research paper on sports and mental health

• 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

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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.

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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.

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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).

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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

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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  

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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.

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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.

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Simon M Rice was supported by a Career Development Fellowship (APP115888) from the National Health and Medical Research Council.

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Sport and Mental Health

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Table of contents (18 chapters)

Front matter, factors affecting mental health in athletes, a proposed novel multidisciplinary approach to the care of the young athlete.

• H. Baron Steven, A. Baron Michael, J. Baron Steven

Gender Differences in the Psychiatric Treatment of Athletes

• Danielle Kamis, Roy Collins

Transcultural and Cultural Aspects of Sport Psychiatry

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Sport and Human Rights

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Sleep and Sleep Disorders in Elite Athletes

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Mental Health Emergencies in Athletes

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Doping in Sports

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After Sexual Abuse or other Extreme Life Events

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Sports in the COVID-19 Era

Pharmacotherapy in sport.

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Concussion in Athletes

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Clinical Mental Health Symptoms and Syndromes in Athletes

Helping the athlete with depression.

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Anxiety in Athletes

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Substance Use in Athletes

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Psychosis in Sports

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Eating Disorders in Sport

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ADHD in Athletes

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• Brain Trauma
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About this book

This user-friendly, comprehensive and highly relevant book allows readers to gain a better understanding of mental health issues in sport and exercise. The field of sports psychiatry continues to grow globally at a rapid pace. This, in part, can be explained by the changing culture of sport leading to an appreciation of the role of psychiatric symptoms and syndromes in the world of sport, but also the increasing spread of both highly performance oriented and grass-roots basic sports and the associated risks in large sections of the population. The long-standing stigma attached to mental health problems, such as depression, anxiety, ADHD, suicide, brain injuries, substance-abuse, is being challenged not only by high-profile athletes, but also in public health and general mental health services.

The book utilizes an innovative case-based and structured didactical format to provide short summaries of recent research by leading experts in the respective fields, as well as up-to date prevention and clinical guidelines for all relevant disorders in a way that is easily accessible to the large and growing groups interested and active in sports. This work is relevant for all mental health professionals and can also be used by a wider readership including medical doctors, psychologists, athletes and coaches.

A second volume covers the role of exercise as an effective treatment for a number of common psychiatric conditions, such as depression, anxiety, eating disorders and substance abuse.

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David Baron

Thomas Wenzel

Andreas Ströhle

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About the editors.

David Baron is founding Chair of the WPA Scientific Section, Exercise, Psychiatry and Sport, (current Vice Chair), Board member, International Society of Sports Psychiatrist, Chair of Concussion and Sport, Consultant to numerous professional sports leagues, NCAA, IOC, WADA, Ministers of Sports, 2018 Fulbright Distinguished Chair in Brain Science. US- Centers for Disease Control consultant on Safety in Youth Sports Program, focusing on concussion in youth sports, named, America’s Top Doc in Sports Psychiatry, Consumer Council of America, Founder and current Director, Center for Health and Sport at Western University. 

Thomas Wenzel, MD, Prof. of Psychiatry (Medical University of Vienna, Austria), is current chair of the World Psychiatric Association Scientific Section on Sport and Exercise Psychiatry. Long term research and clinical focus on psychological trauma, brain trauma, and transcultural issues in Sports and in victims of violence, more than 300 publications and published papers. International teaching in sport psychiatry. He is co-ordinator of the WPA section educational program on healthy sports. Long term chair and co-founder, WPA section on sequels to persecution and torture.

Andreas Ströhle, MD, is a Professor of Psychiatry and Psychotherapy at the Charité- Universitätsmedizin Berlin, Germany. He is leading  a research group on Sports Psychiatry and Psychotherapy, and head of the division of Sports Psychiatry and Psychotherapy of the German Association of Psychiatrists (DGPPN). Besides mental disorders in athletes his clinical work and research focuses on physical activity, exercise and sports in the prevention and treatment of mental disorders. 

Bibliographic Information

Book Title : Sport and Mental Health

Book Subtitle : From Research to Everyday Practice

Editors : David Baron, Thomas Wenzel, Andreas Ströhle, Todd Stull

DOI : https://doi.org/10.1007/978-3-031-36864-6

Publisher : Springer Cham

eBook Packages : Medicine , Medicine (R0)

Copyright Information : The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023

Hardcover ISBN : 978-3-031-36863-9 Published: 13 September 2023

Softcover ISBN : 978-3-031-36866-0 Due: 27 September 2024

eBook ISBN : 978-3-031-36864-6 Published: 12 September 2023

Edition Number : 1

Number of Pages : XII, 312

Number of Illustrations : 13 illustrations in colour

Topics : Psychiatry , Neurology , Clinical Psychology

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Exercise and sport in mental health: a review of the literature

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• 1 Division of Mental Health Services, Israel, Jewish Institute for the Blind, Jerusalem.
• PMID: 2211073

A literature survey was conducted of the most prominent psychological effects and therapeutic applications of physical activity in mental health. This paper primarily reviews the literature comparing therapeutic exercise and sport with more traditional therapies and activities. Commentary on research methods is also presented.

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• Anxiety / psychology
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The Effects of Mental Health Interventions on Labor Market Outcomes in Low- and Middle-Income Countries

Mental health conditions are prevalent but rarely treated in low- and middle-income countries (LMICs). Little is known about how these conditions affect economic participation. This paper shows that treating mental health conditions substantially improves recipients’ capacity to work in these contexts. First, we perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) ever conducted that evaluate treatments for mental ill-health and measure economic outcomes in LMICs. On average, treating common mental disorders like depression with psychotherapy improves an aggregate of labor market outcomes made up of employment, time spent working, capacity to work and job search by 0.16 standard deviations. Treating severe mental disorders, like schizophrenia, improves the aggregate by 0.30 standard deviations, but effects are noisily estimated. Second, we build a new dataset, pooling all available microdata from RCTs using the most common trial design: studies of psychotherapy in LMICs that treated depression and measured days participants were unable to work in the past month. We observe comparable treatment effects on mental health and work outcomes in this sub-sample of highly similar studies. We also show evidence consistent with mental health being the mechanism through which psychotherapy improves work outcomes.

The three authors listed first (Crick Lund, Kate Orkin, and Marc Witte) are jointly the first author. This study was funded by the Wellspring Philanthropic Fund. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

Vikram Patel acknowledges research support from the NIMH, Wellcome Trust, Grand Challenges Canada and the Medical Research Council. He also receives funding from the Lone Star Prize and serves as a consultant to Modern Health and Johnson & Johnson.

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Team Sport Athletes May Be Less Likely To Suffer Anxiety or Depression than Individual Sport Athletes

Emily pluhar.

1 Division of Adolescent Medicine and Young Adult Medicine and Division of Sports Medicine, Department of Orthopedics at Boston Children’s Hospital and Harvard Medical School, USA

Caitlin McCracken

2 Oregon Health Science University College of Pharmacy, Oregon State University, USA

Kelsey L. Griffith

3 The Micheli Center for Sports Injury Prevention and Division of Sports Medicine, Department of Orthopedics at Boston Children’s Hospital, USA

Melissa A. Christino

Dai sugimoto, william p. meehan, iii.

The objective of the study was to determine whether 1) the proportion of athletes with mental health diagnoses and 2) athlete motivations for playing differ between team sports and individual sports. We conducted a cross-sectional study of child and adolescent athletes assessed at a sports injury prevention center. We compared self-reported anxiety, depression, and reasons for participating in sports between athletes in individual sports (e.g. gymnastics, running, diving) and team sports (e.g. soccer, football, hockey). In addition, we categorized motivation for participating in sports as 1) for fun, with associated benefits of participation including, motives such as making friends and being part of a team or 2) for goal-oriented reasons with associated benefits of participation including motives such as obtaining scholarship or controlling weight. At the time of this analysis, 756 athletes between the ages of 6 and 18 years had undergone a sports injury prevention evaluation. Most athletes were White (85%) and there was a slight female predominance (56%). Of the total population, 8% reported suffering from anxiety or depression. A higher proportion of individual sport athletes reported anxiety or depression than team sport athletes (13% vs. 7%, p < 0.01). Individual sport athletes were more likely than athletes in team sports to play their sports for goal-oriented reasons, as opposed to for fun (30% vs. 21%, p < 0.05). Individual sport athletes are more likely to report anxiety and depression than team sport athletes. The mental health benefits of participation in organized sports may vary between individual sport athletes and those playing team sports.

• Individual sport athletes are more likely to report anxiety and depression than team sport athletes.
• Reasons for playing sports vary between individual sport athletes and team sport athletes, wherein individual sport athletes play for goal-oriented reasons and team sport athletes play for fun.
• The mental health benefits of participation in organized sports may vary between individual sport athletes and those playing team sports.

Introduction

As the prevalence of mental health issues continues to increase globally, more studies have focused on physical activity as a potential protective mediator for mental health disorders including anxiety and depression (Boone and Leadbeater, 2006 ; Schaal et al., 2011 ). Having extensively examined how exercise improves physical health, researchers are now focusing on the psychological impacts of physical activity (Eime et al., 2013 ; Nixdorf et al., 2016 ). Between 2-9% of children are diagnosed with major depressive disorder, while 5-10% of children and up to 25% of teenagers suffer from anxiety (Glover and Fritsch, 2018 ; Sabiston et al., 2016 ). Presenting adolescents with an opportunity to socialize, relieve stress, and build confidence, physical activity has been associated with decreased risk of these illnesses (Adachi and Willoughby, 2014 ; Boone and Leadbeater, 2006 ; Findlay and Bowker, 2009 ; Lubans et al., 2016 ; McMahon et al., 2017 ; Toseeb et al., 2014 ). Several studies suggest that physical activity is beneficial to the mental health of young people, 30-40% of whom will show moderate or severe depressive symptoms between ages 12 and 19 (Boone and Leadbeater, 2006 ; Sabiston et al., 2016 ). Strong et al. ( 2005 ) recommend school-age youth should engage in 60 minutes of exercise per day to increase muscle strength, reduce body fat, maintain healthy body weight, promote bone density, improve mood, and decrease symptoms of depression and anxiety. Therefore, individual and team sports seem to help mediate the presentation of psychological disorders and serve as effective treatment measures.

Furthermore, organized sports participation is associated with a decreased risk of anxiety, depression, feelings of hopelessness, suicidal ideation and suicide attempts, illicit drug use, and the smoking of tobacco products, above exercise alone (Miller et al., 2002 ; Miller and Hoffman, 2009 ; Pedersen et al., 2017 ). Organized sports correlate more positively with adolescent mental health than other forms of physical activity (Eime et al., 2013 ). Organized sports have been associated with decreased depressive symptoms, increased self-esteem, and improved social abilities (Sabiston et al., 2016 ; Vella et al., 2017 ). The social benefits of participating in sports have been linked to reduced stress and better self-reported overall mental health in young adults (Sabiston et al., 2016 ; Vella et al., 2017 ). A study from 2015 revealed that those who do not participate in or drop out of organized sports have greater social and emotional difficulties than those who continue to play (Vella et al., 2015 ). Non-athletes are also 10-20% more likely to suffer from mental health issues (Vella et al., 2017 ). The benefits of sport and physical activity on metrics of mental health have been well-established.

Not all sports, however, impact mental health in the same way. Kajbafnezhad et al. ( 2011 ) discovered “significant difference between [team sports and individual sports] in terms of psychological skills and motivation of athletic success” (p. 1904). Playing on a team both encourages fitness and allows young people to develop important mental and social skills (Boone and Leadbeater, 2006 ; Vella et al., 2017 ). Team sports provide an opportunity for children to learn to work well with others and effectively contribute to a group (Sabiston et al., 2016 ). The resulting sense of support and acceptance likely plays an integral role in reducing depressive symptoms and leads to healthy relationships with adults and peers (Eime et al., 2013 ; Boone and Leadbeater, 2006 ). Boone and Leadbeater ( 2006 ) found that positive experiences on teams with coaching, skill development, and peer support contribute to feelings of social acceptance and decreased body dissatisfaction and ultimately fewer depressive symptoms among adolescents.

Individual sports help cultivate other important psychological skills. When athletes practice alone, they can improve their ability to concentrate and improve mental strength. While individual sports often provide less social opportunity, they encourage responsibility and self-reliance. Individual sport athletes may engage in a “higher level of preparation” because their success depends completely on their own skills and training (Kajbafnezhad et al., 2011 ). Yet, this increased sense of accountability can lead to intense feelings of shame or guilt after losing (Nixdorf et al., 2016 ). Team sports are sometimes stressful as a result of competition, team dynamics or coaching issues, but individual sports may cause greater internal attribution such as shame after failure, which is linked to depressive symptoms (Boone and Leadbeater, 2006 ; Hanrahan and Cerin, 2009 ; Nixdorf et al., 2016 ). Nixdorf et al. ( 2016 ) reports that elite junior athletes who play individual sports suffer more from depression than those who play team sports. Sabiston et al. ( 2016 ) reveals that youth who engaged in team sports throughout high school reported fewer depressive symptoms later in life, but the same did not apply to individual sports. Both team and individual sports have been shown to support mental and physical health, but, as noted by Vella et al. ( 2017 ), “the weight of evidence suggests that participation in team sports may be more strongly linked to positive social and psychological outcomes when compared to individual sports” (p.688)

Individual sport athletes can exhibit increased anxiety not only because of the way they internalize failure, but also their tendency to set intense personal goals for themselves (Nixdorf et al., 2013 ). Individual sports for which judges determine success, including gymnastics, figure skating, and dance, correlate with the highest rates of anxiety in elite athletes; these athletes feel immense pressure to differentiate themselves from the competition in the pursuit of perfection and a judge’s approval (Schaal et al., 2011 ). Team sport athletes also engage in perfectionist behaviors, but perhaps not to the extent of individual sport athletes (Nixdorf et al., 2013 ). The current study tests the hypothesis that team and individual sports have distinct associations with the diagnoses of anxiety and depression. In addition, we hypothesized that young team sport athletes are motivated to play for different reasons than individual sport athletes.

Study design

We conducted a cross-sectional study of athletes who underwent an injury prevention evaluation (IPE) at a sports injury prevention center affiliated with an academic pediatric medical center between April 2013 and February 2018. The focus of the center is to reduce the risk of sport-related injuries and conduct research on injury prevention in sport. Specifically, each athlete completes an extensive questionnaire detailing sports participation, previous injury history, training regimen, dietary intake, and sleeping habits followed by anatomic measurements, performance measures, biomechanical evaluations, functional movement assessments, and physical fitness screening. At the end of the evaluation a list of injuries for which the athletes are at highest risk is generated and a prescription for decreasing the risk of those injuries is given to the athlete. Athletes are either self-referred, referred by other athletes who have gone through an IPE, referred in by coaches, or are referred in by physicians who have treated them for past injuries. All stages of athletes from early amateur through professional are evaluated. Only participants aged 18 years and younger were included in these analyses. The institutional review board of Boston Children’s Hospital approved this study.

Participants were provided with a list of the most common sports and asked to select the three organized sports they prioritize participating in yearly; participants were allowed to write in sports not listed. Individual sport was defined as a sport not requiring another person to compete with you (not including the opponent or events such as relays). Individual sports included swimming, cross country, gymnastics, tennis, fencing, track and field, boxing, equestrian, dance, figure skating, long distance running, martial arts, diving, wrestling, and sailing. For the purposes of this analysis, participants were analyzed as individual sport athletes only when they participated exclusively in individual sports year-round; any athlete who participated in a team sport during any season was categorized as a team sport athlete. Single sport athletes were defined as those who only listed participation in one sport during the year and measured as a binary yes/no variable.

Reason for playing was coded into thematic categories. Fun reasons for playing included: to have fun, to make friends, to be part of a team, or enjoyment/love of the sport. Goal-oriented reasons for playing included: to obtain a school scholarship, to control weight, to be strong, to be popular, to make parents happy, or to win a championship. Strenuous and moderate exercise was measured using the Marx Activity Rating Scale and analyzed categorically by how often a participant engaged in either level of exercise outside of their usual practice regimens over the course of a week (0 x/week, 1-2x/week, ≥3x/week).

BMI was adjusted by age and gender using ranges recommended by the Center for Disease Control (CDC, 2017). Anxiety and or depression was defined as clinician diagnosed, but was self-reported by the participant. Alcohol consumption was defined as a binary measure where “no” was defined as an athlete who reported never drinking alcohol and “yes” was defined as an athlete that selected a response option ranging from less than 1x per month to daily.

Statistical analyses

All analyses were performed using Stata® software version 14 (©StataCorp, 2015). We screened for potential covariables by first conducting univariable analyses. A Pearson’s Chi-square or Fisher’s exact test was used to compare categorical variables. Any variable that differed between individual sport and team sport athletes on univariable comparisons with a statistical significance of p <0.2 was entered into a logistic regression model in order to determine the independent effect of each variable on our main outcomes. A p-value of <0.05 or a 95% confidence interval that did not cross 1 were used to define statistical significance.

There were 756 athletes that underwent an injury prevention evaluation during the study period. The mean age of participants was 13.5 ± 2.5 years. The mean age was similar between male and female athletes (13.5 ± 2.6 years, and 13.6 ± 2.6, p = 0.11). Just over half of the study cohort was comprised of female athletes ( Table 1 ). Nearly three quarters of participants had a normal BMI and most participants identified as White ( Table 1 ).

Athletes that underwent an injury prevention evaluation (n = 756).

*Not all respondents answered every question

There were no significant differences in type of sport (individual vs. team) between age groups but a higher proportion of female athletes only participated in individual sports ( Table 2 ). Self-reported diagnoses of depression and or anxiety were also higher among individual sport athletes (13% vs. 7%, p < 0.01) and among female athletes (10.3% vs. 4.9%, p < 0.01). While overall participants were largely within a normal BMI range for their age and gender, the proportion of overweight/obese participants was lower among individual sport athletes ( Table 2 ). Few (n = 8) athletes were underweight. Individual sport athletes had a higher proportion of athletes playing for goal-oriented reasons compared to team sport athletes ( Table 2 ). Individual sport athletes also had a higher proportion of athletes that played only one sport all year ( Table 2 ). There was no significant difference overall between athletes who played mostly for fun compared to those who played for goal-oriented reasons in the proportion with anxiety and depression (8.1% vs. 7.8%, p = 0.87).

Univariable comparisons between individual and team sport athletes †

† Pearson’s χ 2 or Fisher's Exact. Underweight not included (n = 8).

Because single sport athletes included dancers, figure skaters, and gymnasts—sports for which athletes typically train year round—we thought they might have a disproportionate effect on whether athletes who trained year round were also those who only participated in one sport. Thus, in order to ensure that the effect of these athletes was not solely responsible for our findings, we repeated the analyses after removing these athletes.

After removing dancers, figure skaters, and gymnasts, individual sport athletes were still more likely to play one sport exclusively (31% vs. 13%, p < 0.01); however, individual sport athletes were no longer significantly more likely to train year round compared to team sport athletes (82% vs. 73%, p = 0.15). Team sport athletes were more likely to engage in moderate to strenuous exercise outside of practice.

After adjusting for potential covariates, individual sport athletes were significantly less likely to play for fun, more likely to train year round, and more likely to only participate in a single sport. In addition, individual sport athletes were more likely to carry a diagnosis of anxiety or depression, but the significance of this finding decreased as we adjusted for the other variable ( Table 3 ).

Independent associations after adjusting for gender, age, and BMI ‡

‡ Models adjusted for gender and age and gender adjusted BMI.

We hypothesized that type of sport, team vs. individual, would be associated with athletes’ motivations for playing and/or mental health diagnoses. Concerning the relationship between sports and mental health, current research suggests that youth who engage in sports have lower levels of self-reported diagnoses of anxiety and depression than those reported by the general population (Jewett et al., 2014 ). In our study, 8% of athletes reported suffering from physician-diagnosed anxiety or depression, a statistic below the national average. Data from the National Surveys on Drug Use and Health found prevalence rates of major depressive episodes in adolescents and young adults to be 11.3% in 2014, up from 8.7% in 2005 (Mojtabai et al., 2016 ). Therefore, while depression and anxiety rates seem to be increasing over time in the general adolescent population, individual and team sports seem to help mediate the presentation of psychological disorders in adolescents and serve as effective treatment measures (Vella et al., 2017 ). The physical benefits of exercise as well as the sense of accomplishment and self-esteem youth gain by playing sports may contribute to fewer mental health issues (Eime et al., 2013 ; Toseeb et al., 2014 ; Vella et al., 2017 ). In our study, a significantly higher proportion of individual sport athletes suffered from anxiety or depression. While both team and individual sports may be protective factors for these disorders, a greater proportion of individual sport athletes (13%) reported anxiety or depression compared to team sport athletes (7%). After adjusting for other covariates, sport type (individual vs. team) remained associated with a diagnosis of anxiety or depression, but the findings were no longer statistically significant (OR 1.72; 95%CI 0.9-3.2).

In regression analysis however, playing an individual sport alone was not a risk factor for anxiety and dep-resssion. As most of our study individual athletes were female, it raises the question of whether this points to a specific patient population who may be at increased risk for mental health issues. For example, research has shown that sex differences in brain structure and function, such as those that promote reproductive success, are also likely to put women at greater risk of mood and anxiety disorders (Altemus et al., 2014 ). Therefore, it is important to consider how the coupling of gender and sport type may affect risk for mental health issues.

Sports can provide relief for symptoms of mental health issues, allowing adolescents to alleviate and manage their problems (Toseeb et al., 2014 ). This mechanism of amelioration may be most effective through team sports because of their added social component (Boone and Leadbeater, 2006 ; Sabiston et al., 2016 ). The sense of community and the relationships that youth build on teams with peers and adults promote feelings of comfort and acceptance and may reduce emotional problems and insecurities (Boone and Leadbeater, 2006 ; Eime et al., 2013 ; Sabiston et al., 2016 ). Although the benefits of individual sports are evident, they may be grounded in the general effects of physical activity rather than the culture of teamwork in which group athletes train and compete.

A higher proportion of adolescent individual sport athletes also reported training year round in a sport and playing only one sport year round. This type of consistent attention to one sport may suggest a challenging investment in a single activity and make single-sport athletes more vulnerable to anxiety and depression (Schaal et al., 2011 ). We also found that team sport athletes are more likely to work out strenuously three or more times per week, outside of regular practices; having a potentially more balanced schedule and equal distribution of energy among multiple activities could contribute to lower rates of anxiety and depression. Individual athletes could be more likely to suffer from mental health problems, in part, because they may feel increased pressure to perform. Dedicating all of their energy to succeeding in a single athletic pursuit, they may be overly focused on the outcomes and experience greater internal attribution after failure (Nixdorf et al., 2016 ). Whereas team sport athletes can depend on the support of their teammates, individual sport athletes rely on only their own preparation and skill level to achieve success (Kajbafnezhad et al., 2011 ; Nixdorf et al., 2016 ). Competing alone, individual sport athletes can not only experience loneliness, but also, if they do not succeed in accomplishing their goals, may experience the weight of failure alone (Nixdorf et al., 2016 ). While we did not collect data on the pattern of motivation over the course of the athlete’s career, it can be hypothesized that this increased pressure on individual athletes may also result in a change of their intrinsic motivation from pleasure or enjoyment to goal-oriented reasons such as outperforming others.

This study further identifies a major difference between team and individual sports related to what factors motivate adolescents to play each type of sport (Deci and Ryan, 2000 ). Given the critical role of motivation in determining behavior and effort, a closer look at what drives athletes to pursue success in their sport has the potential to be quite informative. The achievement goal theory and self-determination theory are the most common in determining what motivates athletes, and common links are found between the two (Ntoumanis, 2001 ). Achievement goal theory consists of two goal orientations: task, which is the need to perform well, and ego, which is driven by the desire to outperform others. Self-determination theory, on the other hand, “is based on the gratification of the three basic psychological needs for competence, autonomy and relatedness” (Georgiadis et al., 2001 , p. 2). Theories provide interesting context when examining athletes in performing “for fun” or for goal-oriented reasons.”

A greater percentage of individual-sport athletes reported playing sports for goal-oriented reasons, as opposed to for fun. The social component of team sports may play a part in this outcome, as team engagement presents more opportunities for fun than the solo training that many individual sports require. While team sports involve a community and network of players, individual sports focus more directly on one player’s singular track to success. In addition, the possible relationship between individual sports and internal attribution could explain the tendency for individual sport athletes to be goal-oriented. Players who internalize and dread failure would be more likely to hyper-focus on results, enduring the sport in order to attain success, instead of enjoying it (Stenling et al., 2014 ). The nature of scoring for individual sports could also contribute to why athletes are goal-oriented. In sports including running, swimming, and gymnastics, success is usually quantified by a time or number of points (Schaal et al., 2011 ). As a result, individual sport athletes can easily track their success and set concrete, numerical goals in attempt to achieve it (Schaal et al., 2011 ). While goal-oriented motivation is still intrinsically driven, such intense focus on outcome has the potential to strip the athlete of enjoyment in training and competition.

The reach of this study is potentially restricted by a few factors, and underscores the need for further study. The participants involved were not randomly selected, as they are all patients at a sports injury prevention center. The sample is also predominantly White athletes < 18 years old. The narrow representation of this group suggests that the results may be limited in their generalizability. Moreover, while we asked participants if they were diagnosed with anxiety or depression, the responses were ultimately self-reported and not confirmed by medical records or independent professional evaluation. In addition, the questionnaire’s joint assessment of depression and anxiety in only one question does not provide a comprehensive mental health evaluation; it neither distinguishes between disorders that athletes are reporting nor gauges the severity of their symptoms.

Prospective studies examining the effect of team and individual sports on adolescent mental health in a longitudinal manner might further reveal both the immediate and long-term impacts of sport participation on mental health. In addition, to reflect a realistic sample of the adolescent population, studies should include participants who represent a diversity of races and ages.

Among young athletes, anxiety and depression are more common in those who play individual sports than those who play team sports. In addition, adolescent individual-sport athletes are more likely to play their sport for goal-oriented reasons, instead of for fun when compared to their counterparts participating in team sports. Researchers should continue to investigate how children’s motivation for participating in sports may relate to or explain why team sports mediate psychological problems more effectively than individual sports. It is possible that the social opportunities associated with team sports promote fun and stress relief, while training for individual sports is lonelier and can lead to less healthy goal setting and internal attribution after failure.

Acknowledgements

Dr. William Meehan III research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament. The remaining authors do not have any funding sources to disclose.Financial disclosures: Dr. Meehan receives royalties from 1) ABC-Clio publishing for the sale of his books, Kids, Sports, and Concussion: A guide for coaches and parents , and Concussions; 2) Springer International for the book Head and Neck Injuries in Young Athlete and 3) Wolters Kluwer for working as an author for UpToDate . Dr. Meehan’s research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and the National Football League. No other authors have any financial disclosures or conflicts of interest. This study complied with the laws of the country of the authors’ affiliation.

Biographies

Emily PLUHAR

Psychologist in the Division of Sports Medicine at Boston Children’s Hospital

Research interests

Adolescent mental health.

E-mail: [email protected]

Caitlin MCCRACKEN

A research analyst at Oregon State University School of Pharmacy.

Sports medicine.

E-mail: ude.usho@accarccm

Kelsey GRIFFITH

Performance Enhancement & Rehabilitation Specialist at The Micheli Center for Sports Injury Prevention.

The mental challenges associated with sport and sport injury to better reach self-determined goals and optimal performance.

E-mail: moc.retnecilehcimeht@htiffirgyeslek

Melissa CHRISTINO

Orthopaedic Surgeon at Boston Children’s Hospital

The psychological aspects of injury and recovery.

E-mail: [email protected]

Dai SUGIMOTO

Associate Director of Clinical Research at the Micheli Center for Sports Injury Prevention and Instructor at Harvard Medical School.

Sports injuries.

E-mail: [email protected]

William P. MEEHAN III

Director of the Micheli Center for Sports Injury Prevention, Director of Research for the Brain Injury Center at Boston Children’s Hospital.

Sports injuries, spine injuries, and concussive brain injury.

E-mail: [email protected]

• Adachi P.J.C., Willoughby T. (2014) 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 . Journal of Youth and Adolescence 43 ( 1 ), 137-145. [ PubMed ] [ Google Scholar ]
• Altemus M., Sarvaiya N., Epperson C.N. (2014) Sex differences in anxiety and depression clinical perspectives . Frontiers in neuroendocrinology, 35 ( 3 ), 320-330. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Boone E. M., Leadbeater B. J. (2006) Game on: diminishing risks for depressive symptoms in early adolescence through positive involvement in team sports . Journal of Research on Adolescence 16 ( 1 ), 79-90. [ Google Scholar ]
• Centers for Disease Control and Prevention. (2017) Clinical Growth Charts . Available from URL https://www.cdc.gov/growthcharts/clinical_charts.htm
• Deci E. L., Ryan R. M. (2000) Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being . American Psychologist 55 ( 1 ), 68-78. [ PubMed ] [ Google Scholar ]
• Eime R. M., Young J. A., Harvey J. T., Charity M. J., Payne W. R. (2013) A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport . International Journal of Behavioral Nutrition and Physical Activity, 10 ( 1 ), 98. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Findlay L.C., Bowker A. (2009) The link between competitive sport participation and self-concept in early adolescence: a consideration of gender and sport orientation . Journal of Youth and Adolescence 38 ( 1 ), 29-40. [ PubMed ] [ Google Scholar ]
• Georgiadis M.M., Biddle S.J.H., Chatzisarantis N.L.D. (2001) The mediating role of self-determination in the relationship between goal-orientations and physical self-worth in Greek exercisers . European Journal of Sport Science 1 ( 5 ), 1-9. [ Google Scholar ]
• Glover J., Fritsch S. L. (2018) #KidsAnxiety and social media: a review . Child and Adolescent Psychiatric Clinics of North America, 27 ( 2 ), 171-182. [ PubMed ] [ Google Scholar ]
• Hanrahan S.J., Cerin E. (2009) Gender, level of participation, and type of sport: Differences in achievement goal orientation and attributional style . Journal of Science and Medicine in Sport, 12 ( 4 ), 508-512. [ PubMed ] [ Google Scholar ]
• Jewett R., Sabiston C.M., Brunet J., O’Loughlin E.K., Scarapicchia T., O’Loughlin J. (2014) School sport participation during adolescence and mental health in early adulthood . Journal of Adolescent Health 55 ( 5 ), 640-4. [ PubMed ] [ Google Scholar ]
• Kajbafnezhad H., Ahadi H., Heidarie A. R., Askari P., Enayati M. (2011) Difference between team and individual sports with respect to psychological skills, overall emotional intelligence and athletic success motivation in Shiraz city athletes . Journal of Basic and Applied Scientific Research 1 ( 11 ), 1904-1909. [ Google Scholar ]
• Lubans D., Richards J., Hillman C., Faulkner G., Beauchamp M., Nilsson M., Kelly P., Smith J., Raine L., Biddle S. (2016) Physical activity for cognitive and mental health in youth: a systematic review of mechanisms . The Journal of Pediatrics 138 ( 3 ). [ PubMed ] [ Google Scholar ]
• McMahon E.M., Corcoran P., O’Regan G., Keeley H., Cannon M., Carli V., Wasserman C., Hadlaczky G., Sarchiapone M., Apter A., Balazs J., Balint M., Bobes J., Brunner R., Cozman D., Haring C., Iosue M., Kaess M., Kahn J.P., Nemes B., Podlogar T., Poštuvan V., Sáiz P., Sisask M., Tubiana A., Värnik P., Hoven C.W., Wasserman D. (2017) Physical activity in European adolescents and associations with anxiety, depression and well-being . European Child & Adolescent Psychiatry 26 ( 1 ), 111-122. [ PubMed ] [ Google Scholar ]
• Miller K. E., Barnes G. M., Melnick M. J., Sabo D. F., Farrell M. P. (2002) Gender and racial/ethnic differences in predicting adolescent sexual risk: athletic participation versus exercise . Journal of Health and Social Behavior 43 ( 4 ), 436. [ PubMed ] [ Google Scholar ]
• Miller K. E., Hoffman J. H. (2009) Mental well-being and sport-related identities in college students . Sociology of Sport Journal 26 ( 2 ), 335-356. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Mojtabai R., Olfson M., Han B. (2016) National trends in the prevalence and treatment of depression in adolescents and young adults . Pediatrics 138 ( 6 ). [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Nixdorf I., Frank R., Hautzinger M., Beckmann J. (2013) Prevalence of depressive symptoms and correlating variables among German elite athletes . Journal of Clinical Sport Psychology 7 ( 4 ), 313-326. [ Google Scholar ]
• Nixdorf I., Frank R., Beckmann J. (2016) Comparison of athletes' proneness to depressive symptoms in individual and team sports: research on psychological mediators in junior elite athletes . Frontiers in Psychology 7 . [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ntoumanis N. (2001) Empirical links between achievement goal theory and self-determination theory in sport . Journal of Sports Sciences 19 , 397-409. [ PubMed ] [ Google Scholar ]
• Pedersen M.T., Vorup J., Nistrup A., Wikman J.M., Alstrøm J.M., Melcher P.S., Pfister G.U., Bangsbo J. (2017) Effect of team sports and resistance training on physical function, quality of life, and motivation in older adults . Scandinavian Journal of Medicine & Science in Sports 27 ( 8 ), 852-864. [ PubMed ] [ Google Scholar ]
• Promoting Physical Activity. (2017) : Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents 4th edition Elk Grove Village: American Academy of Pediatrics; 193-203. [ Google Scholar ]
• Sabiston C. M., Jewett R., Ashdown-Franks G., Belanger M., Brunet J., O’Loughlin E., O’Loughlin J. (2016) Number of years of team and individual sport participation during adolescence and depressive symptoms in early adulthood . Journal of Sport and Exercise Psychology 38 ( 1 ), 105-110. [ PubMed ] [ Google Scholar ]
• Schaal K., Tafflet M., Nassif H., Thibault V., Pichard C., Alcotte M., Guillet T., El Helou N., Berthelot G., Simon S., Toussaint J.F. (2011) Psychological balance in high level athletes: gender-based differences and sport-specific patterns . PLoS ONE 6 ( 5 ). [ PMC free article ] [ PubMed ] [ Google Scholar ]
• StataCorp. (2015) Stata Statistical Software: Release 14 . College Station TX: StataCorp LP [ Google Scholar ]
• Stenling A., Hassmén P., Holmström S. (2014) Implicit beliefs of ability, approach-avoidance goals and cognitive anxiety among team sport athletes . European Journal of Sport Science 14 ( 7 ), 720-729. [ PubMed ] [ Google Scholar ]
• Strong W.B., Malina R.M., Blimkie C.J.R., Daniels S.R., Dishman R.K., Gutin B., Hergenroeder A.C., Must A., Nixon P.A., Pivarnik J.M., Rowland T., Trost S., Trudeau F. (2005) Evidence based physical activity for school-age youth . The Journal of Pediatrics 146 ( 6 ), 732-737. [ PubMed ] [ Google Scholar ]
• Toseeb U., Brage S., Corder K., Dunn V. J., Jones P. B., Owens M., St. Clair M.C., van Sluijs E.M.F., Goodyer I. M. (2014) Exercise and depressive symptoms in adolescents . JAMA Pediatrics 168 ( 12 ), 1093-1100. [ PubMed ] [ Google Scholar ]
• Vella S., Cliff D., Magee C., Okely A. (2015) Associations between sports participation and psychological difficulties during childhood: a two-year follow up . Journal of Science and Medicine in Sport 18 ( 3 ), 304-309. [ PubMed ] [ Google Scholar ]
• Vella S. A., Swann C., Allen M. S., Schweickle M. J., Magee C. A. (2017) Bidirectional associations between sport involvement and mental health in adolescence . Medicine & Science in Sports & Exercise 49 ( 4 ), 687-694. [ PubMed ] [ Google Scholar ]

Australian Government Department of Health and Aged Care

National Mental Health Workforce Strategy – Research papers

This collection contains research papers that informed the development of the National Mental Health Workforce Strategy.

Scroll down to access downloads and media.

Mental health workforce – Educational institutes review – Final report

Mental health workforce – Labour market analysis – Final report

National Mental Health Workforce Strategy – A literature review

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• Mental health and suicide prevention
• Health workforce
• National Mental Health Workforce Strategy Taskforce
• National Mental Health Workforce Strategy 2022–2032

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Cost of living help and a future made in Australia

Strengthening medicare and the care economy.

Building a better health system than improves outcomes

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High‑quality health services through Medicare

Boosting access to essential health services

Building a better healthcare system

The Government is investing $2.8 billion to continue its commitment to strengthen Medicare. This includes the $1.2 billion package to address pressures facing the health system, which provides:

• $882.2 million to support older Australians avoid hospital admission, be discharged from hospital earlier and improve their transition out of hospital to other appropriate care.
• $227 million to deliver a further 29 Medicare Urgent Care Clinics and boost support for regional and remote clinics. This will increase the total number of clinics across Australia to 87. Since commencing last year, existing clinics have already provided almost 400,000 bulk‑billed visits.
• $90 million to address health workforce shortages by making it simpler and quicker for international health practitioners to work in Australia.

Rohan’s daughter Zoya has been  off school with a runny nose and a cough. By 6pm, she is lethargic and has a fever.

Rohan is concerned because his regular GP is now closed. Instead of waiting for hours at the emergency department, he takes Zoya to a Medicare Urgent Care Clinic, without having to make an appointment. 

During the bulk billed visit, Zoya is diagnosed with an infection by the doctor and prescribed appropriate medication. Rohan and Zoya leave within an hour of arrival. Zoya makes a full recovery.

Improving health outcomes

Almost half of Australians live with a chronic condition. This Budget will provide $141.1 million for research and services for people living with chronic conditions, including bowel and skin cancer, diabetes and dementia.

To improve health outcomes, the Government is providing:

• Support for Australians to enjoy healthier, more active lives by investing $132.7 million in sport participation and performance programs.
• $825.7 million to ensure Australians can continue to access testing for and vaccinations against COVID‑19. The Government is also ensuring continued access to oral antiviral medicines on the Pharmaceutical Benefits Scheme.
• $41.6 million over two years to continue funding for alcohol and other drug treatment and support services, including the Good Sports alcohol management program for community sporting clubs.

The Government is allocating an additional $411.6 million (for a total $1.6 billion over 13 years) through the Medical Research Future Fund to continue existing research and introduce two new research missions for low‑survival cancers and reducing health inequities.

Improving access to medicines

The Government is investing $3.4 billion for new and amended listings to the Pharmaceutical Benefits Scheme, which means eligible patients can save on treatment costs.

By expanding the Closing the Gap Pharmaceutical Benefits Scheme Co‑payment Program, eligible First Nations patients will have free or cheaper access to all Pharmaceutical Benefits Scheme medicines.

Australians will benefit from $141.1 million to support and expand the National Immunisation Program.

Mental health support

The Government’s $888.1 million mental health package over eight years will help people get the care they need, while relieving pressure on the Better Access initiative and making it easier to access services.

A free, low‑intensity digital service will be established to address the gap for people with mild mental health concerns. From 1 January 2026, Australians will be able to access the service without a referral and receive timely, high‑quality mental health support. Once fully established, 150,000 people are expected to make use of this service each year.

The Government is improving access to free mental health services through a network of walk‑in Medicare Mental Health Centres, built on the established Head to Health network. The upgraded national network of 61 Medicare Mental Health Centres will open by 30 June 2026. They will provide clinical services for adults with moderate‑to‑severe mental health needs.

For Australians with complex mental health needs, funding will be provided for Primary Health Networks to partner with GPs to deliver multidisciplinary, wraparound support services and care coordination.

Improving the aged care system

Providing quality care

The Budget provides $2.2 billion to deliver aged care reforms and continue implementing recommendations from the Royal Commission into Aged Care Quality and Safety.

The new Aged Care Act will put the rights and needs of older people at the centre of the aged care system. The new Act will provide the framework for fundamental change within the aged care sector.

More Home Care Packages

The Government is investing $531.4 million to release an additional 24,100 Home Care Packages in 2024–25. This will help reduce average wait times and enable people to age at home if they prefer to do so.

Improving aged care regulation

Funding of $110.9 million over four years will support an increase in the Aged Care Quality and Safety Commission’s regulatory capabilities.

The Government is investing $1.2 billion in critical digital systems to support the introduction of the new Aged Care Act and contemporary IT systems.

The My Aged Care Contact Centre will receive $37 million to reduce call‑waiting times for people seeking information and access to aged care.

Higher wages for aged care workers

The Government has committed to fund the Fair Work Commission decision to increase the award wage for direct and indirect aged care workers once the final determination is made. This will build on the $11.3 billion already allocated to support the interim 15 per cent wage increase for aged care workers.

The Government is providing $87.2 million for workforce initiatives to attract nurses and other workers into aged care.

Reforming the disability sector

Better and more sustainable services

Getting the National Disability Insurance Scheme (NDIS) back on track

A further $468.7 million is being provided to support people with disability and get the NDIS back on track. This includes:

• $214 million over two years to fight fraud and to co‑design NDIS reforms with people with disability, announced earlier this year
• $160.7 million to upgrade the NDIS Quality and Safeguards Commission’s information technology
• $45.5 million to establish a NDIS Evidence Advisory Committee
• $20 million to start consultation and design on reforms to help NDIS participants and people with disability navigate services.

This builds on $732.9 million provided in the 2023–24 Budget.

In December 2023, National Cabinet agreed to work together to improve the experience of participants and restore the original intent of the Scheme to support people with permanent and significant disability, within a broader ecosystem of supports. This builds on an earlier decision by National Cabinet to ensure Scheme sustainability and achieve an 8 per cent growth target by 1 July 2026, with further moderation as the NDIS matures.

Improving employment for people with disability

A $227.6 million investment will support a new specialised disability employment program to replace the existing Disability Employment Services program by 1 July 2025. This includes a modern digital platform for providers and participants. These reforms will support more people with disability into sustainable work, through a program with greater flexibility, increased individual supports, and better service quality. Eligibility will be expanded to include volunteers outside the income support system and those with less than eight hours per week work capacity.

Delivering essential services

Investing in reliability and security

Strengthening resourcing for Services Australia

The Government is delivering safer and more efficient government services for all Australians.

A $1.8 billion provision will support delivery of customer and payment services. This includes funding for frontline and service delivery staff to manage claims, respond to natural disasters and improve the cyber security environment. The Government is providing $314.1 million over two years to strengthen safety and security at Services Australia centres.

The Government is investing $580.3 million over four years and $139.6 million per year ongoing to sustain the myGov platform and identify potential enhancements. A further $50 million will improve usability, safety and security of the myGov platform and ensure Services Australia can support people to protect their information and privacy.

Strengthening the Australian Taxation Office (ATO) against fraud

There will be $187.4 million to better protect taxpayer data and Commonwealth revenue against fraudulent attacks on the tax and superannuation systems. Funding will upgrade the ATO’s information and communications technologies and increase fraud prevention capabilities to manage increasing risk, prevent revenue loss, and support victims of fraud and cyber crime.

Looking after our veterans

Veterans’ claims processing is prioritised with an additional $186 million for staffing resources and $8.4 million to improve case management and protect against cyber risk. The Government will provide $222 million to harmonise veterans’ compensation and rehabilitation legislation.

A further $48.4 million will be available for Veterans’ Home Care and Community Nursing programs and $10.2 million to provide access to funded medical treatment for ill and injured veterans while their claims for liability are processed.

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