mental health in athletes research paper

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

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

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

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

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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.

Availability of Data and Materials

Not applicable.

Abbreviations

International Olympic Committee

Australian Institute of Sport

Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, et al. Mental health in elite athletes: International Olympic Committee consensus statement (2019). British Journal of Sports Medicine. 2019;53(11):667–99. https://doi.org/10.1136/bjsports-2019-100715 .

Article   PubMed   Google Scholar  

Gouttebarge V, Castaldelli-Maia JM, Gorczynski P, Hainline B, Hitchcock ME, Kerkhoffs GM, et al. Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. British Journal of Sports Medicine. 2019;53(11):700–6.

Rice SM, Gwyther K, Santesteban-Echarri O, Baron D, Gorczynski P, Gouttebarge V, et al. Determinants of anxiety in elite athletes: a systematic review and meta-analysis. British Journal of Sports Medicine. 2019;53(11):722–30.

Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG. The mental health of elite athletes: a narrative systematic review. Sports Med. 2016;46(9):1333–53. https://doi.org/10.1007/s40279-016-0492-2 .

Article   PubMed   PubMed Central   Google Scholar  

Allen SV, Hopkins WG. Age of peak competitive performance of elite athletes: a systematic review. Sports Medicine. 2015;45(10):1431–41.

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry. 2005;62(6):593–602.

Gulliver A, Griffiths KM, Mackinnon A, Batterham PJ, Stanimirovic R. The mental health of Australian elite athletes. Journal of science and medicine in sport. 2015;18(3):255–61.

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

Rice SM, Parker AG, Rosenbaum S, Bailey A, Mawren D, Purcell R. Sport-related concussion and mental health outcomes in elite athletes: a systematic review. Sports medicine. 2018;48(2):447–65.

Hammond T, Gialloreto C, Kubas H, Davis HH IV. The prevalence of failure-based depression among elite athletes. Clinical Journal of Sport Medicine. 2013;23(4):273–7.

Frank R, Nixdorf I, Beckmann J. Depression among elite athletes: prevalence and psychological factors. Deut Z Sportmed. 2013;64:320–6.

Google Scholar  

Schaal K, Tafflet M, Nassif H, Thibault V, Pichard C, Alcotte M, et al. Psychological balance in high level athletes: gender-based differences and sport-specific patterns. PLoS One. 2011;6(5):e19007. https://doi.org/10.1371/journal.pone.0019007 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

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

Article   Google Scholar  

Gouttebarge V, Aoki H, Verhagen EA, Kerkhoffs GM. A 12-month prospective cohort study of symptoms of common mental disorders among European professional footballers. Clinical Journal of Sport Medicine. 2017;27(5):487–92.

Gutmann MC, Pollock ML, Foster C, Schmidt D. Training stress in Olympic speed skaters: a psychological perspective. The Physician and Sportsmedicine. 1984;12(12):45–57.

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

Gupta L, Morgan K, Gilchrist S. Does elite sport degrade sleep quality? A systematic review. Sports Medicine. 2017;47(7):1317–33.

Kölling S, Steinacker JM, Endler S, Ferrauti A, Meyer T, Kellmann M. The longer the better: sleep–wake patterns during preparation of the world rowing junior championships. Chronobiology international. 2016;33(1):73–84.

Berntsen H, Kristiansen E. Guidelines for Need-Supportive Coach Development: The Motivation Activation Program in Sports (MAPS). International Sport Coaching Journal. 2019;6(1):88–97.

Sabato TM, Walch TJ, Caine DJ. The elite young athlete: strategies to ensure physical and emotional health. Open access journal of sports medicine. 2016;7:99.

Saw AE, Main LC, Gastin PB. Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review. British Journal of Sports Medicine. 2016;50(5):281–91. https://doi.org/10.1136/bjsports-2015-094758 .

Donnelly AA, MacIntyre TE, O’Sullivan N, Warrington G, Harrison AJ, Igou ER, et al. Environmental influences on elite sport athletes well being: from gold, silver, and bronze to blue green and gold. Frontiers in psychology. 2016;7:1167.

Swartz L, Hunt X, Bantjes J, Hainline B, Reardon CL. Mental health symptoms and disorders in Paralympic athletes: a narrative review. British Journal of Sports Medicine. 2019:bjsports-2019-100731.

Knights S, Sherry E, Ruddock-Hudson M. Investigating elite end-of-athletic-career transition: a systematic review. Journal of Applied Sport Psychology. 2016;28(3):291–308.

Bundon A, Ashfield A, Smith B, Goosey-Tolfrey VL. Struggling to stay and struggling to leave: The experiences of elite para-athletes at the end of their sport careers. Psychology of Sport and Exercise. 2018;37:296–305.

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

Castaldelli-Maia JM. Gallinaro JGdMe, Falcão RS, Gouttebarge V, Hitchcock ME, Hainline B et al. Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment. British Journal of Sports Medicine. 2019;53(11):707–21. https://doi.org/10.1136/bjsports-2019-100710 .

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

Donohue B, Gavrilova Y, Galante M, Gavrilova E, Loughran T, Scott J, et al. Controlled evaluation of an optimization approach to mental health and sport performance. Journal of Clinical Sport Psychology. 2018;12(2):234–67.

Gavrilova Y, Donohue B, Galante M. Mental health and sport performance programming in athletes who present without pathology: A case examination supporting optimization. Clinical Case Studies. 2017;16(3):234–53.

Bapat S, Jorm A, Lawrence K. Evaluation of a mental health literacy training program for junior sporting clubs. Australasian psychiatry. 2009;17(6):475–9.

Beauchemin J. College student-athlete wellness: An integrative outreach model. College Student Journal. 2014;48(2):268–80.

Kern A, Heininger W, Klueh E, Salazar S, Hansen B, Meyer T, et al. Athletes connected: results from a pilot project to address knowledge and attitudes about mental health among college student-athletes. Journal of Clinical Sport Psychology. 2017;11(4):324–36.

Henriksen K, Schinke R, Moesch K, McCann S, Parham William D, Larsen CH, et al. Consensus statement on improving the mental health of high performance athletes. International Journal of Sport and Exercise Psychology. 2019:1–8. https://doi.org/10.1080/1612197X.2019.1570473 .

Moesch K, Kenttä G, Kleinert J, Quignon-Fleuret C, Cecil S, Bertollo M. FEPSAC position statement: mental health disorders in elite athletes and models of service provision. Psychology of Sport and Exercise. 2018.

Schinke RJ, Stambulova NB, Si G, Moore Z. International society of sport psychology position stand: Athletes’ mental health, performance, and development. International journal of sport and exercise psychology. 2018;16(6):622–39.

Queensland Academy of Sport. Athlete wellbeing framework. Queensland Academy of Sport, https://www.qasport.qld.gov.au/about/documents/qas-athlete-wellbeing-framework.pdf . 2014. Accessed 20 May 2019.

Lomax L. System recognises importance of support to help athletes with mental health issues. English Institute of Sport, https://www.eis2win.co.uk/2014/08/21/system-recognises-importance-support-help-athletes-mental-health-issues/ . 2014. .

Australian Football League Players' Association. Development and wellbeing report 2014. Australian football league players' association, http://www.aflplayers.com.au/wp-content/uploads/2015/03/Dev-Wellbeing-2015.pdf . 2014. Accessed 20 May 2019.

Brown GT, Hainline B, Kroshus E, Wilfert M. Mind, body and sport: understanding and supporting student-athlete mental wellness. IN: NCAA: Indianapolis; 2014.

Neal TL, Diamond AB, Goldman S, Klossner D, Morse ED, Pajak DE, et al. Inter-association recommendations for developing a plan to recognize and refer student-athletes with psychological concerns at the collegiate level: an executive summary of a consensus statement. Journal of Athletic Training. 2013;48(5):716–20.

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

Bronfenbrenner U. Ecological systems theory: Jessica Kingsley Publishers; 1992.

Haggerty RJ, Mrazek PJ. Reducing risks for mental disorders: Frontiers for preventive intervention research: National Academies Press; 1994.

Purcell R, Goldstone S, Moran J, Albiston D, Edwards J, Pennell K, et al. Toward a Twenty-First Century Approach to Youth Mental Health Care. International Journal of Mental Health. 2011;40(2):72–87. https://doi.org/10.2753/IMH0020-7411400204 .

McGorry PD, Purcell R, Goldstone S, Amminger GP. Age of onset and timing of treatment for mental and substance use disorders: implications for preventive intervention strategies and models of care. Current opinion in psychiatry. 2011;24(4):301–6.

Rice SM, Purcell R, McGorry PD. Adolescent and young adult male mental health: transforming system failures into proactive models of engagement. Journal of Adolescent Health. 2018;62(3):S9–S17.

Pierce D, Liaw S-T, Dobell J, Anderson R. Australian rural football club leaders as mental health advocates: an investigation of the impact of the Coach the Coach project. International journal of mental health systems. 2010;4(1):10.

Naoi A, Watson J, Deaner H, Sato M. Multicultural issues in sport psychology and consultation. International Journal of Sport and Exercise Psychology. 2011;9(2):110–25.

Vandewalle J, Debyser B, Beeckman D, Vandecasteele T, Van Hecke A, Verhaeghe S. Peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services: A literature review. International Journal of Nursing Studies. 2016;60:234–50.

Donohue B, Galante M, Hussey J, Lee B, Paul N, Perry JE, et al. Empirical Development of a Screening Method to Assist Mental Health Referrals in Collegiate Athletes. Journal of Clinical Sport Psychology. 2019:1–28. https://doi.org/10.1123/jcsp.2018-0070 .

Rice SM, Parker AG, Mawren D, Clifton P, Harcourt P, Lloyd M, et al. Preliminary psychometric validation of a brief screening tool for athlete mental health among male elite athletes: the Athlete Psychological Strain Questionnaire. International Journal of Sport and Exercise Psychology. 2019:1–16.

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

Morse ED. Sports Psychiatrists Working in College Athletic Departments. Clinical Sports Psychiatry. 1988;203.

Moore ZE, Bonagura K. Current opinion in clinical sport psychology: from athletic performance to psychological well-being. Current opinion in psychology. 2017;16:176–9.

Australian Institute of Sport. Mental health referral network: Support for elite AIS-funded athletes with mental health concerns. SportAus, https://www.sportaus.gov.au/ais/MHRN . 2018. Accessed 20 May 2019.

Rice S, Butterworth M, Clements M, Josifovski D, Arnold S, Schwab C, et al. Development and implementation of the national mental health referral network for elite athletes: A case study of the Australian Institute of Sport. Case Studies in Sport and Exercise Psychology. Under review. .

Currie A, McDuff D, Johnston A, Hopley P, Hitchcock ME, Reardon CL et al. Management of mental health emergencies in elite athletes: a narrative review. British Journal of Sports Medicine. 2019:bjsports-2019-100691. doi:10.1136/bjsports-2019-100691.

McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–47.

PubMed   Google Scholar  

Rice SM, Fallon BJ, Aucote HM, Möller-Leimkühler AM. Development and preliminary validation of the male depression risk scale: Furthering the assessment of depression in men. Journal of affective disorders. 2013;151(3):950–8.

Carson F, Walsh J, Main LC, Kremer P. High performance coaches' mental health and wellbeing: Applying the areas of work life model. International Sport Coaching Journal. 2018;5(3):293–300.

Spink KS, Wilson KS, Brawley LR, Odnokon P. The perception of team envrionment: The relationship between the psychological climate and members’ perceived effort in high-performance groups. Group Dynamics: Theory, Research, and Practice. 2013;17(3):150–61.

Stachan L, Côté J, Deakin J. A new view: Exploring positive youth development in elite sport contexts. Qualitative Research in Sport, Exercise and Health. 2011;3(1):9–32.

Chibanda D, Weiss HA, Verhey R, Simms V, Munjoma R, Rusakaniko S, et al. Effect of a primary care–based psychological intervention on symptoms of common mental disorders in Zimbabwe: a randomized clinical trial. Jama. 2016;316(24):2618–26.

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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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Purcell, R., Gwyther, K. & Rice, S.M. Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs. Sports Med - Open 5 , 46 (2019). https://doi.org/10.1186/s40798-019-0220-1

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• Systematic review update
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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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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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Purpose of Review

The goal of the present paper is to provide a comprehensive overview of mental health concerns in young athletes, with a focus on common disorders, as well as population-specific risk factors.

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Athletes experience similar mental health concerns as non-athlete peers, such as anxiety, depression and suicidal ideation, ADHD, eating disorders, and substance abuse. However, they also experience unique stressors that put them at risk for the development or exacerbation of mental health disorders. Student athletes have to balance academics with rigorous training regimens while focusing on optimal performance and managing high expectations. Physical injuries, overtraining, concussion, sleep disorders, and social identity are some of the factors that also impact the mental health of student athletes.

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In the recently published article “Mental Health in the Young Athlete” the following author name was inadvertently misspelled as Christine L. Master. The correct spelling of the author’s name is: Christina L. Master as shown above.

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Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Hawkins J, et al. Youth risk behavior surveillance - United States, 2015. MMWR Surveill Summ. 2016;65(6):1–174. https://doi.org/10.15585/mmwr.ss6506a1 .

Article   PubMed   Google Scholar  

High School Athletics Participation Survey National Federation of State High School Associations. 2020. https://members.nfhs.org/participation_statistics . Accessed April 4 2020.

NCAA. Student-Athletes. http://www.ncaa.org/student-athletes . Accessed Feb 28 2020.

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. https://doi.org/10.1186/1479-5868-10-135 .

Article   PubMed   PubMed Central   Google Scholar  

Taliaferro LA, Eisenberg ME, Johnson KE, Nelson TF, Neumark-Sztainer D. Sport participation during adolescence and suicide ideation and attempts. Int J Adolesc Med Health. 2011;23(1):3–10. https://doi.org/10.1515/ijamh.2011.002 .

Boone E, Leadbeater B. Game on: diminishing risks for depressive symptoms in early adolescence through positive involvement in team sports. J Res Adolesc. 2006;16(1):70–90.

Article   Google Scholar  

Taliaferro LA, Rienzo BA, Miller MD, Pigg RM Jr, Dodd VJ. High school youth and suicide risk: exploring protection afforded through physical activity and sport participation. J Sch Health. 2008;78(10):545–53. https://doi.org/10.1111/j.1746-1561.2008.00342.x .

Reardon CL, Factor RM. Sport psychiatry: a systematic review of diagnosis and medical treatment of mental illness in athletes. Sports Med. 2010;40(11):961–80. https://doi.org/10.2165/11536580-000000000-00000 .

Biddle SJ, Asare M. Physical activity and mental health in children and adolescents: a review of reviews. Br J Sports Med. 2011;45(11):886–95. https://doi.org/10.1136/bjsports-2011-090185 .

Guddal MH, Stensland SO, Smastuen MC, Johnsen MB, Zwart JA, Storheim K. Physical activity and sport participation among adolescents: associations with mental health in different age groups. Results from the Young-HUNT study: a cross-sectional survey. BMJ Open. 2019;9(9):e028555. https://doi.org/10.1136/bmjopen-2018-028555 .

• Mojtabai R, Olfson M, Han B. National Trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics. 2016;138(6). https://doi.org/10.1542/peds.2016-1878 . Highlights the increasing treands of untreated depression, highlighting the epidemic and need to expand screening and service capacity .

Kegler SR, Stone DM, Holland KM. Trends in suicide by level of urbanization - United States, 1999–2015. MMWR Morb Mortal Wkly Rep. 2017;66(10):270–3. https://doi.org/10.15585/mmwr.mm6610a2.

Newman HJ, Howells KL, Fletcher D. The dark side of top level sport: an autobiographic study of depressive experiences in elite sport performers. Front Psychol. 2016;7:868. https://doi.org/10.3389/fpsyg.2016.00868 .

Matta Mello Portugal E, Cevada T, Sobral Monteiro-Junior R, Teixeira Guimaraes T, da Cruz Rubini E, Lattari E, et al. Neuroscience of exercise: from neurobiology mechanisms to mental health. Neuropsychobiology. 2013;68(1):1–14. https://doi.org/10.1159/000350946 .

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 .

Gulliver A, Griffiths KM, Mackinnon A, Batterham PJ, Stanimirovic R. The mental health of Australian elite athletes. J Sci Med Sport. 2015;18(3):255–61. https://doi.org/10.1016/j.jsams.2014.04.006 .

• Williams CA. Elite youth sports—the year that was 2017. Pediatr Exerc Sci. 2018;30(1):25–7. https://doi.org/10.1123/pes.2018-0001 . Discusses developmental considerations of youth sports as they relate to two emerging concerns, sport specialization and professionalism in youth sport .

•• Moreland JJ, Coxe KA, Yang J. Collegiate athletes’ mental health services utilization: a systematic review of conceptualizations, operationalizations, facilitators, and barriers. J Sport Health Sci. 2018;7(1):58–69. https://doi.org/10.1016/j.jshs.2017.04.009 . Using a socio-ecological perspective, examines the extant literature on utilization, barriers, and facilitators of student athletes accessing mental health treatment for key stakeholders .

Ryan H, Gayles JG, Bell L. Student-athletes and mental health experiences. Student Services. 2018;(163):67–79. https://doi.org/10.1002/ss.20271 .

Neal TL, Diamond AB, Goldman S, Liedtka KD, Mathis K, Morse ED, et al. Interassociation recommendations for developing a plan to recognize and refer student-athletes with psychological concerns at the secondary school level: a consensus statement. J Athl Train. 2015;50(3):231–49. https://doi.org/10.4085/1062-6050-50.3.03 .

Institute NCAASS. Mental health best practices: inter-association consensus document: best practices for understanding and supporting student-athlete mental wellness. Indianapolis, IN: National Collegiate Athletic Association; 2016.

Google Scholar  

Kessler RC, Petukhova M, Sampson NA, Zaslavsky AM, Wittchen HU. Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. Int J Methods Psychiatr Res. 2012;21(3):169–84. https://doi.org/10.1002/mpr.1359 .

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. Arch Gen Psychiatry. 2005;62(6):593–602.

Association ACH. American College Health Association–National College Health Assessment II: reference group executive summary fall 2017. American College Health Association, Hanover, MD. 2018. Accessed April 8 2020.

• Egan KP. Supporting mental health and well-being among student-athletes. Clin Sports Med. 2019;38(4):537–44. https://doi.org/10.1016/j.csm.2019.05.003 . This article reviews the frequency and symptoms of the most common mental health concners impacting colliege athletes, as well as treatment approaches and best practices .

Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–9. https://doi.org/10.1016/j.jaac.2010.05.017 .

Auerbach RP, Mortier P, Bruffaerts R, Alonso J, Benjet C, Cuijpers P, et al. WHO world mental health surveys international college student project: prevalence and distribution of mental disorders. J Abnorm Psychol. 2018;127(7):623–38. https://doi.org/10.1037/abn0000362 .

Armstrong LE, VanHeest JL. The unknown mechanism of the overtraining syndrome: clues from depression and psychoneuroimmunology. Sports Med. 2002;32(3):185–209. https://doi.org/10.2165/00007256-200232030-00003 .

Wolanin A, Hong E, Marks D, Panchoo K, Gross M. Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport. Br J Sports Med. 2016;50(3):167–71. https://doi.org/10.1136/bjsports-2015-095756 .

Gill EL Jr. Mental health in college athletics: it’s time for social work to get in the game. Soc Work. 2008;53(1):85–8. https://doi.org/10.1093/sw/53.1.85 .

Drew B, Matthews J. The prevalence of depressive and anxiety symptoms in student-athletes and the relationship with resilience and help-seeking behavior. J Clin Sport Psych. 2018;13(3):421–39. https://doi.org/10.1123/jcsp.2017-0043 .

Downs MF, Eisenberg D. Help seeking and treatment use among suicidal college students. J Am Coll Heal. 2012;60(2):104–14. https://doi.org/10.1080/07448481.2011.619611 .

•• Anchuri KM, Davoren AKP, Shanahan AP, Torres MP, Wilcox HCP. Nonsuicidal self-injury, suicidal ideation, and suicide attempt among collegiate athletes: findings from the National College Health Assessment. J Am Coll Heal. 2019:1–9. https://doi.org/10.1080/07448481.2019.1616743 . This important article evaluated the difference in nonsuicidal self-injury (NSSI), suicidal ideation, suicide attempt, and help-seeking behaviors in collegiate athletes and nonathlete college students, significant concerns that often go unaddressed, particularly in athletes. It also identifies actionable targets for preventing future suicidal behaviors among collegiate athletes.

Rao AL, Asif IM, Drezner JA, Toresdahl BG, Harmon KG. Suicide in National Collegiate Athletic Association (NCAA) athletes: a 9-year analysis of the NCAA resolutions database. Sports Health. 2015;7(5):452–7. https://doi.org/10.1177/1941738115587675 .

Sabo D, Miller KE, Melnick MJ, Farrell MP, Barnes GM. High school athletic participation and adolescent suicide: a nationwide US study. Int Rev Sociol Sport. 2005;40(1):5–23. https://doi.org/10.1177/1012690205052160 .

Perou R, Bitsko RH, Blumberg SJ, Pastor P, Ghandour RM, Gfroerer JC, et al. Mental health surveillance among children—United States, 2005–2011. MMWR Suppl. 2013;62(2):1–35.

PubMed   Google Scholar  

Poysophon P, Rao AL. Neurocognitive deficits associated with ADHD in athletes: a systematic review. Sports Health. 2018;10(4):317–26. https://doi.org/10.1177/1941738117751387 .

Wolraich ML, Hagan JF Jr, Allan C, Chan E, Davison D, Earls M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019;144(4). https://doi.org/10.1542/peds.2019-2528 .

Thomas R, Sanders S, Doust J, Beller E, Glasziou P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics. 2015;135(4):e994–1001. https://doi.org/10.1542/peds.2014-3482 .

Danielson ML, Bitsko RH, Ghandour RM, Holbrook JR, Kogan MD, Blumberg SJ. Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. J Clin Child Adolesc Psychol. 2018;47(2):199–212. https://doi.org/10.1080/15374416.2017.1417860 .

Harmon KG, Clugston JR, Dec K, Hainline B, Herring SA, Kane S, et al. American Medical Society for Sports Medicine Position Statement on concussion in sport. Clin J Sport Med. 2019;29(2):87–100. https://doi.org/10.1097/JSM.0000000000000720 .

Manderino L, Gunstad J. Collegiate student athletes with history of ADHD or academic difficulties are more likely to produce an invalid protocol on baseline ImPACT testing. Clin J Sport Med. 2018;28(2):111–6. https://doi.org/10.1097/JSM.0000000000000433 .

Sundgot-Borgen J, Torstveit MK. Prevalence of eating disorders in elite athletes is higher than in the general population. Clin J Sport Med. 2004;14(1):25–32. https://doi.org/10.1097/00042752-200401000-00005 .

Martinsen M, Sundgot-Borgen J. Higher prevalence of eating disorders among adolescent elite athletes than controls. Med Sci Sports Exerc. 2013;45(6):1188–97. https://doi.org/10.1249/MSS.0b013e318281a939 .

Smink FR, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012;14(4):406–14. https://doi.org/10.1007/s11920-012-0282-y .

Joy E, Kussman A, Nattiv A. 2016 update on eating disorders in athletes: a comprehensive narrative review with a focus on clinical assessment and management. Br J Sports Med. 2016;50(3):154–62. https://doi.org/10.1136/bjsports-2015-095735 .

Sundgot-Borgen J. Prevalence of eating disorders in elite female athletes. Int J Sport Nutr. 1993;3(1):29–40. https://doi.org/10.1123/ijsn.3.1.29 .

Article   CAS   PubMed   Google Scholar  

Nattiv A, Loucks AB, Manore MM, Sanborn CF, Sundgot-Borgen J, Warren MP, et al. American College of Sports Medicine position stand. The female athlete triad. Med Sci Sports Exerc. 2007;39(10):1867–82. https://doi.org/10.1249/mss.0b013e318149f111 .

Mountjoy M, Sundgot-Borgen J, Burke L, Ackerman KE, Blauwet C, Constantini N, et al. International Olympic Committee (IOC) consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Int J Sport Nutr Exerc Metab. 2018;28(4):316–31. https://doi.org/10.1123/ijsnem.2018-0136 .

Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, et al. IOC consensus statement on relative energy deficiency in sport (RED-S): 2018 update. Br J Sports Med. 2018;52(11):687–97. https://doi.org/10.1136/bjsports-2018-099193 .

Milano W, Milano L, Capasso A. Eating disorders in athletes: from risk management to therapy. Endocr Metab Immune Disord Drug Targets. 2020;20(1):2–14. https://doi.org/10.2174/1871530319666190418121446 .

Stryer BK, Tofler IR, Lapchick R. A developmental overview of child and youth sports in society. Child Adolesc Psychiatr Clin N Am. 1998;7(4):697–724 vii.

Lisha NE, Sussman S. Relationship of high school and college sports participation with alcohol, tobacco, and illicit drug use: a review. Addict Behav. 2010;35(5):399–407. https://doi.org/10.1016/j.addbeh.2009.12.032 .

Veliz P, Schulenberg J, Patrick M, Kloska D, McCabe SE, Zarrett N. Competitive sports participation in high school and subsequent substance use in young adulthood: assessing differences based on level of contact. Int Rev Sociol Sport. 2017;52(2):240–59. https://doi.org/10.1177/1012690215586998 .

Veliz P, McCabe SE, Boyd CJ. Extreme binge drinking among adolescent athletes: a cause for concern? Am J Addict. 2016;25(1):37–40. https://doi.org/10.1111/ajad.12323 .

Veliz P, McCabe SE. Examining potential substance use disorders among former interscholastic athletes. Subst Abus. 2015;36(4):400–6. https://doi.org/10.1080/08897077.2014.988324 .

Peretti-Watel P, Beck F, Legleye S. Beyond the U-curve: the relationship between sport and alcohol, cigarette and cannabis use in adolescents. Addiction. 2002;97(6):707–16. https://doi.org/10.1046/j.1360-0443.2002.00116.x .

Green GA, Uryasz FD, Petr TA, Bray CD. NCAA study of substance use and abuse habits of college student-athletes. Clin J Sport Med. 2001;11(1):51–6. https://doi.org/10.1097/00042752-200101000-00009 .

Dunn M, Wang MQ. Effects of physical activity on substance use among college students. Am J Health Stud. 2003;18(2):126–32.

Moore MJ, Werch CE. Sport and physical activity participation and substance use among adolescents. J Adolesc Health. 2005;36(6):486–93. https://doi.org/10.1016/j.jadohealth.2004.02.031 .

Diehl K, Thiel A, Zipfel S, Mayer J, Litaker DG, Schneider S. How healthy is the behavior of young athletes? A systematic literature review and meta-analyses. J Sports Sci Med. 2012;11(2):201–20.

PubMed   PubMed Central   Google Scholar  

Iverson GL, Gardner AJ, Terry DP, Ponsford JL, Sills AK, Broshek DK, et al. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941–8. https://doi.org/10.1136/bjsports-2017-097729 .

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 Med. 2018;48(2):447–65. https://doi.org/10.1007/s40279-017-0810-3 .

•• Strohle A. Sports psychiatry: mental health and mental disorders in athletes and exercise treatment of mental disorders. Eur Arch Psychiatry Clin Neurosci. 2019;269(5):485–98. https://doi.org/10.1007/s00406-018-0891-5 . This in-depth review of mental health in athletes is written from a rapidly growing field of sports psychiatry. It brings to the forefront the role of psychiatry in sport to optimize prevention and treatment of mental health disorders in athletes.

Manley G, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC, et al. A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med. 2017;51(12):969–77. https://doi.org/10.1136/bjsports-2017-097791 .

Haarbauer-Krupa J, Arbogast KB, Metzger KB, Greenspan AI, Kessler R, Curry AE, et al. Variations in mechanisms of injury for children with concussion. J Pediatr. 2018;197:241–8 e1. https://doi.org/10.1016/j.jpeds.2018.01.075 .

Brooks BL, Plourde V, Beauchamp MH, Tang K, Yeates KO, Keightley M, et al. Predicting psychological distress after pediatric concussion. J Neurotrauma. 2019;36(5):679–85. https://doi.org/10.1089/neu.2018.5792 .

Vargas G, Rabinowitz A, Meyer J, Arnett PA. Predictors and prevalence of postconcussion depression symptoms in collegiate athletes. J Athl Train. 2015;50(3):250–5. https://doi.org/10.4085/1062-6050-50.3.02 .

Mainwaring LM, Hutchison M, Bisschop SM, Comper P, Richards DW. Emotional response to sport concussion compared to ACL injury. Brain Inj. 2010;24(4):589–97. https://doi.org/10.3109/02699051003610508 .

Corwin DJ, Zonfrillo MR, Master CL, Arbogast KB, Grady MF, Robinson RL, et al. Characteristics of prolonged concussion recovery in a pediatric subspecialty referral population. J Pediatr. 2014;165(6):1207–15. https://doi.org/10.1016/j.jpeds.2014.08.034 .

Yang J, Peek-Asa C, Covassin T, Torner JC. Post-concussion symptoms of depression and anxiety in division I collegiate athletes. Dev Neuropsychol. 2015;40(1):18–23. https://doi.org/10.1080/87565641.2014.973499 .

Zemek R, Barrowman N, Freedman SB, Gravel J, Gagnon I, McGahern C, et al. Clinical risk score for persistent postconcussion symptoms among children with acute concussion in the ED. JAMA. 2016;315(10):1014–25. https://doi.org/10.1001/jama.2016.1203 .

Didehbani N, Munro Cullum C, Mansinghani S, Conover H, Hart J Jr. Depressive symptoms and concussions in aging retired NFL players. Arch Clin Neuropsychol. 2013;28(5):418–24. https://doi.org/10.1093/arclin/act028 .

Mez J, Daneshvar DH, Kiernan PT, Abdolmohammadi B, Alvarez VE, Huber BR, et al. Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA. 2017;318(4):360–70. https://doi.org/10.1001/jama.2017.8334 .

Plessow F, Pascual-Leone A, McCracken CM, Baker J, Krishnan S, Baggish A, et al. Self-reported cognitive function and mental health diagnoses among former professional American-style football players. J Neurotrauma. 2019. https://doi.org/10.1089/neu.2019.6661 .

Meehan WP 3rd, Taylor AM, Berkner P, Sandstrom NJ, Peluso MW, Kurtz MM, et al. Division III collision sports are not associated with neurobehavioral quality of life. J Neurotrauma. 2016;33(2):254–9. https://doi.org/10.1089/neu.2015.3930 .

Deshpande SK, Hasegawa RB, Rabinowitz AR, Whyte J, Roan CL, Tabatabaei A, et al. Association of playing high school football with cognition and mental health later in life. JAMA Neurol. 2017;74(8):909–18. https://doi.org/10.1001/jamaneurol.2017.1317 .

Brenner JS, Council On Sports M, Fitness. Sports specialization and intensive training in young athletes. Pediatrics. 2016;138(3). https://doi.org/10.1542/peds.2016-2148 .

DiFiori JP, Benjamin HJ, Brenner JS, Gregory A, Jayanthi N, Landry GL, et al. Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine. Br J Sports Med. 2014;48(4):287–8. https://doi.org/10.1136/bjsports-2013-093299 .

Walters BK, Read CR, Estes AR. The effects of resistance training, overtraining, and early specialization on youth athlete injury and development. J Sports Med Phys Fitness. 2018;58(9):1339–48. https://doi.org/10.23736/S0022-4707.17.07409-6 .

Meeusen R, Duclos M, Gleeson M. Prevention, diagnosis and treatment of the overtraining syndrome. Eur J Sport Sci. 2006;6:1–14.

Budgett R. Fatigue and underperformance in athletes: the overtraining syndrome. Br J Sports Med. 1998;32(2):107–10. https://doi.org/10.1136/bjsm.32.2.107 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Smith RE. Toward a cognitive-affective model of athletic burnout. J Sport Psychol. 1986;8:36–50.

Matos NF, Winsley RJ, Williams CA. Prevalence of nonfunctional overreaching/overtraining in young English athletes. Med Sci Sports Exerc. 2011;43(7):1287–94. https://doi.org/10.1249/MSS.0b013e318207f87b .

Brink MS, Visscher C, Coutts AJ, Lemmink KA. Changes in perceived stress and recovery in overreached young elite soccer players. Scand J Med Sci Sports. 2012;22(2):285–92. https://doi.org/10.1111/j.1600-0838.2010.01237.x .

Winsley R, Matos N. Overtraining and elite young athletes. Med Sport Sci. 2011;56:97–105. https://doi.org/10.1159/000320636.

Gustafsson H, Sagar SS, Stenling A. Fear of failure, psychological stress, and burnout among adolescent athletes competing in high level sport. Scand J Med Sci Sports. 2017;27(12):2091–102. https://doi.org/10.1111/sms.12797 .

Kentta G, Hassmen P. Overtraining and recovery. A conceptual model. Sports Med. 1998;26(1):1–16. https://doi.org/10.2165/00007256-199826010-00001 .

Kellman M, Kallus KW. Recovery-stress questionnaire for athletes: user manual. Champaign, IL: Human Kinetics; 2001.

Nederhof E, Brink MS, Lemmink KA. Reliability and validity of the Durch recovery stress questionnaire for athletes. Int J Sport Psychol. 2008.

•• Chang CJ, Putukian M, Aerni G, Diamond AB, Hong ES, Ingram YM, et al. Mental health issues and psychological factors in athletes: detection, management, effect on performance, and prevention: American Medical Society for Sports Medicine Position Statement. Clin J Sport Med. 2020;30(2):e61–87. https://doi.org/10.1097/JSM.0000000000000817 . This seminal position statement from the American Medical Society for Sports Medicine, the premier educational resource for sports medicine physicians, acknowledges and underscores the need for identifying and managing mental health concerns in athletes, an historically underemphasized aspect of sports medicine.

Rechel JA, Yard EE, Comstock RD. An epidemiologic comparison of high school sports injuries sustained in practice and competition. J Athl Train. 2008;43(2):197–204. https://doi.org/10.4085/1062-6050-43.2.197 .

Wolanin A, Gross M, Hong E. Depression in athletes: prevalence and risk factors. Curr Sports Med Rep. 2015;14(1):56–60. https://doi.org/10.1249/JSR.0000000000000123 .

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. J Athl Train. 2013;48(5):716–20. https://doi.org/10.4085/1062-6050-48.4.13 .

Palisch AR, Merritt LS. Depressive symptoms in the young athlete after injury: recommendations for research. J Pediatr Health Care. 2018;32(3):245–9. https://doi.org/10.1016/j.pedhc.2017.11.003 .

Appaneal RN, Levine BR, Perna FM, Roh JL. Measuring postinjury depression among male and female competitive athletes. J Sport Exerc Psychol. 2009;31(1):60–76. https://doi.org/10.1123/jsep.31.1.60 .

Nixdorf I, Frank R, Beckmann J. Comparison of athletes’ proneness to depressive symptoms in individual and team sports: research on psychological mediators in junior elite athletes. Front Psychol. 2016;7:893. https://doi.org/10.3389/fpsyg.2016.00893 .

Pluhar E, McCracken C, Griffith KL, Christino MA, Sugimoto D, Meehan WP 3rd. Team sport athletes may be less likely to suffer anxiety or depression than individual sport athletes. J Sports Sci Med. 2019;18(3):490–6.

Putukian M. The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med. 2016;50(3):145–8. https://doi.org/10.1136/bjsports-2015-095586 .

DeWalt DA, Gross HE, Gipson DS, Selewski DT, DeWitt EM, Dampier CD, et al. PROMIS((R)) pediatric self-report scales distinguish subgroups of children within and across six common pediatric chronic health conditions. Qual Life Res. 2015;24(9):2195–208. https://doi.org/10.1007/s11136-015-0953-3 .

NCAA. Mind, body, sport. Indianapolis, IN: National Collegiate Athletic Association; 2014.

Allison KC, Spaeth A, Hopkins CM. Sleep and eating disorders. Curr Psychiatry Rep. 2016;18(10):92. https://doi.org/10.1007/s11920-016-0728-8 .

Becker SP, Langberg JM, Byars KC. Advancing a biopsychosocial and contextual model of sleep in adolescence: a review and introduction to the special issue. J Youth Adolesc. 2015;44(2):239–70. https://doi.org/10.1007/s10964-014-0248-y .

Owens J, Adolescent sleep working G, committee on a. Insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics 2014;134(3):e921-e932. doi: https://doi.org/10.1542/peds.2014-1696 .

Gregory AM, Sadeh A. Sleep, emotional and behavioral difficulties in children and adolescents. Sleep Med Rev. 2012;16(2):129–36. https://doi.org/10.1016/j.smrv.2011.03.007 .

Bonnar D, Bartel K, Kakoschke N, Lang C. Sleep interventions designed to improve athletic performance and recovery: a systematic review of current approaches. Sports Med. 2018;48(3):683–703. https://doi.org/10.1007/s40279-017-0832-x .

Watson AM. Sleep and athletic performance. Curr Sports Med Rep. 2017;16(6):413–8. https://doi.org/10.1249/JSR.0000000000000418 .

Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep Health. 2015;1(4):233–43. https://doi.org/10.1016/j.sleh.2015.10.004 .

Mah CD, Kezirian EJ, Marcello BM, Dement WC. Poor sleep quality and insufficient sleep of a collegiate student-athlete population. Sleep Health. 2018;4(3):251–7. https://doi.org/10.1016/j.sleh.2018.02.005 .

Swinbourne R, Gill N, Vaile J, Smart D. Prevalence of poor sleep quality, sleepiness and obstructive sleep apnoea risk factors in athletes. Eur J Sport Sci. 2016;16(7):850–8. https://doi.org/10.1080/17461391.2015.1120781 .

Brauer AA, Athey AB, Ross MJ, Grandner MA. Sleep and health among collegiate student athletes. Chest. 2019;156(6):1234–45. https://doi.org/10.1016/j.chest.2019.08.1921 .

Reilly T, Edwards B. Altered sleep–wake cycles and physical performance in athletes. Physiol Behav. 2007;90(2–3):274–84. https://doi.org/10.1016/j.physbeh.2006.09.017 .

Fullagar HH, Skorski S, Duffield R, Hammes D, Coutts AJ, Meyer T. Sleep and athletic performance: the effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise. Sports Med. 2015;45(2):161–86. https://doi.org/10.1007/s40279-014-0260-0 .

Milewski MD, Skaggs DL, Bishop GA, Pace JL, Ibrahim DA, Wren TA, et al. Chronic lack of sleep is associated with increased sports injuries in adolescent athletes. J Pediatr Orthop. 2014;34(2):129–33. https://doi.org/10.1097/BPO.0000000000000151 .

Raikes AC, Athey A, Alfonso-Miller P, Killgore WDS, Grandner MA. Insomnia and daytime sleepiness: risk factors for sports-related concussion. Sleep Med. 2019;58:66–74. https://doi.org/10.1016/j.sleep.2019.03.008 .

Taylor L, Chrismas BC, Dascombe B, Chamari K, Fowler PM. Sleep medication and athletic performance—the evidence for practitioners and future research directions. Front Physiol. 2016;7:83. https://doi.org/10.3389/fphys.2016.00083 .

Rexroat R. NCAA national study of substance use habits of college student-athletes. In: Association NCA, editor. 2014. p. 1-101.

Xanthopoulos MS, Gallagher PR, Berkowitz RI, Radcliffe J, Bradford R, Marcus CL. Neurobehavioral functioning in adolescents with and without obesity and obstructive sleep apnea. Sleep. 2015;38(3):401–10. https://doi.org/10.5665/sleep.4498 .

Madaeva I, Berdina O, Polyakov V, Kolesnikov S. Obstructive sleep apnea and hypertension in adolescents: effect on neurobehavioral and cognitive functioning. Can Respir J. 2016;2016:3950914. https://doi.org/10.1155/2016/3950914 .

• Kroshus E, Wagner J, Wyrick D, Athey A, Bell L, Benjamin HJ, et al. Wake up call for collegiate athlete sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness. Br J Sports Med. 2019;53(12):731–6. https://doi.org/10.1136/bjsports-2019-100590 . This formative paper addresses the importance of sleep in sport performance, wellness, and mental health functioning of athletes.

•• 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). Br J Sports Med. 2019;53(11):667–99. https://doi.org/10.1136/bjsports-2019-100715 . The International Olympic Committee Consensus Work Group critically evaluated the current state of science and provides recommendations in this paper by utilizing s a systematic, standardised, evidence-based approach to mental health symptoms and disorders in elite athletes.

Allan EJ, Madden M. Hazing in view: college students at risk initial findings from the National Study of Student Hazing 2008.

Shetgiri R. Bullying and victimization among children. Adv Pediatr Infect Dis. 2013;60(1):33–51. https://doi.org/10.1016/j.yapd.2013.04.004 .

Hoover NC, Pollard N. National survey: initiation rites and athletics for NCAA sports teams. 1999. Alfred University website: http://www.alfred.edu/sports_hazing . .

McGinley M, Rospenda KM, Liu L, Richman JA. It isn’t all just fun and games: collegiate participation in extracurricular activities and risk for generalized and sexual harassment, psychological distress, and alcohol use. J Adolesc. 2016;53:152–63. https://doi.org/10.1016/j.adolescence.2016.10.001 .

Gershel JC, Katz-Sidlow RJ, Small E, Zandieh S. Hazing of suburban middle school and high school athletes. J Adolesc Health. 2003;32(5):333–5. https://doi.org/10.1016/s1054-139x(03)00021-1 .

Crow RB, MacIntosh EW. Conceptualizing a meaningful definition of hazing in sport. Eur Sport Manag Q. 2009;9:433–51.

Campo S, Poulos G, Sipple JW. Prevalence and profiling: hazing among college students and points of intervention. Am J Health Behav. 2005;29(2):137–49. https://doi.org/10.5993/ajhb.29.2.5 .

Allan EJ, Madden M. The nature and extent of college student hazing. Int J Adolesc Med Health. 2012;24(1):83–90. https://doi.org/10.1515/ijamh.2012.012 .

Sato T, Hodge SR, Eckert K. Experiences of black student-athletes on predominantly white university campuses. J Stud Sports Athletes Educ. 2017;11(2):104–24.

Bernhard LM. “Nowhere for me to go:” black female student-athlete experiences on a predominantly white campus. J Study Sports Athletes Educ. 2014;8(2):67–76.

Peguero AA, Williams LM. Racial and ethnic stereotypes and bullying victimization. Youth Soc. 2013;45(4):545–64.

Volk AA, Lagzdins L. Bullying and victimization among adolescent girl athletes. J Athl Train. 2009;11:13–31.

Tuakli-Wosornu YA, Sun Q, Gentry M, Ona Ayala KE, Doolan FC, Ottesen TD, et al. Non-accidental harms (‘abuse’) in athletes with impairment (‘para athletes’): a state-of-the-art review. Br J Sports Med. 2020;54(3):129–38. https://doi.org/10.1136/bjsports-2018-099854 .

Johns MM, Lowry R, Andrzejewski J, Barrios LC, Demissie Z, McManus T, et al. Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students - 19 states and large urban school districts, 2017. MMWR Morb Mortal Wkly Rep. 2019;68(3):67–71. https://doi.org/10.15585/mmwr.mm6803a3 .

Durso LE, Gates GJ. Serving our youth: findings from a national survey of service providers working with lesbian, gay, bisexual, and transgender youth who are homeless or at risk of becoming homeless. UCLA: the Williams Institute; 2012.

Russell ST, Fish JN. Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annu Rev Clin Psychol. 2016;12:465–87. https://doi.org/10.1146/annurev-clinpsy-021815-093153 .

Katz-Wise SL, Rosario M, Tsappis M. Lesbian, gay, bisexual, and transgender youth and family acceptance. Pediatr Clin N Am. 2016;63(6):1011–25. https://doi.org/10.1016/j.pcl.2016.07.005 .

Marshal MP, Dietz LJ, Friedman MS, Stall R, Smith HA, McGinley J, et al. Suicidality and depression disparities between sexual minority and heterosexual youth: a meta-analytic review. J Adolesc Health. 2011;49(2):115–23. https://doi.org/10.1016/j.jadohealth.2011.02.005 .

Douall M, Watson RJ, Smith A, Homma Y, Saewyc E. Are we leveling the playing field? Trends and disparties in sports participation among sexual minority youth in Canada. J Sport Health Sci. 2018;7:218–26.

Fraser-Thomas JL, Cote J, Deakin J. Youth sports programs: an avene to foster positive youth development. Phys Educ Sport Pedagog. 2007;10(1):19–4.

Johnson A, Miranda L, Lee M. Play to win: improving the lives of LGBTQ youth in. sports. 2018.

Dennison E, Kitchen A. Out on the fields: the first international study on homophobia in sport. 2015. http://www.outonthefields.com/media/#United%20States . .

Shirtcliff EA, Dahl RE, Pollak SD. Pubertal development: correspondence between hormonal and physical development. Child Dev. 2009;80(2):327–37. https://doi.org/10.1111/j.1467-8624.2009.01263.x .

Guidelines for creating policies for transgender children in recreational sports. Transgender Law & Policy Institute; 2009.

NCAA. 2013–2014 NCAA Sports Medicine Handbook. Indianapolis, IN 2013. p. 84–9.

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The authors would like to thank Dr. David Rettew for taking the time to review this manuscript.

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Melissa S. Xanthopoulos, Tami Benton, Jason Lewis & Julia A. Case

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Xanthopoulos, M.S., Benton, T., Lewis, J. et al. Mental Health in the Young Athlete. Curr Psychiatry Rep 22 , 63 (2020). https://doi.org/10.1007/s11920-020-01185-w

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The Declining Mental Health Of The Young And The Global Disappearance Of The Hump Shape In Age In Unhappiness

Across many studies subjective well-being follows a U-shape in age, declining until people reach middle-age, only to rebound subsequently. Ill-being follows a mirror-imaged hump-shape. But this empirical regularity has been replaced by a monotonic decrease in illbeing by age. The reason for the change is the deterioration in young people’s mental health both absolutely and relative to older people. We reconsider evidence for this fundamental change in the link between illbeing and age with micro data for the United States and the United Kingdom. Beginning around 2011 there is a monotonic and declining cross-sectional association between well-being and age. In the UK the recent COVID pandemic exacerbated the trends by impacting most heavily on the wellbeing of the young, but this was not the case in the United States. We replicate the decrease in illbeing by age across 34 countries, including the United States and the United Kingdom, using five ill-being metrics for the period 2020-2024 and confirm the findings.

We thank the United Nations for financial support and Sian Beilock, Andrew Campbell, Pedro Conceiaco, Carol Graham, Josefin Pasanen, Jon Skinner and Bruce Sacerdote for helpful comments and suggestions and Gabriel Gottesman for research assistance. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research.

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During the 2024-25 academic year, three research teams will receive a total of $100,000 to conduct projects designed to enhance student-athletes' psychosocial well-being and mental health.

This is the 10th year of the NCAA Innovations in Research and Practice Grant Program. The panel that reviewed the proposals was composed of current student-athletes, academics, athletics administrators, an athletic trainer, a coach and a mental health clinician. The reviewers felt confident the funded pilot programs will lead to programs that other schools can adopt for use on their campuses or adapt to fit their own needs. 

"It is encouraging to continue to see such a high level of interest in this grant program," said Eric Laudano, the panel chair and a senior associate athletics director at Saint Joseph's. "This year, over 140 proposals were submitted, and with so many strong projects and compelling collaborations, it was challenging for the panel to identify the finalists and select the three recipients. We are confident that these projects will benefit the student-athletes on the receiving campuses in the coming year. Further, we believe the membership will have much to gain as these grant teams share their findings and make their resources widely available in 2025."

These three teams will make their findings available to the membership during the 2024-25 academic year:

Share, like and subscribe: The impact of social media use on student-athletes' identity and sense of belonging on and off the team.

Rebecca Bertuccio, Ph.D., NCSP, LP (project director); Brittany Rhoden, MSEd, MSc; and Grace Landrigan, MPH.

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Of note, the Wanzer and Bleakley project will involve collaboration with three Division I athletics departments (Binghamton University, Delaware and Niagara) and two Division II athletics departments (Daemen and West Chester).

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• Cheryl Stuntz, professor of psychology, St. Lawrence.
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PERSPECTIVE article

Mental health in athletes: where are the treatment studies.

• 1 Department of Psychology, Umeå University, Umeå, Sweden
• 2 Umeå School of Sport Sciences, Umeå University, Umeå, Sweden
• 3 Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway

In recent years, athletes’ mental health has gained interest among researchers, sport practitioners, and the media. However, the field of sport psychology lacks empirical evidence on the effectiveness of psychotherapeutic interventions for mental health problems and disorders in athletes. Thus far, intervention research in sport psychology has mainly focused on performance enhancement using between-subject designs and healthy athlete samples. In the current paper, we highlight three interrelated key issues in relation to treating mental health problems and disorders in athletes. (i) How are mental health and mental health problems and disorders defined in the sport psychology literature? (ii) How are prevalence rates of mental health problems and disorders in athletes determined? (iii) What is known about psychotherapeutic interventions for mental health problems and disorders in athletes? We conclude that the reliance on different definitions and assessments of mental health problems and disorders contributes to heterogeneous prevalence rates. In turn, this limits our understanding of the extent of mental health problems and disorders in athletes. Furthermore, knowledge of the effectiveness of psychotherapeutic interventions for athletes with mental health problems and disorders is scarce. Future research should include athletes with established mental health problems and disorders in intervention studies. We also propose an increased use of N-of-1 trials to enhance the knowledge of effective psychotherapeutic interventions in this population.

Introduction

There has been an increasing interest in athletes’ mental health among researchers and sport practitioners in the past decade. Several reviews and position statements have recently been published on this issue (e.g., Reardon et al., 2019 ; Kuettel and Larsen, 2020 ). Several top athletes also highlighted mental health problems and how it affected their sport performance during the recent Olympic Games in Tokyo, which major news outlets have reported on, such as the New York Times ( Longman, 2021 ) and the Washington Post ( Svrluga, 2021 ). Despite this increased interest, studies on the effectiveness of psychotherapeutic interventions for mental health problems and disorders in athletes are almost nonexistent ( Stillman et al., 2019 ). Most previous research has focused on interventions for performance enhancement (e.g., Schenk and Miltenberger, 2019 ), resulting in an apparent knowledge gap that needs to be addressed in future research.

Researchers have argued that athletes differ from the general population (e.g., Reardon et al., 2019 ) in, but not limited to, personality traits (e.g., narcissistic tendencies, perfectionism, and competitiveness), behaviors (e.g., risk-taking and superstitious rituals; Stillman et al., 2016 ), and barriers to help-seeking ( Gulliver et al., 2012 ). Furthermore, some have argued that these differences, among others, need to be considered when working in a psychotherapeutic setting with athletes ( Stillman and Farmer, 2021 ). However, empirical evidence is scarce, and research is needed to examine whether, and if so, how athletes differ from the general population ( Gouttebarge et al., 2019 ). In addition, researchers have put much effort into determining prevalence rates of mental health problems and disorders in athletes. However, there is an extreme heterogeneity of prevalence rates in the published literature, making it difficult to determine the extent of mental health problems and disorders in athletes ( Gouttebarge et al., 2019 ).

In light of the above, in the current paper, we will discuss three interrelated key issues related to research on treating mental health problems and disorders in athletes. (i) How are mental health and mental health problems and disorders defined in the sport psychology literature? This has important implications for both assessing the prevalence of and treating mental health problems and disorders. (ii) How are prevalence rates of mental health problems and disorder in athletes determined? (iii) What is known about psychotherapeutic interventions for mental health problems and disorders in athletes? We conclude by outlining several issues in need of further research related to treating mental health problems and disorders in athletes and suggest ways to advance knowledge in this area.

Mental Health in Sport Psychology

Definitions of mental health, mental health problems, and mental disorders.

Historically, mental health has been defined in many different ways and how to define it is still under debate (e.g., Keyes, 2002 , 2005 ; Galderisi et al., 2015 ). More recently, a narrative review on mental health in athletes by Lundqvist and Andersson (2021) concluded that what is considered mental health or mental health problems will vary depending on three factors: definition, theoretical perspective, and the assessment chosen by researchers. Hence, an essential prerequisite when researching mental health is to provide a clear definition and a well-grounded theoretical perspective of mental health and mental health problems ( Lundqvist and Andersson, 2021 ).

Several researchers in sport psychology have suggested conceptualizing mental health as part of a continuum rather than adhering to strict diagnostic criteria and viewing it as a binary state ( Moore and Bonagura, 2017 ; Rice et al., 2021 ). On the other hand, Lundqvist and Andersson (2021) argue that continuum models do not provide any guidance regarding how to interpret symptoms and whether symptoms should be viewed as natural reactions to sports or early signs of mental health problems or disorders. Many elite athletes are expected over time to move back and forth along the continuum without necessarily being at risk of developing clinically relevant mental health problems or needing treatment ( Lundqvist and Andersson, 2021 ). Thus, caution is needed not to pathologize everyday human experiences ( Henriksen et al., 2020 ). Despite this increased interest and recent efforts, Lundqvist and Andersson (2021) argue that it is unlikely that consensus will be reached on a uniform definition of mental health in elite sport contexts.

The lack of a uniform definition in the sport psychology literature is also evident in relation to mental health problems and disorders. The terms mental health problem and mental disorder are sometimes used interchangeably despite referring to different levels of severity and diagnosis. A mental disorder refers to a specific psychiatric diagnosis based on several criteria in the Diagnostic and Statistical Manual of Mental Disorders ( DSM -5; American Psychiatric Association, 2013 ), whereas mental health problems usually refer to subclinical psychological ill-being without necessarily fulfilling clinical criteria according to the DSM -5. Symptoms of subclinical psychological ill-being are often signs of how mental health can fluctuate without developing into an all-encompassing disorder (i.e., cognitive and emotional disturbance, abnormal behaviors, and/or impaired functioning; American Psychiatric Association, 2013 ). An example from the sport context is performance anxiety versus an established psychiatric anxiety disorder (e.g., generalized anxiety disorder, social anxiety, and obsessive–compulsive disorder). Performance anxiety most often occurs before a performance and is a passing state, whereas generalized anxiety disorder, for example, is an ongoing state leading to impaired functioning in different areas of life ( Reardon et al., 2021 ).

Although these can be viewed as subtle differences, the nuances have important practical implications related to assessment and treatment. Disregarding these subtle differences increases the risk of underestimating or overestimating mental health problems and disorders in athletes. Relying on different definitions and operationalizations increases the heterogeneity of prevalence rates in the published literature, which, in turn, creates confusion and uncertainty rather than clarity in terms of the extent of mental health problems and disorders in athletes.

Prevalence of Mental Health Problems and Disorders in Athletes

Prevalence rates of mental health problems and disorders in athletes are often studied with quantitative and cross-sectional methods using self-reported data via questionnaires ( Kuettel and Larsen, 2020 ). Consequently, prevalence rates of mental health problems and disorders among athletes vary and are more prominent in some samples than others, often dependent on the type of study design and type of assessment. Prevalence rates are generally higher in studies adopting a broader definition of mental health problems and self-report measures compared to studies that limit assessment to psychiatric diagnosis and clinical evaluation. For example, prevalence rates for depression in athletes range from 4% when clinically assessed ( Schaal et al., 2011 ) to 48% when self-reported ( Foskett and Longstaff, 2018 ), whereas rates for anxiety varies from 9% when clinically assessed ( Schaal et al., 2011 ) to 16% when self-reported ( Åkesdotter et al., 2020 ). Åkesdotter et al. (2020) included both psychiatric disorders and psychological distress symptoms in their definition of mental health problems and used self-report measures, whereas Schaal et al. (2011) examined the prevalence rates of mental health problems based on psychological disorders found in the DSM-IV or International Classification of Diseases 10th version ( ICD -10) with a licensed caregiver conducting additional clinical evaluations.

These discrepancies show that prevalence rates of mental health problems and disorders differ substantially based on the definition and operationalization of mental health problems (e.g., psychiatric diagnosis versus symptoms of psychological distress), type of assessment (e.g., self-report versus clinically assessed), and instruments used, and contribute to the heterogeneity of prevalence rates for mental health problems and disorders in athletes. This heterogeneity and lack of consensus regarding how to assess prevalence limits the understanding of athletes’ mental health problems and disorders. Furthermore, Gouttebarge et al. (2019) argued that prevalence rates for current elite athletes might be slightly higher than in the general population; however, comparisons were not possible due to the lack of reference group from the general population in the studies included in their meta-analysis. Nevertheless, despite these methodological issues, the available evidence indicates that the prevalence rates of the most common mental health problems and disorders seem comparable with those of the general population ( Gorczynski et al., 2017 ; Moesch et al., 2018 ).

Psychotherapeutic Interventions in Sport Psychology

Many recommendations have been put forward about how to address mental health problems and disorders in sport contexts, such as prevention strategies ( Reardon et al., 2019 ), mental health officers ( Henriksen et al., 2020 ), and new screening tools to detect symptoms of mental health problems ( Gouttebarge et al., 2021 ). Surprisingly, very few of these recommendations include calls for more rigorous and controlled studies on psychotherapeutic interventions for athletes. Intervention research has mainly focused on performance enhancement (e.g., Sappington and Longshore, 2015 ; Schenk and Miltenberger, 2019 ), although the constant pressure to perform may increase athletes’ vulnerability to mental health problems ( Kuettel and Larsen, 2020 ). The scarcity of research on interventions for athletes’ mental health problems and disorders has resulted in a critical knowledge gap related to the effectiveness of interventions ( Stillman et al., 2019 ) and the underlying mechanisms that account for intervention outcomes ( Gross et al., 2016 ).

Cognitive behavioral therapy (CBT) has been recommended as an “excellent choice” for treating athletes with mental health problems or disorders because it involves procedures that athletes commonly use, such as structure, direction, goal setting, and practice ( Stillman et al., 2016 ). However, to our knowledge, there are no studies conducted on the effectiveness of CBT on athletes with established mental health problems or disorders. Nevertheless, given that CBT is a well-researched form of psychotherapy and established as one of the most effective and common treatments for a wide range of mental health problems and disorders ( Hofmann et al., 2012 ), it is understandable why CBT is recommended. Despite the lack of clinical studies using CBT for mental health problems or disorders in athlete populations, a limited number of case studies have been conducted using CBT principles with athletes. For example, Gustafsson et al. (2017) performed a six-session exposure intervention with a 17-year-old cross-country skier experiencing a high level of performance anxiety. Furthermore, McArdle and Moore (2012) describe how one of the authors employed key CBT principles when working with a 26-year-old rugby player with a dysfunctional perfectionist mindset. Participants in the abovementioned studies were not diagnosed with a clinical diagnosis but were included on the basis of experiencing mental health problems and underperforming. However, Lundqvist (2020) provides an example of how to use behavioral activation when working with a former Olympic athlete who developed depression (according to the Montgomery-Åsberg Depression Rating Scale) after retirement.

In addition to CBT, so-called third-wave behavioral therapies such as acceptance and commitment therapy (ACT) and compassion-focused therapy (CFT) seem promising (e.g., Ruiz, 2010 ; Craig et al., 2020 ) and should also be evaluated in athlete populations. ACT stems from the traditional behavior and cognitive therapies, such as CBT, but with a stronger emphasis on mindfulness and acceptance ( Hayes et al., 2006 ). ACT has been widely researched in clinical samples with strong evidence for a wide range of mental health problems ( Ruiz, 2010 ), such as anxiety ( Swain et al., 2013 ), depression ( Bai et al., 2020 ), and chronic pain ( Veehof et al., 2016 ). Since introducing ACT ( Hayes et al., 1999 ), many interventions in sport psychology have drawn from the ACT model and its six core processes (i.e., values, contact with the present moment, committed action, acceptance, self as a context, and defusion). Sport psychology researchers have mostly adopted the parts about being present in the moment and accepting internal events (i.e., thoughts and emotions) to enhance performance (e.g., The Mindfulness-Acceptance-Commitment approach; Moore, 2009 ). Mindfulness-based interventions for enhanced athletic performance show promising results of being effective in improving characteristics associated with well-being, such as psychological flexibility and anxiety ( Sappington and Longshore, 2015 ). However, the field currently lacks clinical intervention studies testing the ACT model as a psychotherapeutic intervention in athletes with mental health problems or disorders.

A small number of intervention studies in sport contexts have included parts of the ACT model (see Lundgren et al., 2020 ; Moesch et al., 2020 ). However, in these studies, participants were recruited based on characteristics related to their sport participation (e.g., current injury, motivation to participate), not that they explicitly needed treatment for mental health problems or disorders. It is difficult to draw conclusions about the effectiveness of an intervention on mental health problems (e.g., anxiety, depression, and psychological rigidity) based on research with healthy samples. Research on compassion-based interventions ( Neff, 2003 ; Gilbert, 2009 ) in sport is also scarce but is gaining interest ( Craig et al., 2020 ). However, despite an increased interest, a scoping review ( Röthlin, 2019 ) on the role of self-compassion in competitive sport settings only found one intervention study (i.e., Mosewich et al., 2013 ). Given the lack of empirical evidence, athletes experiencing mental health problems or disorders need to be included in future studies to evaluate the effectiveness of interventions based on CBT, ACT, or CFT.

Targeted and Disorder-Specific or Transdiagnostic Treatment?

There have also been calls for developing comprehensive, targeted, and disorder-specific treatment models for athletes (e.g., Rice et al., 2016 ). However, this suggestion is problematic for several reasons. First, to adopt a targeted, disorder-specific treatment with an individual, that person must fulfill the criteria for a specific disorder, and only those criteria. This is rarely the case and comorbidity (i.e., the occurrence of two or more psychiatric disorders simultaneously) is more often the rule than the exception ( Krueger and Eaton, 2015 ). Second, a sole focus on those with confirmed disorders will exclude many athletes struggling with subclinical mental health problems ( Reardon et al., 2019 ). Third, how can we develop new, comprehensive, targeted, and disorder-specific treatment models when there is a lack of evidence related to the effectiveness of already established psychotherapeutic treatment models (e.g., CBT, ACT, and CFT) in athletic samples?

Researchers in the field of sport psychology seem to agree that mental health problems are more than just specific disorders and that the full range of mental health problems need to be considered (e.g., Moesch et al., 2018 ; Henriksen et al., 2020 ; Kuettel and Larsen, 2020 ; Lundqvist and Andersson, 2021 ). In addition, due to issues such as categorical overlap and high comorbidity rates ( Meidlinger and Hope, 2017 ; Reardon, 2017 ), recognition is growing in terms of acknowledging that traditional psychiatric diagnoses are flawed due to the limitations (e.g., topographical approach, syndromal classification, and diagnosis overlap) of the current DSM -5 diagnostic system, and thus the treatments of them. Because of this, the field of clinical psychology is advancing toward transdiagnostic approaches aimed at targeting underlying mechanisms (e.g., emotional and cognitive avoidance, attentional focus, and worry) hypothesized to drive and maintain a person’s mental health problems ( Frank and McKay, 2020 ). The field of sport psychology would benefit from following this trend and research on how transdiagnostic approaches (e.g., ACT and CFT) can be used in interventions with athletes is warranted. Well-designed clinical studies evaluating established psychotherapeutic interventions in athletes should be prioritized over developing new, comprehensive, targeted, and disorder-specific treatment models.

General Discussion

When examining the literature on the prevalence rates of mental health problems and disorders in athletes, it is apparent that the field lacks a shared language to discuss mental health, mental health problems, and mental disorders, and the terms are often not clearly defined. The lack of consensus regarding the definition of mental health and mental health problems likely contributes to heterogeneous prevalence rates for mental health problems and disorders among athletes ( Lundqvist and Andersson, 2021 ). Furthermore, using clinical cutoff values and diagnostic criteria are essential in future research; however, a strict focus on cutoff values and criteria is not very helpful when designing psychotherapeutic interventions for athletes with mental health problems and disorders. In a treatment setting, it is likely more effective to focus on factors underlying and underpinning mental health problems rather than fulfilling diagnostic criteria ( Hayes et al., 2020 ).

In line with the increasing interest in research on mental health problems and disorders in sport, it is reasonable to assume that research on treatments for such problems would follow. However, this has not been the case. Clinical studies testing well-researched and evidence-based psychotherapeutic interventions in athletes with mental health problems or disorders are long overdue within sport psychology. Consequently, interventions in sport psychology have been criticized to be “a shot in the dark” ( Moore and Bonagura, 2017 , p. 178), and researchers have expressed that athletes deserve to receive support for their mental health equal to what they receive for their physical health ( Currie et al., 2021 ).

We argue that an increased use of N-of-1 studies and including athletes with established mental health problems or disorders in intervention studies would greatly benefit the understanding of effective treatments. N-of-1 studies have been recommended in contexts where variability in patient response is large, when the evidence is limited, and/or when the patient differs in important ways from the population participating in conventional randomized trials ( Mirza et al., 2017 ). Furthermore, an N-of-1 approach is especially valuable when taking on new research areas ( Barker et al., 2020 ). All these recommendations are applicable to research on interventions for mental health problems and disorders in athletes where the variability in type and prevalence varies greatly (e.g., Rice et al., 2016 ; Gouttebarge et al., 2019 ), and the evidence for interventions for mental health problems and disorders is scarce ( Stillman et al., 2019 ). Furthermore, the athletic population has been suggested to differ from the general population in how mental health problems and disorders are expressed and factors that affect mental health, which may impact the effectiveness of interventions in this population ( Reardon et al., 2019 ). However, this suggestion requires confirmation in empirical studies.

Summarizing Conclusion

There is an urgent need for well-designed clinical studies testing established psychotherapeutic interventions in athletes with established mental health problems or disorders. We argue that N-of-1 studies provide a promising approach to build a knowledge base for treating mental health problems and disorders in athletes, which would aid in psychologists’ mission to offer the best possible support for athletes who need it.

Data Availability Statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

Author Contributions

RE wrote the manuscript. AS and SH critically reviewed and revised for intellectual content before submission. The authors discussed and agreed upon the main messages during the paper’s preparation. All authors contributed to the article and approved the submitted version.

Conflict of Interest

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

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Åkesdotter, C., Kenttä, G., Eloranta, S., and Franck, J. (2020). The prevalence of mental health problems in elite athletes. J. Sci. Med. Sport 23, 329–335. doi: 10.1016/j.jsams.2019.10.022

CrossRef Full Text | Google Scholar

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. 5th Edn. Washington: American Psychiatric Association.

Google Scholar

Bai, Z., Luo, S., Zhang, L., Wu, S., and Chi, I. (2020). Acceptance and commitment therapy (ACT) to reduce depression: a systematic review and meta-analysis. J. Affect. Disord. 260, 728–737. doi: 10.1016/j.jad.2019.09.040

PubMed Abstract | CrossRef Full Text | Google Scholar

Barker, J. B., Slater, M. J., Pugh, G., Mellalieu, S. D., McCarthy, P. J., Jones, M. V., et al. (2020). The effectiveness of psychological skills training and behavioral interventions in sport using single-case designs: a meta regression analysis of the peer-reviewed studies. Psychol. Sport Exerc. 51:101746. doi: 10.1016/j.psychsport.2020.101746

Craig, C., Hiskey, S., and Spector, A. (2020). Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations. Expert Rev. Neurother. 20, 385–400. doi: 10.1080/14737175.2020.1746184

Currie, A., Blauwet, C., Bindra, A., Budgett, R., Campriani, N., Hainline, B., et al. (2021). Athlete mental health: future directions. Br. J. Sports Med. 55, 1243–1244. doi: 10.1136/bjsports-2021-104443

Foskett, R. L., and Longstaff, F. (2018). The mental health of elite athletes in the United Kingdom. J. Sci. Med. Sport 21, 765–770. doi: 10.1016/j.jsams.2017.11.016

Frank, R. I., and McKay, M. (2020). “Psychological vulnerabilities and coping responses: an innovative approach to transdiagnostic assessment and treatment planning in the age beyond DSM-5,” in Beyond the DSM: Toward a Process-Based Alternative for Diagnosis and Mental Health Treatment. eds. S. C. Hayes and S. G. Hofmann (Oakland, CA: New Harbinger Publications), 73–96.

Galderisi, S., Heinz, A., Kastrup, M., Beezhold, J., and Sartorius, N. (2015). Toward a new definition of mental health. World Psychiatry 14, 231–233. doi: 10.1002/wps.20231

Gilbert, P. (2009). Introducing compassion-focused therapy. Adv. Psychiatr. Treat. 15, 199–208. doi: 10.1192/apt.bp.107.005264

Gorczynski, P. F., Coyle, M., and Gibson, K. (2017). Depressive symptoms in high-performance athletes and non-athletes: a comparative meta-analysis. Br. J. Sports Med. 51, 1348–1354. doi: 10.1136/bjsports-2016-096455

Gouttebarge, V., Bindra, A., Blauwet, C., Campriani, N., Currie, A., Engebretsen, L., et al. (2021). International Olympic Committee (IOC) sport mental health assessment tool 1 (SMHAT-1) and sport mental health recognition tool 1 (SMHRT-1): towards better support of athletes’ mental health. Br. J. Sports Med. 55:30, –37. doi: 10.1136/bjsports-2020-102411

Gouttebarge, V., Castaldelli-Maia, J. M., Gorczynski, P., Hainline, B., Hitchcock, M. E., Kerkhoffs, G. M., et al. (2019). Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. Br. J. Sports Med. 53, 700–706. doi: 10.1136/bjsports-2019-100671

Gross, M., Moore, Z. E., Gardner, F. L., Wolanin, A. T., Pess, R., and Marks, D. R. (2016). An empirical examination comparing the mindfulness-acceptance-commitment approach and psychological skills training for the mental health and sport performance of female student athletes. Int. J. Sport Exerc. Psychol. 16, 431–451. doi: 10.1080/1612197x.2016.1250802

Gulliver, A., Griffiths, K. M., and Christensen, H. (2012). Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC Psychiatry 12:157. doi: 10.1186/1471-244X-12-157

Gustafsson, H., Lundqvist, C., and Tod, D. (2017). Cognitive behavioral intervention in sport psychology: a case illustration of the exposure method with an elite athlete. J. Sport Psychol. Action 8, 152–162. doi: 10.1080/21520704.2016.1235649

Hayes, S. C., Hofmann, S. G., and Ciarrochi, J. (2020). “Creating an alternative to syndromal diagnosis: needed features of processes of change and the models that organize them,” in Beyond the DSM: Toward a Process-Based Alternative for Diagnosis and Mental Health Treatment. eds. S. C. Hayes and S. G. Hofmann (Oakland, CA: New Harbinger Publications), 1–22.

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., and Lillis, J. (2006). Acceptance and commitment therapy: model, processes and outcomes. Behav. Res. Ther. 44, 1–25. doi: 10.1016/j.brat.2005.06.006

Hayes, S., Strosahl, K., and Wilson, K. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford.

Henriksen, K., Schinke, R., Moesch, K., McCann, S., Parham, W. D., Larsen, C. H., et al. (2020). Consensus statement on improving the mental health of high performance athletes. Int. J. Sport Exerc. Psychol. 18, 553–560. doi: 10.1080/1612197X.2019.1570473

Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., and Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit. Ther. Res. 36, 427–440. doi: 10.1007/s10608-012-9476-1

Keyes, C. L. M. (2002). The mental health continuum: From languishing to flourishing in life. J. Health Soc. Behav. 43, 207–222. doi: 10.2307/3090197

Keyes, C. L. (2005). Mental illness and/or mental health? Investigating axioms of the complete state model of health. J. Consult. Clin. Psychol. 73, 539–548. doi: 10.1037/0022-006X.73.3.539

Krueger, R. F., and Eaton, N. R. (2015). Transdiagnostic factors of mental disorders. World Psychiatry 14, 27–29. doi: 10.1002/wps.20175

Kuettel, A., and Larsen, C. H. (2020). Risk and protective factors for mental health in elite athletes: a scoping review. Int. Rev. Sport Exerc. Psychol. 13, 231–265. doi: 10.1080/1750984X.2019.1689574

Longman, J. (2021). Simone Biles rejects a long tradition of stoicism in sports. The New York Times . Available at: https://www.nytimes.com/2021/07/28/sports/olympics/simone-biles-mental-health.html (Accessed September 1, 2021).

Lundgren, T., Reinebo, G., Näslund, M., and Parling, T. (2020). Acceptance and commitment training to promote psychological flexibility in ice hockey performance: a controlled group feasibility study. J. Clin. Sport Psychol. 14, 170–181.

Lundqvist, C. (2020). Ending an elite sports career: case report of behavioral activation applied as an evidence-based intervention with a former Olympic athlete developing depression. Sport Psychol. 34, 329–336. doi: 10.1123/tsp.2019-0152

Lundqvist, C., and Andersson, G. (2021). Let's talk about mental health and mental disorders in elite sports: a narrative review of theoretical perspectives. Front. Psychol. 12:2515. doi: 10.3389/fpsyg.2021.700829

McArdle, S., and Moore, P. (2012). Applying evidence-based principles from CBT to sport psychology. Sport Psychol. 26, 299–310. doi: 10.1123/tsp.26.2.299

Meidlinger, P. C., and Hope, D. A. (2017). The new transdiagnostic cognitive behavioral treatments: commentary for clinicians and clinical researchers. J. Anxiety Disord. 46, 101–109. doi: 10.1016/j.janxdis.2016.11.002

Mirza, R. D., Punja, S., Vohra, S., and Guyatt, G. (2017). The history and development of N-of-1 trials. J. R. Soc. Med. 110, 330–340. doi: 10.1177/0141076817721131

Moesch, K., Ivarsson, A., and Johnson, U. (2020). “Be mindful even though it hurts”: a single-case study testing the effects of a mindfulness- and acceptance-based intervention on injured athletes’ mental health. J. Clin. Sport Psychol. 14, 399–421. doi: 10.1123/jcsp.2019-0003

Moesch, K., Kenttä, G., Kleinert, J., Quignon-Fleuret, C., Cecil, S., and Bertollo, M. (2018). FEPSAC position statement: mental health disorders in elite athletes and models of service provision. Psychol. Sport Exerc. 38, 61–71. doi: 10.1016/j.psychsport.2018.05.013

Moore, Z. E. (2009). Theoretical and empirical developments of the mindfulness-acceptance-commitment (MAC) approach to performance enhancement. J. Clin. Sport Psychol. 3, 291–302. doi: 10.1123/jcsp.3.4.291

Moore, Z. E., and Bonagura, K. (2017). Current opinion in clinical sport psychology: From athletic performance to psychological well-being. Curr. Opin. Psychol. 16, 176–179. doi: 10.1016/j.copsyc.2017.05.016

Mosewich, A. D., Crocker, P. R., Kowalski, K. C., and DeLongis, A. (2013). Applying self-compassion in sport: an intervention with women athletes. J. Sport Exerc. Psychol. 35, 514–524. doi: 10.1123/jsep.35.5.514

Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self Identity 2, 85–101. doi: 10.1080/15298860309032

Reardon, C. L. (2017). Psychiatric comorbidities in sports. Neurol. Clin. 35, 537–546. doi: 10.1016/j.ncl.2017.03.007

Reardon, C. L., Gorczynski, P., Hainline, B., Hitchcock, M., Purcell, R., Rice, S., et al. (2021). Anxiety disorders in athletes: A clinical review. Adv. Psychiatry Behav. Health 1, 149–160. doi: 10.1016/j.ypsc.2021.05.011

Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., et al. (2019). Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br. J. Sports Med. 53, 667–699. doi: 10.1136/bjsports-2019-100715

Rice, S. M., Purcell, R., De Silva, S., Mawren, D., McGorry, P. D., and Parker, A. G. (2016). The mental health of elite athletes: A narrative systematic review. Sports Med. 46, 1333–1353. doi: 10.1007/s40279-016-0492-2

Rice, S., Walton, C. C., Gwyther, K., and Purcell, R. (2021). “Mental health,” in Stress, Well-Being, and Performance in Sport , eds. R. Arnold and D. Fletcher (New York, NY: Routledge), 167–187.

Röthlin, P. (2019). Go soft or go home? A review of empirical studies on the role of self-compassion in the competitive sport setting. Curr. Issues in Sport Sci. 4:013.

Ruiz, F. J. (2010). A review of acceptance and commitment therapy (ACT) empirical evidence: correlational, experimental psychopathology, component and outcome studies. Int. J. Psychol. Psychol. Ther. 10, 125–162.

Sappington, R., and Longshore, K. (2015). Systematically reviewing the efficacy of mindfulness-based interventions for enhanced athletic performance. J. Clin. Sport Psychol. 9, 232–262. doi: 10.1123/jcsp.2014-0017

Schaal, K., Tafflet, M., Nassif, H., Thibault, V., Pichard, C., Alcotte, M., et al. (2011). Psychological balance in high level athletes: gender-based differences and sport-specific patterns. PLoS One 6:e19007. doi: 10.1371/journal.pone.0019007

Schenk, M., and Miltenberger, R. (2019). A review of behavioral interventions to enhance sports performance. Behav. Interv. 34, 248–279. doi: 10.1002/bin.1659

Stillman, M. A., Brown, T., Ritvo, E. C., and Glick, I. D. (2016). Sport psychiatry and psychotherapeutic intervention, circa 2016. Int. Rev. Psychiatry 28, 614–622. doi: 10.1080/09540261.2016.1202812

Stillman, M. A., and Farmer, H. (2021). “Psychotherapeutic approaches to addressing mental health problems among elite athletes,” in Contemporary Advances in Sport Science. ed. R. Taiar (London: IntechOpen), 229–238.

Stillman, M. A., Glick, I. D., McDuff, D., Reardon, C. L., Hitchcock, M. E., Fitch, V. M., et al. (2019). Psychotherapy for mental health symptoms and disorders in elite athletes: a narrative review. Br. J. Sports Med. 53, 767–771. doi: 10.1136/bjsports-2019-100654

Svrluga, B. (2021). Tokyo Olympics’ lasting lesson: sometimes, it’s better to let go than push through. The Wash Post . Available at: https://www.washingtonpost.com/sports/olympics/2021/08/05/mental-health-tokyo-olympics/ (Accessed September 1, 2021).

Swain, J., Hancock, K., Hainsworth, C., and Bowman, J. (2013). Acceptance and commitment therapy in the treatment of anxiety: a systematic review. Clin. Psychol. Rev. 33, 965–978. doi: 10.1016/j.cpr.2013.07.002

Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., and Schreurs, K. M. G. (2016). Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cogn. Behav. Ther. 45, 5–31. doi: 10.1080/16506073.2015.1098724

Keywords: mental disorders, mental health problems, interventions, psychotherapy, sports

Citation: Ekelund R, Holmström S and Stenling A (2022) Mental Health in Athletes: Where Are the Treatment Studies? Front. Psychol . 13:781177. doi: 10.3389/fpsyg.2022.781177

Received: 22 September 2021; Accepted: 13 June 2022; Published: 04 July 2022.

Reviewed by:

Copyright © 2022 Ekelund, Holmström and Stenling. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Rebecka Ekelund, [email protected]

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

Mental Health in Athletes: Where Are the Treatment Studies?

Affiliations.

• 1 Department of Psychology, Umeå University, Umeå, Sweden.
• 2 Umeå School of Sport Sciences, Umeå University, Umeå, Sweden.
• 3 Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway.
• PMID: 35859831
• PMCID: PMC9289539
• DOI: 10.3389/fpsyg.2022.781177

In recent years, athletes' mental health has gained interest among researchers, sport practitioners, and the media. However, the field of sport psychology lacks empirical evidence on the effectiveness of psychotherapeutic interventions for mental health problems and disorders in athletes. Thus far, intervention research in sport psychology has mainly focused on performance enhancement using between-subject designs and healthy athlete samples. In the current paper, we highlight three interrelated key issues in relation to treating mental health problems and disorders in athletes. (i) How are mental health and mental health problems and disorders defined in the sport psychology literature? (ii) How are prevalence rates of mental health problems and disorders in athletes determined? (iii) What is known about psychotherapeutic interventions for mental health problems and disorders in athletes? We conclude that the reliance on different definitions and assessments of mental health problems and disorders contributes to heterogeneous prevalence rates. In turn, this limits our understanding of the extent of mental health problems and disorders in athletes. Furthermore, knowledge of the effectiveness of psychotherapeutic interventions for athletes with mental health problems and disorders is scarce. Future research should include athletes with established mental health problems and disorders in intervention studies. We also propose an increased use of N-of-1 trials to enhance the knowledge of effective psychotherapeutic interventions in this population.

Keywords: interventions; mental disorders; mental health problems; psychotherapy; sports.

Copyright © 2022 Ekelund, Holmström and Stenling.

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This Therapy Helps Victims of Violent Crime. Who Will Pay for It?

“Trauma recovery centers” are favored by law-and-order officials and progressive activists alike for one big reason: They work. But to stay open in New York, they need more funding.

By Ginia Bellafante

Ginia Bellafante writes the Big City column, a weekly commentary on the politics, culture and life of New York City.

Last spring, Randy White was shot in the stomach when he was caught in the crossfire of a gunfight at an Atlanta gas station. The injury kept him in the hospital for a week, but his mental state was paid little consideration. Discharged with no meaningful plan to deal with the psychological fallout that would inevitably come, he found himself adrift.

A few months later he was still struggling, so he moved back to Coney Island, where he grew up. “I did bad stuff in New York, but I never got shot,” he told me recently. There had been several arrests on drug charges, time spent in jail, a baby at 19, all preceded by a difficult childhood. “I didn’t have a family, like, with love,” he volunteered.

Perhaps unsurprisingly, returning to New York did not bring him the serenity he had hoped to find. Soon after he arrived, he was in a car accident. It was at this point that a friend suggested that he see a therapist.

As it happened, there was a place in the neighborhood called the Trauma Recovery Center , operated out of the Jewish Community Council of Greater Coney Island, a longstanding social service organization. T.R.C.s, as they are known, came into being more than 20 years ago and have spurred something of a movement — a means of helping victims of violent crime, specifically in low-income communities where a distrust of traditional mental-health treatment can be pervasive. A 2022 survey from the Alliance for Safety and Justice found that 74 percent of victims did not receive counseling to help them process what had happened, a matter both of reluctance and inadequate service.

Since the first T.R.C. opened in San Francisco in 2001, 52 programs across 12 states have followed, and they have largely received bipartisan support on the grounds that they function both palliatively and preventively. The structure allows counselors and case managers to deal with the emergency and whatever practical concerns might arise from it, and then allows them to stay with the victim to help manage the emotional effects: anger and turmoil that can result in dangerous acts of recrimination, or anxiety and depression that can spiral toward unemployment and homelessness.

In addition to the Coney Island facility, two other trauma recovery centers have opened in New York over the past year, one in East Flatbush and another in the Bronx. Their foremost evangelist is the City Council speaker, Adrienne Adams, who was central to establishing them. But the funding — $5 million, which has come entirely from the Council’s discretionary funds over the past two budget cycles — is not enough to sustain them.

The Council wants the city to provide long-term funding as a matter of commitment in its budget, and not have the recovery centers’ survival dependent on the support of Ms. Adams, whose second and last term ends on Jan. 1, 2026.

Ensuring their survival has been perhaps the speaker’s biggest rallying cry, even at a moment of intensely competing interests, when so many services have been threatened with cuts. There has been no state funding so far.

In her district in Queens, Speaker Adams said, she has spent a lot of time around victims of gun violence. “I’ve met the mothers of these people and the grandmothers. I have sat in their homes,” she said. “And what do we do for them? These families want to retaliate. Siblings want to retaliate. But we’re looking at crisis intervention, legal advocacy.

“We have some place for folks to go where they can find comfort,” she continued. “These centers are absolutely the answer.”

At the Coney Island branch, Mr. White began to see a therapist and unpack himself. He was 38 and had never sought counseling; it was hard work. “I was not opened up at all,” he said. “I was just giving her bits and pieces.” But when he began to deliver a fuller picture of himself, the progress came quickly.

Within three months he had a job that the center had helped him acquire — at a homeless shelter on Neptune Avenue — and he found release from various anxieties and temptations. “My mind is a straight path: I just want to go to work and go home,” he said after speaking at a ribbon-cutting ceremony this week for the new dedicated space the center now occupies on Mermaid Avenue.

In 2006, a randomized trial was conducted to study the effectiveness of the first trauma recovery center, in San Francisco. The research looked at people in hospitals in the aftermath of serious physical injuries resulting from violence. They followed up with patients referred to a T.R.C. and with those referred to a standard community mental health program, and found that those who had gone through a T.R.C. were far less likely to become homeless or suffer from depression.

Another study looked at women at a rape-crisis center and found that those who went on to a T.R.C. were much more likely to file police reports than those who did not. The trauma recovery centers were also cheaper to run than the less effective community mental health programs. Subsequent studies out of Long Beach, Calif., and Cleveland reached similar conclusions.

The approach is successful in part because it does not ignore the importance of satisfying immediate material needs. Getting someone in the door to address a housing issue, for example, can build the trust that smooths the path to receiving therapy or other forms of help. Alicia Boccellari , a professor of psychiatry at the University of California, San Francisco, School of Medicine and the founder of the trauma recovery model, offered an example of how the system works.

She described a case in which a woman had lost her daughter in random gunfire, an incident in which her son and one of her grandchildren were also injured. She was left to raise that grandchild and the child’s siblings, but she was tormented and afraid to send the children to school. As a result of the crime, her car had been impounded as evidence — a seemingly trivial problem by comparison but one with a profound impact. The trauma recovery center connected her with the local child welfare agency and with an auto dealership that donated a car.

“The model is not about one clinician,” Dr. Boccellari said. Rather, it is designed with the goal of shifting a powerful worldview that victims of serious crimes can carry with them: that the world is defined by violence and cruelty.

In recent years, the idea of “trauma” has been cheapened in the popular discourse, having attached itself to what was once imagined as mere inconvenience. That a “trauma recovery center” might breed skepticism in certain circles is hardly inconceivable. But a political and media apparatus that puts victims on display as a means of justifying punitive criminal justice policies, without committing to helping these victims, is harder to endorse. The proposed city budget would also cut $3 million from a Safe Horizon program that places a victim advocate in every police precinct in the city.

A trauma recovery center aims to bring someone not necessarily back to a former self, but to a better, more whole one. As Randy White put it: “If I didn’t do this, I’d be on the streets. I’d be dead.”

Ginia Bellafante has served as a reporter, critic and, since 2011, as the Big City columnist . She began her career at The Times as a fashion critic, and has also been a television critic. She previously worked at Time magazine. More about Ginia Bellafante

Politics in the New York Region

State Budget: New York State leaders have agreed on the outline of a $237 billion state budget  that includes a sweeping package  aimed at stemming one of the worst housing shortages in the nation.

Jail Project: The demolition of a Manhattan jail complex in Chinatown to make way for a bigger one has damaged a neighboring building  and raised concerns about years of dust and disruption.

Adultery as Crime: An antiquated but seldom-enforced state law categorizes adultery as a crime, and past efforts to repeal it have gone nowhere . But that seems poised to change.

Limiting Social Media’s Hold: New York’s governor and attorney general joined forces to pass a law  trying to restrict social media companies’ ability to use algorithms to shape content for children. Big Tech is putting up a battle with a high-stakes lobbying effort.

Targeting Trans Athletes: A proposed ban on transgender women playing on women’s sports teams  has turned a Long Island county into the latest battleground for conservatives who have put cultural issues at the center of a nationwide political strategy.

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Suicidality Among Men in Russia: A Review of Recent Epidemiological Data

Val bellman.

1 Psychiatry, University of Missouri, Kansas City School of Medicine, Kansas City, USA

Vaishalee Namdev

2 Medicine and Surgery, Mahatma Gandhi Medical College and Research Institute, Indore, IND

Suicide is a phenomenon that is not related to a specific class of countries but is a problem worldwide. Many studies have attempted to explain gender differences in suicidal behaviors. Unfortunately, Russia holds the world’s top place for the number of suicides committed by its male citizens. Russia is still demonstrating unusually high death rates due to non-natural causes, and these demographic trends are concerning. We analyzed suicidality among men in Russia over the past 20 years using official data published by the Federal State Statistics Service (Rosstat) and secondary sources. We also discussed male suicide as a social problem, analyzed, and evaluated male suicidality in Russia from 2000 to 2020, and reviewed the factors influencing the prevalence of male suicides over female suicides in Russia.

Russia is still going through one of the most significant historical changes in the last 100 years. Our analysis showed discrepancies between official numbers and data published by non-government organizations in Russia. Unemployment, low socioeconomic status, underdiagnosed and/or untreated mental illness, and substance abuse are major risk factors for suicide in Russian men. Cultural influences also make suicidal behavior socially scripted in Russia.

By providing examples and analyzing data, we aspire to encourage improvements in the practice of mental wellbeing in Russia and other post-Soviet countries. The recommendations within this report are intended as a starting point for dialogue to guide effective suicide prevention in this country.

Introduction

Suicides and self-harming behaviors are significant public health and social problems in post-Soviet Russia. Suicide is one of the leading causes of death worldwide [ 1 ], accounting for over 58,000 deaths annually in Europe [ 2 ] and 16,546 deaths in Russia in 2020 [ 3 ]. According to experts, there are 11.4 suicides per 100,000 people in the world, which equates to 804,000 suicides annually [ 4 ]. Although the suicide rates in Russia are gradually decreasing (39.1/100,000 in 2000 to 23.4/100,000 in 2010 and 11.3/100,000 in 2020 [ 3 ]), the number of suicides among men is significantly higher than among Russian females [ 5 , 6 ].

The suicide rates vary greatly between Russian cities and within the country, and the difference between regions varies tenfold. The suicide rates are higher in rural communities when compared with their urban counterparts. Social deprivation, economic depression, unemployment, heavy alcohol consumption, etc. are also more prevalent in rural areas of Russia. Indigenous peoples around the country are burdened with a markedly increased suicide rate, which may be associated with a challenging social situation, inadequate family support, lower socioeconomic status, and an increased prevalence of alcohol and psychoactive substances, which also act as suicide risk factors in general [ 7 , 8 ]. The suicide rates among men in Russia (26.1 per 100,000) were over three times higher than among women (6.9 per 100,000) in 2016. Committing suicide appears to be a male phenomenon over the past 20 years in post-Soviet Russia [ 9 ]. For suicide attempts, the level estimated by the World Health Organization (WHO) is 20 times higher than the suicide rate [ 10 ]; the gender gap is less pronounced.

This phenomenon, when men commit suicide more frequently than women while women are much likelier to commit suicide attempts, is known as the gender paradox of suicidal behavior [ 2 , 6 ]. All Russian citizens are expected to receive medical care that meets the highest standards, regardless of their race, religion, national origin, sexual orientation, gender identity, or expression. Although the Russian healthcare system remains gender-neutral, Russian men are not considered a “risk” group and are not involved in targeted state-sponsored suicide prevention programs [ 11 ].

Materials and methods

Data on the population and male suicide rates were taken from the official reports of Rosstat and the Ministry of Health of the Russian Federation for 2001-2020. Secondary data were obtained from international databases and published studies in Russian and English. We used descriptive statistics to summarize the information about the population being studied. This methodology helped us summarize data in the form of simple quantitative measures, such as percentages and means, or visual summaries, such as diagrams and bar charts. The literature review attempted to bring together all available evidence on a specific, clearly defined topic.

Published studies were identified through ‘pearl growing’, citation chasing, a search of databases, using the filters, and the authors’ topic knowledge. The articles were searched in MEDLINE, PubMed, EMBASE, COCHRANE, eLibrary, and CyberLeninka. A search of databases was undertaken in December 2021 using predefined keywords. Citation chasing was conducted by analyzing the references for each included study. A total of 122 potential papers were identified. We also included at least 20 Russian biomedical journals listed in databases, which were translated into English. The summary document contained the list of included and excluded articles; the inclusion status for each article was based on a review of the full-text manuscript. The inclusion criteria were articles with the target population, specific location, investigated epidemiological trends, or the comparison between two-to-three studied regions (cities, states, or districts). Exclusion criteria were unrelated, duplicated, unavailable full texts published before 2001. Data were abstracted from 60 eligible papers. Some of these sources had English-language abstracts, but other articles’ texts had to be translated. The evidence was graded for each source based on the quantity and quality of studies and potential data flaws. The quality, validity, and type of published data were considered. 

The citation management system EndNote allowed us to organize our literature databases with internet searches and have add-ons for Office programs, which made the process of literature citation convenient. However, the majority of articles in Russian could not be captured by the citation management system. Additionally, the search for article content was sometimes unavailable for search engines. The authors had to enter this information manually to ensure consistency in the referencing of studies. Some Russian sources were originally published as extensive PDF files of the entire journal issue without dividing it into separate articles and providing no descriptors, making manual, time-consuming input of information the only possibility.

Not only are men likelier to die of suicide than women between the ages of 10 and 60 years, but the suicide rate among men also grows with every decade of life, reaching a peak at 50 [ 12 , 13 ]. Russian men become increasingly inclined to commit suicide before their 60th birthday, usually via firearms or strangulation. Although men aged 60, 70, and 80 die from suicide less often than men aged 40 to 59, gender differences prevail. The suicide rate among men over 60 is about 30 cases, compared to about 10 (per 100,000 people) among women of the same age [ 11 , 12 ]. 

Official data illustrate that suicide rates among men have gradually decreased over the past 20 years. While in 2000 it was 68.4 cases per 100,000 people, in 2010, it was 41 cases per 100,000 people, gradually decreasing to 29.3, 27.6, 21.7, 20.5, and 19.8 cases in 2015, 2016, 2018, 2019, and 2020, respectively, per 100,000 people. Suicide mortality among women is significantly lower than among men. In 2015-2016, it was nearly four times lower than among men and amounted to 7.5 and 7.1 cases per 100,000 people, respectively, in 2015 and 2016. The suicide rate among men in 2000-2020 per 100,000 people is shown in Figure ​ Figure1 1 [ 3 ].

According to official data, the suicide rate among all age groups decreased. In recent years, the suicide rate among adult men has varied. Data demonstrate that the suicide rate among men increases with every decade of life, reaching a peak of 50 years. Thus, at the age of 15-19 years, the mortality rate from suicide among men was 10-12 cases in 2015-2016 per 100,000 people, at the age of 20-24 years: 18-20 cases, 25-29 years: 24-26 cases, 30-34 years: 31-35 cases, 35-39 years: 37-40 cases, and reaching a maximum in the age group of 50-54 years at 38-41 cases, then decreases gradually. Figure ​ Figure2 2 summarizes data on male suicide mortality in 2015-2016, depending on the age per 100,000 people [ 12 ].

The data show that the suicide mortality rate among the male population in various age groups has been steadily decreasing since 2002. Between 2000-2003, all age groups of the male population demonstrated a growth in the number of suicide cases. It peaked in this period (2000-2020), except for the 15-29 age group. Between 2004 and 2010, there was the fastest decline in the suicide mortality rate among the male population in different age groups, after which the rate of decline in the mortality rate slowed, which may have been due to the financial and economic crisis in Russia (2008-2010). Figures ​ Figures3 3 - ​ -5 5 summarize the changes in the suicide mortality rate among men in different age groups in 2000-2020 [ 3 ].

Between 2000-2020, the male suicide rate was variable across all levels of urbanization with higher rates in nonmetropolitan/rural areas than in medium or large metropolitan clusters. Geographic disparities (specific federal districts versus Russia overall) in suicide rates might reflect suicide risk factors known to be prevalent in less urban areas, such as limited access to mental health care, social isolation, and substance abuse.

Official data show that in 2015-2017, the suicide mortality rates among the male population in the Central Federal District, the city of Moscow, and the North Caucasian Federal District were lower than the average for the Russian Federation. The lowest rates were seen in the city of Moscow and the North Caucasian Federal District. In the Northwestern Federal District, suicide mortality rates among the male population were about the same as those in the Russian Federation overall. In the Volga Federal District, Ural Federal District, Siberian Federal District, and Far Eastern Federal District, suicide mortality rates among the male population were higher than the average in Russia. Figure ​ Figure6 6 summarizes the male suicide mortality rates in various federal districts and the Russian Federation in 2015-2017 [ 11 , 12 ]. 

Interestingly, Mal et al. (2020) stated that the highest suicide mortality rates were in five Russian federal districts: Northwestern, Volga, Ural, Siberian, and Far Eastern; however, their analysis focused on suicide mortality rates in general. Additionally, the authors indicated that suicide mortality rates were significantly lower in Central, Southern, and North Caucasian Federal Districts [ 14 ].

The impact of urbanization on suicidality in Russian men and on the mental health of the general population remains underestimated [ 15 ]. The highest degree of urbanization was recorded in the Northwestern Federal District of Russia, where almost 85 percent of the inhabitants lived in city areas. The extent to which the suicide rate in urban areas is influenced by exposure to risk factors other than urbanization remains unknown due to a lack of data. The lowest male suicide mortality rates in the Northwestern Federal District are seen in the city of St. Petersburg, where these numbers are lower than the indicators for the Northwestern Federal District. Suicide mortality rates among the male population in the Northwestern Federal District decreased in 2015-2017. The most significant decrease occurred in the Novgorod region. Figure ​ Figure7 7 shows the suicide mortality rates among the male population in various regions of the Northwestern Federal District in 2015-2017 [ 11 , 12 ].

Interestingly, the regions located in the Northern Caucasus demonstrate significantly lower male suicide rates compared to the rest of the nation [ 16 ]. These numbers and demographic trends were noted almost 20 years ago and remain consistent with our data. The published data suggest that the highest suicide mortality rates among the male population in the North Caucasian Federal District were in the Republic of Alania, being higher than the indicators for the North Caucasian Federal District by about 15%. The lowest male suicide mortality rates were in the Republic of Ingushetia. The numbers are lower than these indicators for the whole North Caucasian Federal District by over two times. These male suicide mortality rates are the lowest of those discussed in this report. However, higher suicide rates were found among male soldiers who served in the Chechen wars and/or were actively serving in other areas of the Caucasus [ 17 ]. Figure ​ Figure8 8 shows suicide mortality rates among the male population in various regions of the North Caucasian Federal District in 2015-2017 [ 11 , 12 ].

Interestingly, the Russian Southern Federal District borders the republics of the North Caucasus. While some parts of that district are ethnically like the North Caucasus, the male suicide mortality rates are like other regions of Russia with a predominantly Slavic population. Data on male suicide mortality rates in various regions of the Southern Federal District from 2015-2017 showed a gradual tendency to decrease, but those numbers are still significantly higher than in the North Caucasus region. In the Republic of Kalmykia, suicide mortality rates among the male population in 2015-2017 were higher than in the Southern Federal District by about 20%. In the Rostov region, suicide mortality rates among the male population in 2015-2017 were about 15% lower than those in the Southern Federal District. Figure ​ Figure9 9 illustrates suicide mortality rates among the male population in various regions of the Southern Federal District in 2015-2017. 

The Central Federal District is located in the center of the European part of Russia. It is the district with the highest density of population in Russia-60.30 people per square kilometer: a high level of urbanization, as about 50% of the population lives in the Moscow region. This region has a high level of economic and social activity and a presumably better socioeconomic situation. However, male suicide mortality rates vary between cities. Suicide mortality rates among the male population in the Belgorod Region and the city of Moscow were lower than in the whole Central Federal District. In the Kursk and Moscow regions, mortality rates were about the same as in the Central Federal District, especially in 2017. In the regions of Bryansk, Vladimir, Voronezh, Ivanovo, Kaluga, Smolensk, Tver, and Yaroslavl, suicide mortality rates among the male population were higher than in the Central Federal District. In 2015-2017, nearly all regions of the Central Federal District demonstrated decreased male suicide mortality rates. The fastest rates of decline were observed in the regions of Belgorod, Kursk, Smolensk, and Tver. In the Voronezh region, there was an increase in the death rate from suicide among the male population. In Moscow in 2016, the suicide mortality rate increased among the male population compared to 2015. In 2017, this index dropped again. Males aged 55 years and older were more likely to die from suicide than any other age group for both males and females. Figure ​ Figure10 10 shows male suicide mortality rates in various regions of the Central Federal District and the Russian Federation in 2015-2017 [ 11 , 12 ].

The red column (4.3) is the suicide mortality rate among the female population in Moscow in 2016 [ 11 , 12 ]

Male suicides in the Volga Federal District showed a linear trend of decline in 2015-2017, despite the risk factors for suicide generally increasing. The most significant decrease in male suicide mortality rates among the male population was observed in the Saratov region, which initially showed an unexpected increase in male suicide rates (higher than in the Volga Federal District by about 23%) [ 11 , 12 ]. Suicide mortality rates among the male population in the Ural Federal District in 2015-2017 also showed a tendency to decrease [ 11 , 12 ]. 

Social marginalization and depopulation are particularly widespread in regions of the Asian part of the country. Despite the implementation of additional state-run social and demographic incentives, the impoverishment of human capital is still evident in this region. This region is far removed from Russia’s European core and financial centers but remains uncomfortably close to dynamic and powerful China. Despite the oil and gas resources of East Siberia and the Far East Federal District, its regional product amounts to just 5-6 percent of Russia’s total gross domestic product (GDP). 

These two regions have long been known as underdeveloped and socially challenging. Despite these circumstances, the suicide mortality rates among the male population in the Siberian Federal District (SFD) in 2015-2017 also showed a tendency to decrease. The most significant decrease in suicide mortality rates among the male population occurred in the Altai Republic. In the Krasnoyarsk Region, the Irkutsk region, the indicators were fairly even, like the rates for the Siberian Federal District. Interestingly, in Omsk, suicide mortality rates among the male population in 2015-2017 were about 10% lower than those in the entire Siberian Federal District. The official data show that the highest male suicide mortality rates in the Far Eastern Federal District were in the Amur and Sakhalin Regions, being higher than these rates for the Far Eastern Federal District by 28% and 23%, respectively. Interestingly, the lowest male suicide mortality rates were in the Kamchatsky Territory, where these numbers were lower than the indicators for the Far Eastern Federal District by about 10-15%. Figures ​ Figures11 11 and 12 summarize data regarding male suicide mortality rates in various regions of the SFD and the Far Eastern Federal District in 2015-2017 [ 11 , 12 ]. 

Data accuracy issues 

According to the World Bank, Russia ranks third in the world in the suicide mortality rate, and this rate in 2019 was 25.10/100,000 per year. However, this rate is disproportionally higher for men. It is important to mention that these rates have been declining over the past 20 years. The available data highlight that the suicide mortality rate among Russian men was as high as 96.7/100,000 in 2000 and decreased to 43.60 in 2019 [ 18 ]. Interestingly, these numbers do not correlate with the data provided by Rosstat [ 3 ]. Table ​ Table1 1 provides additional information on this matter.

Adopted from  macrotrends.com  [ 18 ]. 

The research data published in Russia are not always transparent. For example, the “event of undetermined intent” has shown exponential growth since 2014 and has exceeded suicide mortality rates [ 19 ]. The researchers believe that this subcategory includes “latent homicides and suicides,” while actual suicide mortality rates remain unclear. Local coding and data recording standards vary significantly and can negatively affect the transparency of the data. Specifically, many suicides are frequently listed within the “external causes of morbidity and mortality” subcategory [ 19 ]. The ICD-10 classification category includes multiple “environmental events and circumstances as the cause of injury, and other adverse effects,” where potential suicides can be included without any further systematization. “Latent suicides” include falls from heights, poisoning, and hanging with unspecified intent. They account for a significant proportion of suicide mortality. Since they are counted as events of undetermined intent, statistics show a sharp drop in suicide mortality rates, which has a linear trend [ 20 ]. This approach serves as a perfect example of data distortion practices. Moreover, there is no distinct updated information regarding suicides committed in Chechnya and in other North Caucasus republics. Yumaguzin (2019) indicated that suicide rates are significantly underestimated, while ill-defined causes of death are used to misinterpret data related to suicide and self-harming behaviors [ 19 ].

According to Verbitskaya [ 21 ], 80% of publications in Russian have methodological issues or unacceptable research designs. Based on our analysis, many studies conducted or published in Russia have methodological flaws (e.g., incomparable populations, lack of standards, internationally approved scales, and different designs). An analysis of the literature published in Russian showed that many journals have no specific or evidence-based standards for the description and presentation of research results. Although these issues are not directly related to our assessment of men’s suicide rates, it is important to mention these flaws to facilitate positive changes in data reporting. No matter how much the data vary, male suicide mortality rates remain exceptionally high. 

Socioeconomic environment

Many experts agree that male suicide mortality rates are a consequence of social, economic, psychological, and demographic issues. Some of Russia’s cultural norms can be attributed to the nation’s tumultuous history, such as that of the former Soviet Union. With the fall of communism, the nation experienced social and economic hardships that adversely affected many Russians’ mental health. Some theorize that such monumental societal changes during that time have had long-term effects, persisting until the present day. However, there has been a downward trend in suicide rates over the last two decades because the nation has improved on many socioeconomic indicators [ 22 ]. The number of suicides correlates with social changes, such as resettlement, assimilation, and the destruction of the conventional social structure. 

Financial struggles can be attributed to increased suicidality in men. The three main economic indicators, which are GDP, unemployment rate, and consumer price index, are associated with suicidal ideas, suicide attempts, and suicides [ 23 ]. In the economic crises of the 1990s, unemployment and a decrease in personal income were directly correlated with growing suicide rates, especially among men [ 24 ]. Another study evaluated how certain socioeconomic factors influenced suicide patterns within Russia. The findings demonstrated a significant decline in the male suicide rate with the country’s improvement in economic indicators (e.g., income per capita, GRP growth rate, etc.). The study also evaluated the effects of marriage and divorce on suicide rates among men. Marriage has negative effects on suicide rates, while divorce has positive effects on suicide rates [ 25 ]. Russian men are more prone to relocate and tend to move to large cities to obtain employment and work on a shift basis. These difficulties have also led to the insufficient development of institutions expected to address these social issues [ 26 ]. 

Geographical aspects

People living in rural areas of Russia are at a greater risk of suicide than those living in urban areas or big cities. The strength of the connection between intoxication and suicide also depends on the geographical region in Russia. Specifically, the data show that rates increase from the south and west to the north and east of the country [ 24 ]. 

Not only are suicide rates significantly lower in the Northern Caucasus, but other factors also make it important to consider other psychosocial factors. For example, a higher proportion of Muslims in these regions results in a different cultural context in the Northern Caucasus than in the rest of Russia, plus religious differences and Islamic scriptures against suicide. Furthermore, the intersection of these cultural factors with social institutions means that several of the measures included here as controls are confounded with a location in this area.

Average alcohol consumption in central Russia is high with a relatively large proportion of unrecorded consumption ranging from almost zero to 21 liters [ 27 ]. The rates of heavy alcohol consumption (more than 40 g of pure alcohol per day) among men were the lowest in Kabardino-Balkaria and Karachay-Cherkessia (2.3 L of ethanol per adult/year) and the highest in Magadan region (24.3 L per adult/year) [ 28 ]. Alcohol consumption is lower in these regions, and wine products are more often consumed here than in the rest of the country, meaning that the preference for vodka is not as strong as elsewhere in Russia.

Cultural aspects

The Russian mentality is characterized by a man destined to serve the motherland, the army, and his family. Russian culture is rooted in rigid gender roles, and these norms are present even at the institutional level. In The ABC for Men, the author determined that Russia has over a dozen laws that discriminate against men. For example, Russian law supports the idea of motherhood among women, yet no laws exist that support fatherhood. Although there is no concept of "single father" in Russian law, the number of families consisting of single fathers with children is slowly growing in Russia (1.18% in 2002 vs. 1.27% in 2010. According to Russian law, these men are eligible for the same benefits as single mothers [ 29 , 30 , 31 ]. Russian legislators have attempted to pass several similar bills that, although unsuccessful, highlight the inequities between males and females.

Along these lines, men experience different expectations in terms of occupation. Women are not allowed to work certain jobs that are considered difficult or dangerous. Likewise, these occupations consist solely of male employees, allowing men easier access to suicide modalities at hazardous places of work. Such methods, such as pesticides or firearms, are more lethal. Not only this, but a man’s age of retirement is a full five years later than that of a woman [ 31 ]. These policies indicate Russian cultural pressures, which may adversely affect men’s mental health and suicide rates. Finally, 40-50 percent of all marriages in Russia will end in divorce or separation. High divorce rates may also contribute to the likelihood of higher suicide rates in this country [ 32 ].

Child and adolescent suicidality in Russia

Across all post-Soviet countries, Russia has one of the highest rates of child and adolescent suicide [ 33 ]. Parental neglect, such as physical, sexual, or emotional abuse in childhood (PSEA), is very common in Russian families. The link between PSEA and the risk of suicide throughout life has been confirmed by published research data [ 34 ]. 

According to multiple reports, Russia has often outstripped Europe when it comes to teen suicide rates [ 35 ]. The adolescent suicide rates (specifically between ages 15-34) have steadily increased since 1996, more so than the older age groups. Suicide among young Russian males is four times more common than among young females (32.8 per 100,000 people versus 7.6 in 2004), and it occurs among ever-younger males, some in their early teens [ 36 ]. Although younger groups have had consistently lower suicide rates than middle-aged and older adults, young Russian men have attempted suicide almost twice as often as female youth since 1989. According to reports, almost 4,000 teen suicide attempts were registered in Russia annually, and as many as 1,500 of them resulted in death. In 2016, an ominous report by journalist Galina Mursaliyeva in the Russian newspaper Novaya Gazeta surfaced, which brought to light the presence of online “death groups” on the social media platform  vk.com , which influenced countless teenagers to commit suicide worldwide [ 37 ], the biggest proportion of which were Russian teenagers.

In turn, the administrations’ knee-jerk reactions to increasing internet censorship did little to address the situation. There was a 14% spike in emergency room trips for potential suicides by children and adolescents in 2018 compared to 2017 (692 in 2017 versus 788 in 2018), according to findings reported by state officials [ 38 ]. Local media reports estimated that adolescent suicide rates remained relatively unchanged in 2018-2019. Interestingly, local experts noted that increasingly more Russian teenagers wanted to participate in or “supervise” online suicide games in 2020-2021 [ 39 ].

The underlying conditions that deem these children more susceptible to suicidal ideations are social isolation, a dysfunctional family system (e.g. families with interpersonal conflicts, misbehavior, child abuse or neglect), increased social isolation due to stigma surrounding mental health, an inability to relate to the opposite sex, and intolerance toward LGBTQ+ youth [ 40 , 41 ]. Additionally, decreased attention by caregivers to a child’s emotional needs has been the norm for a long time.

Multiple support groups, such as Your Territory and Deti 404, have since emerged on  Vk.com  to give teenagers a platform to express their frustrations with a skilled support network that provides counseling and mental health support [ 40 ].

Mental health and stigma

Studies of the relationship between psychopathology, substance abuse, and suicide consistently indicate that around 70% of people who die from suicide suffer from an identifiable mental disorder before death. Episodes of major depression associated with a major depressive disorder or bipolar disorder account for at least half of suicide cases [ 42 ]. The prevalence of affective disorders in Russia ranges from 30-40%. The majority of cases remain underdiagnosed and undertreated [ 43 ]. Among suicides, there are usually many factors that can increase underlying risks or interact with depression and increase suicide risk, such as alcohol- and drug-related disorders, which are more common in men [ 44 ].

In almost all regions across the country, men consistently live shorter lives than women. Especially among middle-aged Russian men, high alcohol consumption and ongoing mental health problems contributed to gender differences in all-cause mortality [ 45 ]. 

In Russia, there is a stigma associated with mental health and consequent suicide. Many Russians consider mental health disorders to be self-inflicted and do not believe in treatment. This stigma can extend to a suicidal individual’s friends, family, and mental health professionals. 

Binge drinking is commonplace among Slavic nations, with Russia being one of them. Suicides among men in Russia are specifically associated with high rates of alcoholism. Russia’s cultural pressures also affect the physical health of the country’s men. Men are discouraged from coping with life stressors in healthy ways, and many men turn to drinking or smoking to cope [ 31 ]. Data have shown that many Russian men drink alcohol to cope with stress, unemployment, depression - in situations in which they would otherwise have difficulty coping. High levels of alcoholism in Russia existed before the collapse of the Soviet Union. However, a sharp rise began in the early 1990s and has risen to one of the highest worldwide. Local officials have estimated that alcohol consumption is up to 15 liters per person per year, while consumption in the European Union and the United States is between 7 and 10 liters [ 31 ].

Vodka accounts for roughly 75% of the nation’s alcohol consumption, and approximately one-third of Russian men report binge drinking vodka at least once monthly [ 46 ]. While inebriated, individuals are more susceptible to existing mental health issues and maybe likelier to act on suicidal thoughts. It was shown that life expectancy decreased by 12% between 1990 and 1994, which was directly related to alcohol mortality [ 24 ]. Researchers estimate that 61% of male suicides in Russia involve alcohol, compared to 22% of deaths worldwide that involve alcohol [ 47 ].

Future trends 

Russia is witnessing extremely high male suicide rates. As the high suicide rate among Russian males is multifaceted, it can be difficult to develop effective solutions. Current thinking suggests that access to mental health services can lessen suicide rates. Considering all the difficulties, the transition of primarily descriptive results to specialized suicide prevention programs among men turned out to be a challenging task that requires complex medical and social approaches [ 48 - 50 ].

In the last two decades, the Russian Federation has introduced many measures that have yielded tangible results. In the early 2000s, the state became fully involved in the control of the alcohol market [ 46 ]. In 2006, Russia implemented an alcohol policy to control the alcohol market and contain alcohol-related poisonings. President Putin implemented the law in January 2006, which regulated the volume and quality of alcohol products. The patterns thereafter revealed important learnings as to how alcohol consumption affects suicide rates. One study determined that the 2006 policy yielded a 9% decrease in male suicide mortality. This translates into 40, 000 male lives saved yearly from suicide by restricting alcohol [ 24 ]. 

The WHO published data that, in 2003, both alcohol-related mortality and the amount of alcohol consumed per year decreased significantly [ 51 ]. In this way, the mortality of men has decreased by as much as 40%, while men’s life expectancy has increased from 57 to 68 years over the past 15 years [ 51 ]. In the early stages of the COVID-19 crisis, local experts suggested that the pandemic might lead to an increase in suicide among Russians. Official data released by Rosstat suggested that for the entire year 2020, the standardized mortality ratio due to suicides dropped by 4.1%. However, WHO experts concluded that suicide mortality in Russia is worse than officially reported. According to their report, “Suicide Worldwide in 2019: Global Health Estimates,” the suicide rates (per 100 000) were 25.1 (crude suicide rate) and 21.6 (age-standardized suicide rate), or at least twice as high as the official data [ 52 ]. Given these discrepancies in the data, it is almost impossible to predict future tendencies in men’s suicide mortality. Algorithms used to estimate suicide mortality in men are no longer valid since the data are often inaccurate.

Several effective suicide prevention programs have been implemented in Russia. For example, school- and college-based suicide prevention programs [ 53 - 55 ] have proven effective in reducing the number of suicide attempts among students. Programs aimed at meeting the needs of elderly people from high-risk groups were less effective due to the questionable design of those interventions [ 56 ], none of which have been implemented since 2019. 

Laws that prevent access to a particular method, be they stricter firearm control laws, restriction of access and use of blister packs of pills, lockable pesticide boxes, or bridge barriers (often in combination with a crisis intervention telephone hotline), may affect the suicide rate, even if some adjustments to those methods may occur over time [ 57 ].

While Russia, unlike the United States, does not have anything like the Second Amendment in its Constitution, it does provide its citizens with the constitutional right to self-defense. Additionally, background checks before the ownership of guns are more rigorous and consider an individual’s medical and psychological history [ 58 ]. Despite stricter laws, certain individuals could easily bypass background checks either via corrupt measures or obtain firearms via illegal channels, which is a huge market. This problem was brought to the fore, especially after the mass shooting incident in the Russian city of Kazan in May 2021, when a 19-year-old went on a shooting spree, killing nine people and injuring 23. The authorities quickly passed stricter gun control laws, which included more stringent background checks and control over illegal gun trafficking [ 59 ].

The country also saw a spate of physician deaths during the COVID-19 pandemic, in which two healthcare workers died, and one suffered serious injuries due to falling from a building. While the cause of death is still a matter of speculation, it brought into light a system underequipped to deal with the pandemic due to a short supply of equipment and manpower. Reports also highlight the apathy of the hospital administration in dealing with the sudden spike of COVID-19 cases and caring for healthcare workers, many of whom worked tirelessly even after becoming symptomatic [ 60 ].

Conclusions

Although the suicide statistics in Russia are profound, the suicide rate may be even higher than what has been reported. One of the biggest drivers of male suicidality in Russia is the country’s cultural norms. Russia remains very rooted in tradition, and within this tradition lies unique societal pressures. Cultural and psychosocial aspects of the Russian male experience, such as gender norms, low quality of life, and alcohol consumption, are likely key contributors to the country’s high suicide rates.

Our analysis of official reports and secondary sources in Russia also confirmed that there are too many publications of poor-quality study design and statistical analysis. Finally, continuous improvement of public health policy and fundamental and translational research can contribute to reducing the future suicide rate among the male population in Russia.

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The authors have declared that no competing interests exist.

Human Ethics

Consent was obtained or waived by all participants in this study

Animal Ethics

Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.