate certain stressors, such as performance anxiety , and both set boundaries and manage expectations for those around them.

4. Support During Injury Recovery: When an athlete experiences an injury, it’s not only difficult from a physical standpoint, but it’s oftentimes emotionally challenging as well. Sports psychiatrists are essential in providing mental health support during injury recovery and assessing progress from a psychological standpoint during the duration of an athlete’s rehabilitation. Sports psychiatrists can provide medication management, if indicated, when an athlete’s injury leads to clinical diagnoses, such as depression or anxiety. Oftentimes, anxiety after an injury surrounds fear of reinjury and fear of not being able to return to play with the same skill level as before the injury.

5. Treatment of Mental Health Conditions: Athletes are certainly not immune to mental health conditions and have similar rates of depression and anxiety as the general population. Sports psychiatrists are essential in assessing, diagnosing, and treating mental health conditions in athletes. By working with sports psychiatrists, athletes may be able to uncover issues that were previously holding them back, further propelling them into their athletic careers.

Sports and performance psychiatrists play an essential role in not only the diagnosis, treatment, and education of mental health conditions in elite athletes but also in helping train athletes from a mental standpoint to accelerate their growth to reach their potential.

1. McDuff DR, Garvin M. Working with sports organizations and teams. Int Rev Psychiatry. 2016 Dec;28(6):595-605. doi: 10.1080/09540261.2016.1212820. Epub 2016 Aug 9. PMID: 27686114.

Brook Choulet, M.D., is a board-certified psychiatrist who helps high-achieving professionals, athletes, and their children optimize their mental health and enhance their performance.

• Find a Therapist
• Find a Treatment Center
• Find a Psychiatrist
• Find a Support Group
• Find Online Therapy
• International
• New Zealand
• South Africa
• Switzerland
• Asperger's
• Bipolar Disorder
• Chronic Pain
• Eating Disorders
• Passive Aggression
• Personality
• Goal Setting
• Positive Psychology
• Stopping Smoking
• Low Sexual Desire
• Relationships
• Child Development
• Self Tests NEW
• Therapy Center
• Diagnosis Dictionary
• Types of Therapy

At any moment, someone’s aggravating behavior or our own bad luck can set us off on an emotional spiral that threatens to derail our entire day. Here’s how we can face our triggers with less reactivity so that we can get on with our lives.

• Emotional Intelligence
• Gaslighting
• Affective Forecasting
• Neuroscience

Premium Content

• MIND, BODY, WONDER

Pickleball is everywhere. Here's why the fast-growing sport is good for your health

Once thought of as a backyard sport for retirees, the popular activity actually has several physical and mental benefits for all ages.

Utah business owner Ed Wertz was looking for a way to stay active after his gym closed early in the pandemic. His wife suggested they try pickleball for a date night one evening. “We've played two to three times a week ever since," the 71-year-old says.

The couple join the more than 36 million Americans playing what has become the fastest-growing sport in the United States for three consecutive years.

"In a relatively short time, pickleball has already reached the levels of running, basketball, biking and golf in popularity—and the wide age range of people now playing indicates its growth will likely continue," says Jim Edwards, a physical therapist and rehabilitation manager at Cleveland Clinic Rehabilitation & Sports Therapy in Ohio.

Originating in the United States in 1965 , pickleball is a racquet sport that combines elements of tennis, badminton, and ping pong. Played either one on one (singles) or two on two (doubles) on a 20 x 44-foot court (for comparison, tennis courts are 27 feet wide x 78 feet long), players use a solid ping-pong like paddle to hit a hollow, perforated plastic ball back and forth over a net.

As fun as participants say pickleball is to play, the sport's primary benefit may be that it's good for the body and the mind.

"Pickleball truly is a whole-body workout that improves cardiovascular health, assists with weight loss, and can help with balance, coordination, and flexibility," says Matthew Anastasi, a physician and sports medicine specialist at Mayo Clinic. "It also provides a great opportunity for socialization and can reduce stress and provide mental health benefits."

Once thought of as a leisurely backyard activity for seniors and retirees, data shows the average age of participants is now 35—with younger and younger players joining every year.

For Hungry Minds

"We now have people of all ages engaging in it, including celebrities like Taylor Swift, George Clooney, Leonardo DiCaprio, and Billie Eilish," says Emily Hemendinger, a psychiatrist and outpatient clinical director at the University of Colorado Anschutz Medical Campus. Even star athletes like Patrick Mahomes, Serena Williams, LeBron James, and Tom Brady have publicly touted their love of the sport.

Why pickleball is good for social and mental health

Independent of its trendiness or newfound fame, pickleball provides great social and mental health benefits. For one, because the game is not confined by age or gender, it's known to improve social lives by bringing people of many backgrounds together.

"Men frequently play against women, and kids commonly play with parents and grandparents—dynamics not necessarily seen in other sports or activities, which definitely makes pickleball unique," says Lance Dalleck, an exercise and sports scientist at Western Colorado University.

The regular social interaction that is common to pickleball both while playing and as participants rotate courts and partners is one reason multiple studies show the game reducing feelings of loneliness , decreasing depressive symptoms , and increasing life satisfaction .

"These benefits are especially important among older adults as they are more likely to be isolated and experience depression and anxiety," says Hemendinger.

Indeed, o ne study measured multiple levels of connection among seniors and found that "the highest connection levels occurred in those who played pickleball multiple times a month for at least one year," explains Michael Fredericson, a physician and the director of the Physical Medicine and Rehabilitation division at Stanford University.

The sport also helps with mental agility .

"Pickleball aids cognitive functions such as reaction times, cognitive flexibility, and complex thinking," says Hemendinger. It accomplishes this, she explains, because each fast-paced game requires players to hold multiple concepts at once such as proper positioning and technique, anticipating where the ball or your teammate is going to be, and constantly having to react to your opponent—all while being mindful of server rotation, court rules, and staying on top of a complex scoring system. "You have to keep the big picture and many details in mind in order to be successful," she says.

Despite these layers of focus and concentration; the social, fun, and competitive components of the sport have been shown to help people better manage emotions and stress and anxiety levels.

You May Also Like

Swimming just might be the best exercise out there. Here’s why.

Do you really need 10,000 steps a day? Here’s what the science says.

Walking is the sixth vital sign. Here’s how to do it right.

"We encourage exercise, in part, because it helps to release endorphins and hopefully distracts from the stressors of our lives," explains Edwards. He says pickleball accomplishes these goals and more, "making it a useful tool for improving mental health."

Physical benefits abound

Pickleball's physical benefits are no less compelling.

"Pickleball is a great workout for the whole body as it works both lower and upper extremities," says Hemendinger.

This includes building and toning lower-body muscles like hamstrings, glutes, quadriceps, and calves; plus upper body ones like triceps, pectorals, deltoids, the erector spinae, and all core muscles. Various muscle groups may be affected "every time you run, jump, or move in different directions because each movement promotes positive adaptations throughout bodily structures," says Landon Uetz, an Arizona-based physiotherapist who specializes in treating and coaching pickleball players.

These movements also improve joint and bone health and burn between 200-300 calories per 30-minute game— 36 percent more calories than steadily walking the same amount of time. Pickleball also gets the blood pumping, as research shows that a person's average heart rate during a game qualifies the sport as a moderate-intensity workout, providing "improved cardiorespiratory fitness, lower blood pressure, and a better cholesterol profile," says Dalleck, who co-authored the study.

Edwards also praises pickleball for helping with hand-eye coordination and aiding in neuromuscular communication, better posture, and improved balance. "Eventually we are coordinated enough to hit a dink or a smash, maybe even put some spin on a serve or return shot," he says.

These benefits are especially beneficial in those 65 and older; individuals most affected by lower activity levels as aging occurs. "The combination of aging plus inactivity can accelerate the decline in fitness levels, which can markedly increase the risk for various chronic diseases such as type 2 diabetes and heart disease," explains Dalleck.

His research team investigated this age group specifically and learned that the average senior pickleball participant increased their cardiorespiratory fitness levels by about 12 percent. "This improvement carries important benefits as each 10 percent improvement equates to a 15 percent reduced risk for cardiovascular disease mortality," he explains. It's one reason, he says, "that the middle-aged and older adult populations might potentially have the most to gain by picking up an activity or sport such as pickleball."

Injuries are common

But it isn't all good news as injuries related to the sport do occur and have, unsurprisingly, risen with the growing number of participants. From 2013 through 2022 in the U.S., for instance, "there was a total of 12,021 estimated pickleball injuries," says Fredericson. He says the wrist is the most common injury location, accounting for about 70 percent of needed medical interventions.

Anastasi has treated many pickleball-related injuries, "ranging from simple muscle strains and sprains to lacerations, fractures, and shoulder dislocations, plus everything in between ." To avoid or reduce such issues, he suggests, "players need a relatively good baseline balance, because there is a lot of forward, backward, and lateral movement."

He also recommends wearing proper footwear and encourages players to stretch before and after each game.

And because pickleball involves hitting "a hard polymer ball at speeds up to 30 mph to 40 mph, protective eyewear is recommended,” adds Fredericson.

How to get started

Most community centers and pickleball clubs offer beginner classes and even one-on-one coaching, which is a good place to begin.

( 15 gifts for the pickleball lover in your life )

Wertz advises against buying an expensive paddle until you learn the game and says to be patient with your progress. "Though it has a much shorter learning curve than most sports, it can take a few games to get a handle on things, so never get discouraged if you're struggling—we've all been there."

Uetz suggests practicing a few times and familiarizing yourself with the rules and basic techniques, then showing up at the courts when others are playing to observe and jump in.

"Whether you end up playing for 10 minutes or until the sun goes down," echoes Hemendinger, "you’re likely to get a great workout—both physically and mentally."

Related Topics

• MENTAL HEALTH

8 strategies to make your New Year’s resolutions stick

E-bikes are good for the environment—but what about your health?

Extreme heat can be deadly – here’s how to know if you’re at risk

What lifting weights does to your body—and your mind

How to get high on your own hormones—naturally

• Paid Content
• Environment
• Photography
• Perpetual Planet

History & Culture

• History & Culture
• Mind, Body, Wonder
• Terms of Use
• Privacy Policy
• Your US State Privacy Rights
• Children's Online Privacy Policy
• Interest-Based Ads
• About Nielsen Measurement
• Do Not Sell or Share My Personal Information
• Nat Geo Home
• Attend a Live Event
• Book a Trip
• Inspire Your Kids
• Shop Nat Geo
• Visit the D.C. Museum
• Learn About Our Impact
• Support Our Mission
• Advertise With Us
• Customer Service
• Renew Subscription
• Manage Your Subscription
• Work at Nat Geo
• Sign Up for Our Newsletters
• Contribute to Protect the Planet

Copyright © 1996-2015 National Geographic Society Copyright © 2015-2024 National Geographic Partners, LLC. All rights reserved

The impact of sports participation on mental health and social outcomes in adults: a systematic review and the 'Mental Health through Sport' conceptual model

Affiliations.

• 1 Centre for Active Living and Learning, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. [email protected].
• 2 College of Human and Social Futures, School of Education, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. [email protected].
• 3 Centre for Active Living and Learning, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
• 4 College of Health, Medicine, and Wellbeing, School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
• 5 Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, VIC, 3011, Australia.
• 6 School of Science, Psychology and Sport, Federation University Australia, University Drive, Mount Helen, VIC, 3350, Australia.
• PMID: 37344901
• PMCID: PMC10286465
• DOI: 10.1186/s13643-023-02264-8

Background: Sport is a subset of physical activity that can be particularly beneficial for short-and-long-term physical and mental health, and social outcomes in adults. This study presents the results of an updated systematic review of the mental health and social outcomes of community and elite-level sport participation for adults. The findings have informed the development of the 'Mental Health through Sport' conceptual model for adults.

Methods: Nine electronic databases were searched, with studies published between 2012 and March 2020 screened for inclusion. Eligible qualitative and quantitative studies reported on the relationship between sport participation and mental health and/or social outcomes in adult populations. Risk of bias (ROB) was determined using the Quality Assessment Tool (quantitative studies) or Critical Appraisal Skills Programme (qualitative studies).

Results: The search strategy located 8528 articles, of which, 29 involving adults 18-84 years were included for analysis. Data was extracted for demographics, methodology, and study outcomes, and results presented according to study design. The evidence indicates that participation in sport (community and elite) is related to better mental health, including improved psychological well-being (for example, higher self-esteem and life satisfaction) and lower psychological ill-being (for example, reduced levels of depression, anxiety, and stress), and improved social outcomes (for example, improved self-control, pro-social behavior, interpersonal communication, and fostering a sense of belonging). Overall, adults participating in team sport had more favorable health outcomes than those participating in individual sport, and those participating in sports more often generally report the greatest benefits; however, some evidence suggests that adults in elite sport may experience higher levels of psychological distress. Low ROB was observed for qualitative studies, but quantitative studies demonstrated inconsistencies in methodological quality.

Conclusions: The findings of this review confirm that participation in sport of any form (team or individual) is beneficial for improving mental health and social outcomes amongst adults. Team sports, however, may provide more potent and additional benefits for mental and social outcomes across adulthood. This review also provides preliminary evidence for the Mental Health through Sport model, though further experimental and longitudinal evidence is needed to establish the mechanisms responsible for sports effect on mental health and moderators of intervention effects. Additional qualitative work is also required to gain a better understanding of the relationship between specific elements of the sporting environment and mental health and social outcomes in adult participants.

Keywords: Adults; Experimental; Mental health; Model; Observational; Psychological health; Review; Social health; Sport.

© 2023. The Author(s).

Publication types

• Systematic Review
• Exercise / psychology
• Mental Health*

Media Center 5/17/2024 1:00:00 PM Saquandra Heath

Sports betting culture negatively impacts mental health; NCAA works to support student-athletes

Imagine playing a sport you love, giving it your all in every game. In addition, you're balancing your academic studies as you pressure yourself to succeed in the classroom and on the field. If that weren't enough pressure, you also have strangers harassing you via social media, spouting abusive threats because they've lost money based on your performance or that of your team. 

It's a mental health nightmare.

Harassment related to sports betting can cause serious harm to student-athlete mental health and well-being. The NCAA is doing more than ever to address the rise of sports betting — including monitoring and flagging abusive social media content, providing e-learning content, educating on campuses and even lobbying states to change sports betting laws. The NCAA believes bets placed on individual college athletes' performances, known as prop bets, should be eliminated. These types of bets target the individual for harassment and are more easily manipulated, threatening competition integrity. That's why the NCAA is  advocating  for elimination of player-specific prop bets in collegiate competitions. The NCAA's efforts are paying off.

For example, in  Ohio , student-athletes, campus leaders, athletics administrators and the national office collaborated with gaming regulators to remove prop bets from their books across the state. Since Ohio's action, Vermont, Maryland, Louisiana and others have moved to prohibit prop bets. The NCAA is also urging states to implement antiharassment measures, including implementation of a reporting system to allow states to place certain bettors who harass student-athletes on a list that excludes them from being able to place bets.  West Virginia  has taken action in this space, creating a framework that other states are interested in modeling. Student-athletes are speaking out about this issue and working to create awareness about the detrimental impacts of harassment. Their voices are critical to this effort. 

Just 12 days after North Carolina legalized sports betting, including player prop bets on college competitions, North Carolina men's basketball student-athlete Armando Bacot publicly reported receiving betting-related abuse via private social media direct messages after his performance. 

"It's terrible. Even at the last game, I guess I didn't get enough rebounds or something. I thought I played pretty good last game, but I looked at my DMs, and I got like over 100 messages from people telling me I sucked and stuff like that because I didn't get enough rebounds," Bacot said.

Since these remarks and NCAA outreach, North Carolina lawmakers have  filed bills  to ban college player prop bets. State legislators in New Jersey have also filed a  bill , which has bipartisan support, that would ban college prop bets.

Earlier this year, Cody Shimp and Morgan Wynne, chair and vice chair of the Division I Student-Athlete Advisory Committee, joined NCAA President Charlie Baker in writing a memo to college athletics leaders about the severity of online harassment. They urged campus stakeholders to use their voice to effect change and increase safeguards to protect student-athletes from abuse.

"The sports betting landscape in America is rapidly evolving and requires careful consideration of all involved stakeholders," Shimp, Wynne and Baker said in the memo. "The NCAA will continue to do its part to lead in this space to identify practical solutions to guard against the dangers of sports betting, such as harassment. Your role is critical in driving change locally. Together, we can help our student-athletes compete in a safer college sports atmosphere."

The NCAA has launched several initiatives to address harassment, including engaging  Signify Group . Its Threat Matrix artificial intelligence service supports the Association in studying and responding to online abuse and threats directed at NCAA championship participants, including student-athletes, coaches, officials and committee members for the 2023-24 championship season. This unique initiative is intended to further promote the mental health and well-being of the college sports community through data collection and analytics.

While the championship season is still underway, some trends the data already shows include:

• One in 3 high-profile athletes receive abusive messages from someone with a betting interest. 
• Higher-profile events with sports betting markets attract increased volumes of abuse or threats.
• Ninety percent of harassment is generated online or through social media. 
• In sports with high volumes of betting, 15%-25% of all abuse surrounding that competition is betting related. 
• During March Madness, Signify covered nearly 1,000 Division I men's and women's basketball student-athletes, 64 teams, over 280 coaches and 120 NCAA match officials. 
• Across the Division I Men's and Women's Basketball Championships, over 54,000 posts/comments were flagged by Signify's AI for potential abuse or threats and reviewed by human in-house analysts. 
• Of those 54,000, 4,000 were confirmed as abusive or threatening and reported to the relevant social media platforms, with some elevated to law enforcement.
• More than 540 abusive betting-related messages were directed at men's and women's basketball student-athletes, including death threats. 
• Women's basketball student-athletes received approximately three times more threats than men's basketball student-athletes.
• Student-athletes are not the only group experiencing these threats and abuse. Game officials, administrators and other athletics employees have been harassed related to their respective involvement in competitions.

Insights from the initial set of championships covered by the service will be released later and will be used as a benchmark for monitoring efforts at future NCAA championships. Furthermore, Signify's unique DM risk management service will also be offered to student-athletes and officials to protect them from the type of abuse experienced by Bacot. 

Additionally, the NCAA has expanded programming through  e-learning content  and with EPIC Global Solutions to educate student-athletes not only about how to handle abusive threats, but more broadly on the risks of sports betting and problem gambling. The program won  Player Protection Initiative of the Year  at the 2024 SBC Summit, a conference and trade show focused on the online betting and gambling industry.

To date, more than 55,000 student-athletes have been educated through EPIC Global Solutions lived-experience sessions, leaving a lasting impact: 

"This seminar really changed my perspective on gambling and the severity of it. … It was very educational and informative on the risks, factors and harm betting can do," said one student-athlete in an anonymous survey following an EPIC session. "Really caught my attention on how this can really be a problem. I've seen people with betting addiction but just never knew how to help."

Increasing education and growing awareness of the complexities of sports betting fueled the NCAA's  Draw the Line  campaign, launched at the start of March Madness. 

The campaign prioritizes student-athlete education on the effects of sports betting while also addressing responsible gambling for all who consume and participate in college sports.

While the campaign is focused on social media promotion to reach student-athletes where they are, it also includes a  membership toolkit  for member schools and conferences to access resources that extend the campaign for on-campus education. 

All these initiatives have been developed and implemented to help protect student-athlete well-being and mental health to safeguard the overall student-athlete experience in a rapidly evolving landscape. 

If you are a student-athlete or campus administrator and want to learn more about the resources the NCAA is making available,  click here . If you are a student-athlete, you live in a state that permits prop bets and you want to help get these bets pulled from the market, please email  [email protected] .

Thanks for visiting !

The use of software that blocks ads hinders our ability to serve you the content you came here to enjoy.

We ask that you consider turning off your ad blocker so we can deliver you the best experience possible while you are here.

Thank you for your support!

was not found

• Current Opinion
• Open access
• Published: 28 November 2019

Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs

• Rosemary Purcell 1 , 2 ,
• Kate Gwyther 1 , 2 &
• Simon M. Rice   ORCID: orcid.org/0000-0003-4045-8553 1 , 2  

Sports Medicine - Open volume  5 , Article number:  46 ( 2019 ) Cite this article

203k Accesses

162 Citations

73 Altmetric

Metrics details

The current ‘state of play’ in supporting elite athlete mental health and wellbeing has centred mostly on building mental health literacy or awareness of the signs of mental ill-health amongst athletes. Such awareness is necessary, but not sufficient to address the varied mental health needs of elite athletes. We call for a new model of intervention and outline the backbone of a comprehensive mental health framework to promote athlete mental health and wellbeing, and respond to the needs of athletes who are at-risk of developing, or already experiencing mental health symptoms or disorders. Early detection of, and intervention for, mental health symptoms is essential in the elite sporting context. Such approaches help build cultures that acknowledge that an athlete’s mental health needs are as important as their physical health needs, and that both are likely to contribute to optimising the athlete’s overall wellbeing in conjunction with performance excellence. The proposed framework aims at (i) helping athletes develop a range of self-management skills that they can utilise to manage psychological distress, (ii) equipping key stakeholders in the elite sporting environment (such as coaches, sports medicine and high-performance support staff) to better recognise and respond to concerns regarding an athlete’s mental health and (iii) highlighting the need for specialist multi-disciplinary teams or skilled mental health professionals to manage athletes with severe or complex mental disorders. Combined, these components ensure that elite athletes receive the intervention and support that they need at the right time, in the right place, with the right person.

Currently, there is no comprehensive framework or model of care to support and respond to the mental health needs of elite athletes.

We propose a framework that recognises the impact of general and athlete-specific risk factors, and engages key individuals that may identify and promote athlete mental health.

The framework is adaptable and responsive to varied career stages and mental health states.

There has been a rapid increase in research examining the mental health of elite athletes culminating with the International Olympic Committee’s (IOC’s) recent Expert Consensus Statement on mental health in elite athletes [ 1 ]. This statement provides a comprehensive analysis of, and recommendations for, the treatment of both high prevalence (e.g. anxiety and mood symptoms) and more complex mental health disorders (e.g. eating and bipolar disorders) in the elite sporting context. This is a timely resource which will help guide and ultimately improve the clinical management of athletes by sports medicine, mental health, and allied health professionals. The primary focus of the consensus statement, along with much of the extant literature, is on managing the individual athlete affected by mental ill-health. There has been little scholarly and service-level attention to more comprehensive frameworks that (a) recognise the role of the broader elite sports ecology as both a contributor to athlete mental health difficulties and a facilitator of their remediation, and (b) approaches that emphasise the prevention of mental health symptoms, along with early detection and intervention to restore athlete wellbeing (and ideally optimise performance).

Risk Factors for Mental Ill-health in Elite Athletes

Meta-analytic reviews indicate that elite athletes experience broadly comparable rates of mental ill-health relative to the general population in relation to anxiety, depression, post-traumatic stress and sleep disorders [ 2 , 3 ]. This should not be unexpected given the considerable overlap in the years of active elite competition and the primary ages of onset for most mental disorders [ 4 , 5 , 6 ].

Increasing evidence points to a range of both athlete-specific and general risk factors associated with mental ill-health in elite athletes. Athlete-specific risk indicators include sports-related injury and concussion [ 3 , 7 , 8 , 9 ], performance failure [ 10 ], overtraining (and overtraining syndrome) [ 11 ] and sport type (e.g. individual sports conferring a higher risk that team sports) [ 12 ]. General risk indicators include major negative life events [ 13 , 14 ], low social support [ 15 , 16 ] and impaired sleep [ 17 , 18 ]. These risk factors may impact the severity and onset of particular mental health symptoms, but can also guide appropriate response strategies.

The salience of particular risk factors may vary across career phases. For example, in junior development years, supportive relationships with parents and coaches are imperative to athlete wellbeing [ 19 , 20 ]. During the high performance and elite phase, in addition to the coaching relationship, environmental and training demands become more relevant to mental health and wellbeing [ 21 ], including extended travel away from home and exposure to unfamiliar (training) environments [ 22 ]. Environmental conditions and travel may be especially salient for the mental health of para-athletes, who often encounter disruptive logistical issues associated with travel, such as a lack of adaptive sport facilities and sleeping conditions [ 23 ]. Prominent risk factors during the transition out of sport include involuntary or unplanned retirement and lack of a non-athletic identity, both of which are associated with a range of psychological challenges [ 24 ]. For para-athletes, involuntary retirement due to declassification (i.e. no longer meeting the required criteria to be classified as a para-athlete) is a unique burden [ 25 ].

Optimising the Mental Health and Wellbeing of Elite Athletes: Barriers and Facilitators

A comprehensive framework for mental health in elite athletes needs to consider the range of relevant risk factors across key career phases, as well as factors that inhibit or facilitate the ability to effectively respond to athletes’ needs. Key barriers include more negative attitudes towards help-seeking amongst athletes than the general population [ 26 ], as well as greater stigma and poorer mental health literacy. Fear of the consequences of seeking help (e.g. loss of selection) and lack of time are also influential [ 26 , 27 , 28 ]. Facilitative factors include support and acknowledgment from coaches [ 27 ] who can help to create a non-stigmatised environment where help-seeking can be normalised [ 28 ]. Approaches that seek to optimise athletic performance while simultaneously providing intervention for mental health symptoms may also facilitate engagement [ 29 , 30 ]. Brief anti-stigma interventions and mental health literacy programs that seek to increase knowledge of mental health symptoms have been shown to improve help-seeking intentions in elite athletes [ 31 , 32 , 33 ], although the impact of such programs on help-seeking behaviours is not known.

Are there Existing Frameworks or Models of Care for Mental Health in Elite Sport?

To date there are no published frameworks regarding how best to support the mental health needs of elite athletes. In addition to the IOC Consensus Statement, recent position statements have emphasised the need to build awareness of mental health problems and increase help-seeking behaviours [ 34 , 35 , 36 ]. These initiatives are unquestionably warranted; however, improving awareness and help-seeking behaviours are at best pointless, and at worst unsafe, if systems of care to respond to athlete’s need are not available. A whole of system approach needs to be developed simultaneously.

Beyond the peer-reviewed literature, useful guidelines exist within selected sporting associations regarding supporting athlete wellbeing [ 37 , 38 , 39 ]. These resources highlight a number of critical factors in managing athlete mental health in the sporting context including (i) the sports’ responsibility for managing the athlete’s care and support (e.g. duty of care issues); (ii) the need for regular screening or monitoring of athletes to detect changes in mental state or behaviour; (iii) privacy and confidentiality regarding mental health as key ethical issues and challenges; (iv) athlete preferences for help-seeking (how and from whom); (v) the need to refer out to or engage external mental health professionals where expertise does not exist within the sporting environment; and (vi) the value of trained peer workers (former athletes/players) to provide support and guidance to athletes and to coordinate activities related to professional development needs (such as public speaking or financial planning) and individual goal-setting (e.g. around educational or post-sport vocational interests). However, no single framework incorporates all of these factors nor is there a framework that focuses on the spectrum of athlete/player mental health needs, from symptom prevention to specialist mental health care. There has been some progress in developing mental health guidelines in collegiate-level athletes [ 40 , 41 , 42 ], which highlight the need to provide specific and targeted support, while noting that few comprehensive or targeted models of care for mental health have been developed for this population.

Developing a Comprehensive Mental Health Framework to Support Elite Athletes

Many of the general and athlete-specific risk factors for mental ill-health are potentially modifiable (e.g. coping strategies, coaching style, training demands) and require intervention at the individual athlete, the sporting or environmental and/or organisational levels. A comprehensive framework for athlete mental health that is conceptualised within the broader ‘ecology’ of elite sporting environments will be best able to respond to the range of risk indicators in this context (see Fig. 1 ). Ecological systems help to explain the relationship between the aspects or experiences of an individual (termed ‘ontogenetic’ factors, such as coping or substance use) and the broader social and cultural contexts in which they exist [ 43 ]. In the case of elite athletes, this includes the ‘microsystem’ of coach(es), teammates (where appropriate) and family/loved ones. The wider sporting environment (e.g. the athlete’s sport, its rules and governing body) forms the exosystem, while the role of national and international sporting bodies and the media and broader society form the macrosystem.

An ecological systems model for elite athlete mental health

Any mental health framework that ignores wider ecological factors runs the risk of focusing exclusively on, and potentially pathologising the individual athlete, when other factors may be more influential in contributing to, or perpetuating poor mental health. Such factors may include maladaptive relationships with coaches or parents, social media abuse and/or financial pressures.

In addition to ecological factors, a comprehensive framework for mental health should encompass both prevention and early intervention, consistent with established models that are influential in public health and social policy (e.g. Haggerty and Mrazek’s mental health promotion spectrum [ 44 ]; see Fig. 2 ). An early intervention framework can optimise athlete mental wellbeing and respond rapidly to mental health symptoms and disorders as they emerge to best maintain the athlete’s overall function.

The mental health promotion spectrum

Within this framework, the prevention stages aim to reduce the risk of mental health symptoms developing or to minimise their potential impact and severity; the treatment and early intervention stages seek to identify and halt the progression of emerging mental health difficulties; and the continuing care stages help an individual to recover and prevent relapse, typically through ongoing clinical care with a mental health professional [ 44 ].

Based on the extant literature regarding risk factors for mental ill-health in elite athletes, along with existing sporting guidelines or statements regarding athlete wellbeing, and our experience developing and implementing early intervention services and system reform for young people’s mental health [ 45 , 46 , 47 ], we propose the following framework to respond to the mental health of elite athletes (see Fig. 3 ).

Elite athlete mental health and wellbeing framework

Preventative or ‘Foundational’ Components

Core foundational components should include (i) mental health literacy to improve understanding, reduce stigma and promote early help-seeking; (ii) a focus on athlete development (both career and personal development goals) and skill acquisition to help attain these goals; and (iii) mental health screening of, and feedback to, athletes. The purpose of these foundational components is to enhance awareness of the importance of athlete wellbeing across the elite sport ‘ecology’. This in turn addresses workplace duty of care and occupational health and safety responsibilities towards athletes’ overall wellbeing in the context of sport-related stressors.

Mental Health Literacy

Mental health literacy programs should be provided to athletes, coaches and high-performance support staff to help to create a culture that values enhancing the mental health and wellbeing of all stakeholders. Programs should also be offered to the athlete’s family or friends to build their capacity to identify symptoms and encourage help-seeking, particularly as these are the individuals from whom athletes will initially seek help and support [ 48 , 49 ]. Engaging an array of individuals, including organisational staff, in these programs broadens the reach of mental health literacy within an athlete’s (or sport’s) ecology (see Fig. 1 ). Gulliver and colleagues effectively trialled the delivery of a mental health literacy program to elite athletes via team-based workshops facilitated by mental health professionals [ 26 ]. This delivery method is preferred given the opportunity for qualified facilitators to discuss and explore athlete questions or concerns (especially regarding confidentiality and the implications of help-seeking for selection) and to potentially problem-solve together. The content of such training should be customised to address the specific aspects of the sport (e.g. team-based versus individual sport) and developmental stages (e.g. junior versus retiring athletes). Basic program content should cover (i) athlete-specific and general risk factors that can increase susceptibility to mental ill-health; (ii) key signs or symptoms of impaired wellbeing; (iii) how and from whom to seek help, both within and outside the sport; and (iv) basic techniques for athletes to self-manage transient mood states or psychological distress, such as relaxation techniques, adaptive coping strategies, self-compassion and mindfulness.

Individually Focused Development Programs

Individually focused development programs can assist athletes to identify personal/vocational goals and acquire the skills necessary to achieve them. This is necessary to help develop a parallel non-athletic identity, the skills to manage life-sport balance and to prepare for the eventual end of competitive sport. The latter may be challenging in younger athletes who often lack the longer-term perspective or life experience to perceive the need for such planning. However, a focus on developing a non-athletic identity must occur at all phases of the sporting career and not be confined to the transition out of sport phase, since building such skills takes time (and athletes are prone to unplanned retirement due to injury). These activities are ideally facilitated by a skilled, well-trained ‘peer workforce’. These are individuals who have a lived experience of mental ill-health and sufficient training to share their knowledge to help support others in similar situations [ 50 ]. In the sporting context, a peer workforce could include former athletes or coaches who work with current athletes to discuss and normalise experiences of mental health symptoms or their risk factors. Former athletes can assist with athlete development programs and mobilise athletes to the importance of actively participating with such programs, based on their own experiences [ 39 ].

Mental Health Screening

Mental health screening should be included alongside routine physical health checks by medical staff as part of a comprehensive framework. Screening items should be sensitive to the elite context [ 50 , 51 ] and should be designed to provide feedback to athletes to help promote improved self-awareness, such as their mental state and triggers for symptoms. Critical times to screen are following severe injury (including concussion) and during the transition into, and out of sport [ 1 ], and the lead-up to and post major competitions may also be periods of higher risk. It is important to note that there is currently a lack of widely validated athlete-specific screening tools, though one elite athlete sensitised screening measure—the Athlete Psychological Strain Questionnaire—has been validated in a large sample of male elite athletes reporting strong psychometric properties [ 52 ], and is under further validation with female and junior athletes. Research potential exists to not only develop further athlete-specific measures, but to determine who is best suited to conduct screening, and what credentials or training may be required to ensure safety and integrity in this process (e.g. that appropriate help or referral is provided to athletes who screen positive).

Indicated (‘at-risk’) Prevention Programs

The second phase is indicated prevention programs for those considered or assessed as being ‘at-risk’ of impaired mental health and wellbeing. This phase aims to mitigate the likelihood of deterioration in mental health by detecting symptoms as early as possible and facilitating referral to appropriate health professionals. Key staff within the sports system can be assisted to develop skills in early symptom identification and to promote professional help-seeking. This includes coaches, athletic trainers and teammates (where appropriate) who are in a position to notice ‘micro’ changes in an athlete over days or weeks, and sports medicine staff, such as physiotherapists who may detect other non-observable signs, such as changes in energy or body tension. We term these individuals ‘navigators’ in the mental health framework, as they have a crucial role in observing the athlete’s behaviour or mental state and being able to link them to professional care. These navigators can be provided with additional training (adjunctive to mental health literacy) to better recognise and interpret the athlete’s behaviour in relation to their overall wellbeing, understand athlete privacy concerns that inhibit the disclosure of mental health symptoms and build self-efficacy to be able to raise their concerns safely with the affected athlete or medical/mental health staff.

Sport administrators should also consider developing guides on ‘what to do if concerned about an athlete’s mental wellbeing’ and make these available to all relevant staff. These should include information regarding appropriate referral sources, responses (e.g. prevention program vs. early intervention) and facilitators to engage athletes, such as support and encouragement [ 27 , 28 ] and/or linking mental wellbeing with athletic performance [ 29 , 30 ]. Protocols or guides for responding to mental health concerns become less stigmatised when wellbeing needs are already routinely promoted via foundational programs.

Early Intervention

Early intervention is necessary in instances where the performance and life demands placed on an athlete exceed their ability to cope (i.e. major career-threatening injury or significant life stress). Structured clinical interventions for mild to moderate mental ill-health are typically indicated at this phase and should ideally be provided ‘in-house’ by mental health clinicians, such as sports or clinical psychologists or psychiatrists, or medical staff where appropriate (e.g. pharmacotherapy). The use of in-house professionals helps to counter the low levels of service use associated with referring athletes out to external service providers and the stigma that is associated with the athlete needing expert ‘outside help’ [ 53 ]. Where requisite in-house expertise does not exist, this can be managed by the use of qualified consultants, but ideally these professionals should be ‘embedded’ to some extent within the sporting environment to ensure that athletes and other staff understand ‘who they are and what their role is’, even if their presence is infrequent [ 54 ]. When referral out is necessary, or preferred by the athlete, ideally this should be to a mental health professional with appropriate sport sensitised training, knowledge and experience assisting elite athletes.

Early interventions need not always be face-to-face, but can be augmented by telephone or web-enabled consultations, the latter particularly relevant given the frequency with which elite athletes travel unaccompanied by the sporting entourage. All interventions, regardless of the mode of delivery, should use an individualised care approach that is based on assessment and conceptualisation of the individual athlete’s presenting problem(s). The intervention should target the psychological processes of the athlete that are impeding mental health [ 55 ] and take account of the specific familial, sporting and organisational issues that may be impacting on the athlete’s wellbeing.

An example of an early intervention model of care is the Australian Institute of Sport (AIS) mental health referral network [ 56 ]. Athletes are assessed by an AIS mental health advisor, who can make a referral, if necessary, to a qualified mental health practitioner who has been credentialed to work within the network. This practitioner then works individually with the athlete to address their needs and ideally restore their mental health and functioning [ 57 ].

Specialist Mental Health Care

Despite best efforts to prevent or intervene early, some athletes will nonetheless experience severe or complex psychopathology requiring specialist mental health care, particularly where there is a risk of harm to self or others. In some cases, this may include hospitalisation or specialist inpatient or day programs. The IOC Expert Consensus Statement provides a summary of recommended clinical interventions for a range of mental disorders, including bipolar, psychotic, eating and depressive disorders, and suicidality [ 1 ]. Developing and implementing a mental health emergency plan may also be required, particularly in cases where an athlete presents with an acute disturbance in their mental state, for instance agitation/paranoia, or suicidal ideation [ 58 ]. The IOC Expert Consensus Statement recommends that structured plans should acknowledge and define what constitutes a mental health emergency, identify which personnel (or local emergency services) are contacted and when, and consider relevant mental health legislation [ 1 ].

There is also arguably a need for ‘return to sport or training’ guidance for athletes who have been unable to compete or train for their sport due to mental illness, akin to guidelines for managing concussion [ 59 ]. Such guidance could potentially provide a graduated, step-by-step protocol that prepares not only the athlete for a successful return to sport, but also the microsystem that supports them.

Conclusions

We have proposed a comprehensive framework for elite athlete mental health. More research is needed to bolster the efficacy of the approaches discussed here in the elite sports context, as well as other factors that are under-researched in the literature, such as gender-specific considerations in mental health [ 60 ] and considerations for para-athletes [ 23 ]. We are mindful that coaches and other high-performance staff are vulnerable to mental health problems [ 61 ] and the needs of these individuals need to be incorporated into a more inclusive model of care. Further, we recognise the scope of this framework does not cover the needs of non-elite athletes. Elements of this framework may be tailored in the future to be applicable and contextualised for non-elite environments where there may be limited resources, less professional staffing and greater limitations in athlete schedules.

Despite the exponential increase in research interest related to athlete mental wellbeing, major service delivery and treatment gaps remain. Evaluating the efficacy of mental health prevention and intervention programs via controlled trials or other high-quality designs is urgently needed. Program evaluation should ideally adopt an ecological systems approach to account for competition-related, individual-vulnerability and organisational factors on mental health outcomes, for example by seeking to measure system-level variables (e.g. the degree of perceived psychological safety within the sporting organisation [ 62 , 63 ]) and individual athlete-level variables (e.g. coping skills, relationship with coach, injury history). As initiatives are evaluated and enhanced or adapted, developers should consult with elite sport organisations and individuals to ensure the relevance and sport sensitivity of their programs. Increased resources and research funding to support the evaluation and implementation of athlete mental health programs is needed, such as currently exists for managing athletes’ physical health (e.g. musculoskeletal injuries, concussion).

Finally, we are acutely aware that a framework such as that articulated here requires substantial investment and that such funding is scant even in high income settings. The foundational and at-risk components lend themselves, we believe, to be adaptable to low resource settings, given the emphasis on athlete self-management and a trained peer workforce. Adaptations to providing early intervention in low resource settings will be needed, and innovations in general mental health can act as a blueprint [ 64 ]. Regardless of settings or resources, investment in a comprehensive response to athlete mental health needs attention if it is to ever gain parity with physical health.

Availability of Data and Materials

Not applicable.

Abbreviations

International Olympic Committee

Australian Institute of Sport

Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). British Journal of Sports Medicine. 2019;53(11):667–99. https://doi.org/10.1136/bjsports-2019-100715 .

Article   PubMed   Google Scholar  

Gouttebarge V, Castaldelli-Maia JM, Gorczynski P, Hainline B, Hitchcock ME, Kerkhoffs GM, et al. Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. British Journal of Sports Medicine. 2019;53(11):700–6.

Rice SM, Gwyther K, Santesteban-Echarri O, Baron D, Gorczynski P, Gouttebarge V, et al. Determinants of anxiety in elite athletes: a systematic review and meta-analysis. British Journal of Sports Medicine. 2019;53(11):722–30.

Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG. The mental health of elite athletes: a narrative systematic review. Sports Med. 2016;46(9):1333–53. https://doi.org/10.1007/s40279-016-0492-2 .

Article   PubMed   PubMed Central   Google Scholar  

Allen SV, Hopkins WG. Age of peak competitive performance of elite athletes: a systematic review. Sports Medicine. 2015;45(10):1431–41.

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry. 2005;62(6):593–602.

Gulliver A, Griffiths KM, Mackinnon A, Batterham PJ, Stanimirovic R. The mental health of Australian elite athletes. Journal of science and medicine in sport. 2015;18(3):255–61.

Peluso MAM, Andrade LHSGd. Physical activity and mental health: the association between exercise and mood. Clinics. 2005;60(1):61-70.

Rice SM, Parker AG, Rosenbaum S, Bailey A, Mawren D, Purcell R. Sport-related concussion and mental health outcomes in elite athletes: a systematic review. Sports medicine. 2018;48(2):447–65.

Hammond T, Gialloreto C, Kubas H, Davis HH IV. The prevalence of failure-based depression among elite athletes. Clinical Journal of Sport Medicine. 2013;23(4):273–7.

Frank R, Nixdorf I, Beckmann J. Depression among elite athletes: prevalence and psychological factors. Deut Z Sportmed. 2013;64:320–6.

Google Scholar  

Schaal K, Tafflet M, Nassif H, Thibault V, Pichard C, Alcotte M, et al. Psychological balance in high level athletes: gender-based differences and sport-specific patterns. PLoS One. 2011;6(5):e19007. https://doi.org/10.1371/journal.pone.0019007 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Nixdorf I, Frank R, Hautzinger M, Beckmann J. Prevalence of depressive symptoms and correlating variables among German elite athletes. Journal of Clinical Sport Psychology. 2013;7(4):313–26.

Article   Google Scholar  

Gouttebarge V, Aoki H, Verhagen EA, Kerkhoffs GM. A 12-month prospective cohort study of symptoms of common mental disorders among European professional footballers. Clinical Journal of Sport Medicine. 2017;27(5):487–92.

Gutmann MC, Pollock ML, Foster C, Schmidt D. Training stress in Olympic speed skaters: a psychological perspective. The Physician and Sportsmedicine. 1984;12(12):45–57.

Kotnik B, Tušak M, Topič MD, Leskošek B. Some psychological traits of Slovenian Olympians (Beijing 2008)—a gender comparison. Kinesiologia Slovenica. 2012;18(2).

Gupta L, Morgan K, Gilchrist S. Does elite sport degrade sleep quality? A systematic review. Sports Medicine. 2017;47(7):1317–33.

Kölling S, Steinacker JM, Endler S, Ferrauti A, Meyer T, Kellmann M. The longer the better: sleep–wake patterns during preparation of the world rowing junior championships. Chronobiology international. 2016;33(1):73–84.

Berntsen H, Kristiansen E. Guidelines for Need-Supportive Coach Development: The Motivation Activation Program in Sports (MAPS). International Sport Coaching Journal. 2019;6(1):88–97.

Sabato TM, Walch TJ, Caine DJ. The elite young athlete: strategies to ensure physical and emotional health. Open access journal of sports medicine. 2016;7:99.

Saw AE, Main LC, Gastin PB. Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review. British Journal of Sports Medicine. 2016;50(5):281–91. https://doi.org/10.1136/bjsports-2015-094758 .

Donnelly AA, MacIntyre TE, O’Sullivan N, Warrington G, Harrison AJ, Igou ER, et al. Environmental influences on elite sport athletes well being: from gold, silver, and bronze to blue green and gold. Frontiers in psychology. 2016;7:1167.

Swartz L, Hunt X, Bantjes J, Hainline B, Reardon CL. Mental health symptoms and disorders in Paralympic athletes: a narrative review. British Journal of Sports Medicine. 2019:bjsports-2019-100731.

Knights S, Sherry E, Ruddock-Hudson M. Investigating elite end-of-athletic-career transition: a systematic review. Journal of Applied Sport Psychology. 2016;28(3):291–308.

Bundon A, Ashfield A, Smith B, Goosey-Tolfrey VL. Struggling to stay and struggling to leave: The experiences of elite para-athletes at the end of their sport careers. Psychology of Sport and Exercise. 2018;37:296–305.

Gulliver A, Griffiths KM, Christensen H. Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC psychiatry. 2012;12(1):157.

Castaldelli-Maia JM. Gallinaro JGdMe, Falcão RS, Gouttebarge V, Hitchcock ME, Hainline B et al. Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment. British Journal of Sports Medicine. 2019;53(11):707–21. https://doi.org/10.1136/bjsports-2019-100710 .

Reardon CL, Factor RM. Sport psychiatry: A systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Medicine. 2010;40(11):961–80.

Donohue B, Gavrilova Y, Galante M, Gavrilova E, Loughran T, Scott J, et al. Controlled evaluation of an optimization approach to mental health and sport performance. Journal of Clinical Sport Psychology. 2018;12(2):234–67.

Gavrilova Y, Donohue B, Galante M. Mental health and sport performance programming in athletes who present without pathology: A case examination supporting optimization. Clinical Case Studies. 2017;16(3):234–53.

Bapat S, Jorm A, Lawrence K. Evaluation of a mental health literacy training program for junior sporting clubs. Australasian psychiatry. 2009;17(6):475–9.

Beauchemin J. College student-athlete wellness: An integrative outreach model. College Student Journal. 2014;48(2):268–80.

Kern A, Heininger W, Klueh E, Salazar S, Hansen B, Meyer T, et al. Athletes connected: results from a pilot project to address knowledge and attitudes about mental health among college student-athletes. Journal of Clinical Sport Psychology. 2017;11(4):324–36.

Henriksen K, Schinke R, Moesch K, McCann S, Parham William D, Larsen CH, et al. Consensus statement on improving the mental health of high performance athletes. International Journal of Sport and Exercise Psychology. 2019:1–8. https://doi.org/10.1080/1612197X.2019.1570473 .

Moesch K, Kenttä G, Kleinert J, Quignon-Fleuret C, Cecil S, Bertollo M. FEPSAC position statement: mental health disorders in elite athletes and models of service provision. Psychology of Sport and Exercise. 2018.

Schinke RJ, Stambulova NB, Si G, Moore Z. International society of sport psychology position stand: Athletes’ mental health, performance, and development. International journal of sport and exercise psychology. 2018;16(6):622–39.

Queensland Academy of Sport. Athlete wellbeing framework. Queensland Academy of Sport, https://www.qasport.qld.gov.au/about/documents/qas-athlete-wellbeing-framework.pdf . 2014. Accessed 20 May 2019.

Lomax L. System recognises importance of support to help athletes with mental health issues. English Institute of Sport, https://www.eis2win.co.uk/2014/08/21/system-recognises-importance-support-help-athletes-mental-health-issues/ . 2014. .

Australian Football League Players' Association. Development and wellbeing report 2014. Australian football league players' association, http://www.aflplayers.com.au/wp-content/uploads/2015/03/Dev-Wellbeing-2015.pdf . 2014. Accessed 20 May 2019.

Brown GT, Hainline B, Kroshus E, Wilfert M. Mind, body and sport: understanding and supporting student-athlete mental wellness. IN: NCAA: Indianapolis; 2014.

Neal TL, Diamond AB, Goldman S, Klossner D, Morse ED, Pajak DE, et al. Inter-association recommendations for developing a plan to recognize and refer student-athletes with psychological concerns at the collegiate level: an executive summary of a consensus statement. Journal of Athletic Training. 2013;48(5):716–20.

Thompson R, Sherman R. Managing student-athletes’ mental health issues. National Collegiate Athletic Association: Indianapolis; 2007.

Bronfenbrenner U. Ecological systems theory: Jessica Kingsley Publishers; 1992.

Haggerty RJ, Mrazek PJ. Reducing risks for mental disorders: Frontiers for preventive intervention research: National Academies Press; 1994.

Purcell R, Goldstone S, Moran J, Albiston D, Edwards J, Pennell K, et al. Toward a Twenty-First Century Approach to Youth Mental Health Care. International Journal of Mental Health. 2011;40(2):72–87. https://doi.org/10.2753/IMH0020-7411400204 .

McGorry PD, Purcell R, Goldstone S, Amminger GP. Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care. Current opinion in psychiatry. 2011;24(4):301–6.

Rice SM, Purcell R, McGorry PD. Adolescent and young adult male mental health: transforming system failures into proactive models of engagement. Journal of Adolescent Health. 2018;62(3):S9–S17.

Pierce D, Liaw S-T, Dobell J, Anderson R. Australian rural football club leaders as mental health advocates: an investigation of the impact of the Coach the Coach project. International journal of mental health systems. 2010;4(1):10.

Naoi A, Watson J, Deaner H, Sato M. Multicultural issues in sport psychology and consultation. International Journal of Sport and Exercise Psychology. 2011;9(2):110–25.

Vandewalle J, Debyser B, Beeckman D, Vandecasteele T, Van Hecke A, Verhaeghe S. Peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services: A literature review. International Journal of Nursing Studies. 2016;60:234–50.

Donohue B, Galante M, Hussey J, Lee B, Paul N, Perry JE, et al. Empirical Development of a Screening Method to Assist Mental Health Referrals in Collegiate Athletes. Journal of Clinical Sport Psychology. 2019:1–28. https://doi.org/10.1123/jcsp.2018-0070 .

Rice SM, Parker AG, Mawren D, Clifton P, Harcourt P, Lloyd M, et al. Preliminary psychometric validation of a brief screening tool for athlete mental health among male elite athletes: the Athlete Psychological Strain Questionnaire. International Journal of Sport and Exercise Psychology. 2019:1–16.

McDuff DR. Sports psychiatry: strategies for life balance and peak performance. American Psychiatric Pub; 2012.

Morse ED. Sports Psychiatrists Working in College Athletic Departments. Clinical Sports Psychiatry. 1988;203.

Moore ZE, Bonagura K. Current opinion in clinical sport psychology: from athletic performance to psychological well-being. Current opinion in psychology. 2017;16:176–9.

Australian Institute of Sport. Mental health referral network: Support for elite AIS-funded athletes with mental health concerns. SportAus, https://www.sportaus.gov.au/ais/MHRN . 2018. Accessed 20 May 2019.

Rice S, Butterworth M, Clements M, Josifovski D, Arnold S, Schwab C, et al. Development and implementation of the national mental health referral network for elite athletes: A case study of the Australian Institute of Sport. Case Studies in Sport and Exercise Psychology. Under review. .

Currie A, McDuff D, Johnston A, Hopley P, Hitchcock ME, Reardon CL et al. Management of mental health emergencies in elite athletes: a narrative review. British Journal of Sports Medicine. 2019:bjsports-2019-100691. doi:10.1136/bjsports-2019-100691.

McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–47.

PubMed   Google Scholar  

Rice SM, Fallon BJ, Aucote HM, Möller-Leimkühler AM. Development and preliminary validation of the male depression risk scale: Furthering the assessment of depression in men. Journal of affective disorders. 2013;151(3):950–8.

Carson F, Walsh J, Main LC, Kremer P. High performance coaches' mental health and wellbeing: Applying the areas of work life model. International Sport Coaching Journal. 2018;5(3):293–300.

Spink KS, Wilson KS, Brawley LR, Odnokon P. The perception of team envrionment: The relationship between the psychological climate and members’ perceived effort in high-performance groups. Group Dynamics: Theory, Research, and Practice. 2013;17(3):150–61.

Stachan L, Côté J, Deakin J. A new view: Exploring positive youth development in elite sport contexts. Qualitative Research in Sport, Exercise and Health. 2011;3(1):9–32.

Chibanda D, Weiss HA, Verhey R, Simms V, Munjoma R, Rusakaniko S, et al. Effect of a primary care–based psychological intervention on symptoms of common mental disorders in Zimbabwe: a randomized clinical trial. Jama. 2016;316(24):2618–26.

Download references

Acknowledgements

Simon M Rice was supported by a Career Development Fellowship (APP115888) from the National Health and Medical Research Council.

Author information

Authors and affiliations.

Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Melbourne, Victoria, 3052, Australia

Rosemary Purcell, Kate Gwyther & Simon M. Rice

Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia

You can also search for this author in PubMed   Google Scholar

Contributions

RP and SMR made substantial contributions to the conception of the manuscript. RP, KG and SMR drafted, revised and approved the final version.

Corresponding author

Correspondence to Simon M. Rice .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors, Rosemary Purcell, Kate Gwyther, and Simon M. Rice, declare that they have no competing interests relevant to the content of this article.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and permissions

About this article

Cite this article.

Purcell, R., Gwyther, K. & Rice, S.M. Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs. Sports Med - Open 5 , 46 (2019). https://doi.org/10.1186/s40798-019-0220-1

Download citation

Received : 07 July 2019

Accepted : 09 October 2019

Published : 28 November 2019

DOI : https://doi.org/10.1186/s40798-019-0220-1

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Alzheimer's disease & dementia
• Arthritis & Rheumatism
• Attention deficit disorders
• Autism spectrum disorders
• Biomedical technology
• Diseases, Conditions, Syndromes
• Endocrinology & Metabolism
• Gastroenterology
• Gerontology & Geriatrics
• Health informatics
• Inflammatory disorders
• Medical economics
• Medical research
• Medications
• Neuroscience
• Obstetrics & gynaecology
• Oncology & Cancer
• Ophthalmology
• Overweight & Obesity
• Parkinson's & Movement disorders
• Psychology & Psychiatry
• Radiology & Imaging
• Sleep disorders
• Sports medicine & Kinesiology
• Vaccination
• Breast cancer
• Cardiovascular disease
• Chronic obstructive pulmonary disease
• Colon cancer
• Coronary artery disease
• Heart attack
• Heart disease
• High blood pressure
• Kidney disease
• Lung cancer
• Multiple sclerosis
• Myocardial infarction
• Ovarian cancer
• Post traumatic stress disorder
• Rheumatoid arthritis
• Schizophrenia
• Skin cancer
• Type 2 diabetes
• Full List »

share this!

May 20, 2024

This article has been reviewed according to Science X's editorial process and policies . Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

peer-reviewed publication

reputable news agency

U-shaped link detected between adolescent BMI and mental health

by Elana Gotkine

There is a U-shaped association between adolescent body mass index (BMI) and mental health, according to a study published online May 15 in JAMA Psychiatry .

Shanquan Chen, Ph.D., from the London School of Hygiene & Tropical Medicine, and colleagues estimated the association between BMI and mental health and examined changes from 2002 to 2018 in a repeated multicountry cross-sectional study. Data were obtained from the Health Behavior in School-aged Children survey in Europe and North America, including a study population of 1,036,869 adolescents (527,585 girls) aged 11 to 15 years.

The researchers identified a U-shaped association between BMI and mental health . Compared with those with healthy weight, adolescents with low body mass, overweight, or obesity had increased psychosomatic symptoms (unstandardized β, 0.14, 0.27, and 0.62, respectively), while fewer symptoms were seen for adolescents with underweight (β, −0.18).

Across different years, sex, and grade, the association was observed. Psychosomatic concerns increased significantly in 2006, 2010, 2014, and 2018 compared with 2002 (unstandardized β, 0.19, 0.14, 0.48, and 0.82, respectively).

Significantly higher psychosomatic concerns were seen for girls than boys (unstandardized β, 2.27). Psychosomatic concerns increased significantly in middle and high school versus primary school (unstandardized β, 1.15 and 2.12, respectively).

"These insights can inform public health and school programs, emphasizing correcting body image misconceptions, encouraging healthy weight, and creating supportive peer environments," the authors write.

Copyright © 2024 HealthDay . All rights reserved.

Explore further

Feedback to editors

Regular fish oil supplement use might increase first-time heart disease and stroke risk

4 hours ago

Pedestrians may be twice as likely to be hit by electric/hybrid cars as petrol/diesel ones

Study finds jaboticaba peel reduces inflammation and controls blood sugar in people with metabolic syndrome

5 hours ago

Study reveals how extremely rare immune cells predict how well treatments work for recurrent hives

7 hours ago

Researchers find connection between PFAS exposure in men and the health of their offspring

Researchers develop new tool for better classification of inherited disease-causing variants

Specialized weight navigation program shows higher use of evidence-based treatments, more weight lost than usual care

Exercise bouts could improve efficacy of cancer drug

Drug-like inhibitor shows promise in preventing flu

Scientists discover a novel way of activating muscle cells' natural defenses against cancer using magnetic pulses

8 hours ago

Related Stories

Study reports on the health of adolescents in Germany

Mar 4, 2024

1999 to 2018 saw decline in mean BP among US children, teens

Apr 6, 2021

All screens toxic for teen health after just two hours of use

Mar 29, 2022

Body dissatisfaction linked with depression risk in children

Dec 13, 2023

Fewer teens now perceive themselves as overweight, finds international study of more than 745,000 adolescents

Jul 3, 2023

Race, sex, age influence pediatric mental health emergency visits

Oct 26, 2023

Recommended for you

Heart rate synchrony predicts effective group decision-making, research suggests

11 hours ago

Study models how ketamine's molecular action leads to its effects on the brain

12 hours ago

Study shows exercise spurs neuron growth and rewires the brain, helping mice forget traumatic and addictive memories

Researchers discover top-down signals in brain circuits regulating depression

Yoga and meditation-induced altered states of consciousness are common in the general population, study says

Let us know if there is a problem with our content.

Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. For general inquiries, please use our contact form . For general feedback, use the public comments section below (please adhere to guidelines ).

Please select the most appropriate category to facilitate processing of your request

Thank you for taking time to provide your feedback to the editors.

Your feedback is important to us. However, we do not guarantee individual replies due to the high volume of messages.

E-mail the story

Your email address is used only to let the recipient know who sent the email. Neither your address nor the recipient's address will be used for any other purpose. The information you enter will appear in your e-mail message and is not retained by Medical Xpress in any form.

Newsletter sign up

Get weekly and/or daily updates delivered to your inbox. You can unsubscribe at any time and we'll never share your details to third parties.

More information Privacy policy

Donate and enjoy an ad-free experience

We keep our content available to everyone. Consider supporting Science X's mission by getting a premium account.

E-mail newsletter