Athletes are often admired for their physical prowess. However, despite their exceptional talents, the demands of performance can take a drastic toll on their mental health.
In recent years, the medical field, sports organizations, and popular culture have given more recognition to the importance of mental health in athletes.
However, factors including personality, intense training, and the nature of competition can provoke psychological issues in this population.
Keep Reading To Learn
- Which factors influence athletes’ mental health
- How to address mental health concerns in athletes
- How to destigmatize mental health concerns in the sports world
The Rate of Mental Health Issues in Athletes
Many people experience a mental health condition at some point in their lives. Athletes, like other individuals, are susceptible to mental health challenges throughout their lifetimes. In fact, athletes may have an increased risk of developing mental health conditions.
A 2019 study found that about 35% of elite athletes have mental health concerns. The top issues reported by athletes included feelings of burnout, depression, and anxiety.
Athletes operate under intense pressure. They often face unrealistic expectations from coaches, fans, teammates, and even themselves. The relentless pursuit of perfection can take a toll on their well-being.
Athletes often face the challenges of balancing personal responsibilities and meeting their sports commitments. For instance, student athletes must ensure their grades remain in good standing while being part of a school team.
Mental health issues can affect anyone at any stage of their life. However, athletes often face unique stressors, which can leave them vulnerable to mental health conditions.
Recognizing the Signs of Mental Health Issues in Athletes
Looking for the signs of mental health issues is the responsibility of coaches, athletic trainers, and family members. Although each individual experiences symptoms differently, there are common indicators to look out for. The following are potential signs that an athlete is struggling:
- Sudden changes in behavior
- Increased irritability
- Withdrawal from social activities
- Decreased motivation
- Changes in eating habits
- Changes in sleeping patterns
- Decline in athletic performance
- Negative self-talk
- Difficulty concentrating
Mental Health Disorders Among Athletes
Athletes can face a variety of mental health challenges throughout their sports careers. For instance, an athlete forced into retirement due to an injury will likely feel sad or even depressed.
Common mental health concerns for athletes include the following.
Depression
Eating Disorders
Substance Addiction
Sleep Issues
Anxiety
Obsessive Compulsive Disorder
ADHD
Factors Influencing Mental Health in Athletes
A combination of personality, cultural, and environmental factors influence the rate of mental health disorders in athletes.
Personality
Athletes often possess specific personality traits that help them succeed. Certain characteristics often allow them to thrive in competition. However, these traits can predispose athletes to mental health disorders.
Research shows that athletes tend to be:
- Hardworking
- Persistent
- Committed
- Intelligent
- Able to have a high level of self-control
- Achievement-oriented
- Good decision-makers
Persistence and diligence are often viewed as positive traits. However, these same characteristics can lead athletes to place a lot of pressure on themselves.
The intense pressure to perform consistently and endure grueling training regimens can contribute to high anxiety levels.
Perfectionism can have negative consequences, and sports teams often want flawless game play. However, when someone overthinks their performance, such stress can undermine their ability. When athletes underperform, they question their self-worth, heightening their fear of failure.
Gender and Sexual Misconduct
An NCAA Student-Athlete Well-Being study released in 2022 found that female athletes experienced more incidences of mental exhaustion, sadness, and anxiety than their male counterparts. Suicide rates among female athletes have increased in recent years.
For example, in 2022, five female athletes in the NCAA took their own lives. In many of the cases where female athletes died by suicide, injuries and mounting pressures have been contributing factors.
Sexual misconduct and harassment have also factored into the mental health spectrum in athletics. All genders face a risk of harassment from coaches and teammates. Studies show that peers on sports teams are more likely to commit acts of sexual misconduct than coaches. Abuse can range in severity, but higher levels of competition have been linked to an increased likelihood of sexual misconduct.
Hazing and Bullying
Hazing is the practice of subjecting new players to abusive rituals. The practice can have severe short- and long-term effects on an athlete’s mental health.
Hazing often involves taking health risks, such as drinking an excessive amount of alcohol in a short period. Not only does hazing pose mental health challenges, but the acts put a person’s physical well-being in jeopardy. Hazing rituals put an individual at risk for a career-ending injury and an increased chance of negatively affecting athletic performance on the field.
Bullying in athletics can involve coaches or peers as perpetrators. Bullying can take on different forms and have long-term consequences. Bullied athletes can experience feelings of exclusion, isolation, and low self-esteem. Some individuals who are bullied during sports can develop depression, anxiety, or acute stress disorder.
Injury and Illness
Sustaining an injury or falling ill can prove stressful for anyone. However, injured athletes often feel intense pressure to rehabilitate quickly and return to the field.
If an injury is severe and an athlete can’t return to their sport, they can experience a loss of identity. An injury can sometimes unmask mental health issues such as anxiety and depression.
Injuries can increase the risk of substance misuse as players attempt to self-medicate to recover quickly. Additionally, injured athletes are at risk of disordered eating—they may significantly limit their calorie intake because they are hurt and feel they “don’t deserve to eat.”
Concussions
Concussions pose a serious risk to athletes. According to a 2014 study, an estimated 1.6 to 3.8 million concussions occur annually in the U.S.
High-risk sports for males include American football, rugby, wrestling, and ice hockey. For women, basketball and soccer pose a higher concussion risk.
Common symptoms of a concussion include dizziness, headache, nausea, confusion, memory impairment, balance issues, and cognitive impairment. Concussions have been linked to mental health issues including anxiety, depression, and sleeping difficulties.
Most people recover from a concussion over time. However, repeated concussions can lead to chronic post-concussion syndrome and chronic neurodegeneration.
In recent years, more attention has been given to chronic traumatic encephalopathy (CTE), a progressive brain disease found in people who have sustained repeated impacts to the head. Contact sports like American football are a primary cause of CTE.
While many symptoms overlap with those of concussions, CTE symptoms typically manifest years or even decades after experiencing brain trauma or after an individual stops actively participating in contact sports.
Overtraining Syndrome
With the intense competition of sports, athletes may think that more training is better. However, even strong, athletic bodies can only endure a certain amount of stress. Overtraining syndrome (OTS) occurs when athletes train beyond their bodies’ ability to recover and do not allow adequate rest.
The exact process of OTS is still unknown, but it is believed a lack of rest and repair places the body into survival mode. When this happens, multiple systems within the body adapt to the inhospitable environment created by stress and insufficient rest. These adaptations, which are designed to keep the body alive at a basic level, lead to immunological, neurological, muscular, metabolic, and psychological changes.
In overtraining syndrome, athletes reach a plateau followed by a decline in performance. Symptoms of overtraining syndrome include fatigue, changes in appetite, muscle soreness, depression, and difficulty concentrating.
Treatment plans for athletes with OTS are unique to the individual but often include rest as well as psychotherapy and antidepressant medication.
Supporting Student Athlete Mental Health
https://embed.deconstructingstigma.org/media/oembed?url=https%3A//vimeo.com/802740858&max_width=0&max_height=0&hash=FM2SUm2UAzw0izu7_zLkARPkA-U82Hj3hVeR2KFcrxk
Cali Werner, LCSW, shares ways to spot signs and symptoms of mental health challenges in athletes and discusses how we can talk to our kids about mental health.
7 Tips to Support Athletes’ Mental Health
To effectively support the mental health of athletes, it’s essential for everyone involved in their lives to adopt a comprehensive approach. Athletes need support at the individual, team, and organizational levels.
Consider the following key strategies to support athletes’ mental health.
1. Create a Supportive Team Environment
2. Emphasize Balance
3. Promote Mental Health Literacy
4. Elevate Open and Supportive Communication
5. Encourage Education Programs
6. Develop Self-Care Plans
7. Speak Up
Diet & Mental Health
Learn how our food choices can positively or negatively affect our mood and mental wellness.
Age Considerations of Athletes
It’s important to consider age in the context of mental health. The risks of mental health issues are different for athletes at the youth, college, professional, and retirement levels.
Youth
According to the American Academy of Pediatrics, youth sports offer positive mental health benefits, including better sleep, improved communication skills, better concentration, and a boost to self-confidence.
However, since young athletes often fear failure, they are at risk of experiencing stress and anxiety.
As the level of competition increases, the risks of anxiety, eating disorders, and depression grow. Today, college and professional teams start the recruitment process early, and many high school students may not be prepared for the intensity of the experience.
In high school, about 57% of all students participate in at least one sport. High school sports have a higher level of competition than recreational youth leagues.
High school sports also frequently require more practice and training time. The physical and mental commitment can take a toll on teens.
More than 60% of those who participate in sports report feeling moderate to severe levels of stress. The stress of sports affects all areas of students’ lives—including athletic performance. High school athletes often hide feelings of stress and anxiety and rarely seek out mental health treatments.
College
Previously, college athletics had rules in place to prevent financial gain from playing for a school team. However, since 2021, new NIL (name, image, likeness) deals have increased the pressure on college athletes and high school prospects.
College athletes can now earn six figures or more by securing endorsement deals. The pressure to attain such competitive deals creates yet another form of stress.
College athletes also face pressure related to performing well on the field and maintaining the GPA needed to qualify for participation. Students may need to work extra hard to keep up with academics when games and scheduled trainings force them to miss classes.
According to the NCAA Student-Athlete Well-Being study, feelings of depression, hopelessness, and mental exhaustion among student athletes have remained at elevated rates since 2020.
Professional
Recently, high-profile athletes have brought much-needed attention to prioritizing mental health.
In 2021, Naomi Osaka withdrew from the French Open, citing concerns about her mental well-being. Gymnast Simone Biles has also sat out competitions to protect her mental health. When professional athletes speak out about their personal mental health challenges, they help combat stigma around these experiences.
Professional athletes have extreme performance expectations placed upon them. Since these individuals are paid to play sports, they are expected to perform at a high level for prolonged periods.
Teammates, coaches, and fans often place unrealistic expectations on pro athletes. Professionals don’t receive time off and are expected to recover quickly from injuries. They may also feel they must consistently prove themselves to secure a place on their team.
Retirement and Older Adulthood
The retirement age for athletes varies depending on the specific sport’s physical demands. However, athletes generally retire far earlier than people in other professions.
Retirement for athletes can create a distressing shift in identity. For much of their lives, athletes receive attention for their abilities and often experience fulfillment in using their talents. In addition, professional athletes live highly structured lives, where coaches, trainers, and managers organize their schedules for them.
When retiring, athletes often need to learn new skills or approach their sport with a new perspective. It can take time for athletes to redefine themselves or adjust values and priorities to suit their new life stage.
As is the case with everyone, aging athletes go through physical changes. They experience decreased strength, endurance, and speed. Because so much of an athlete’s life has been centered on peak performance, it can be especially hard to no longer attain the results they were accustomed to achieving.
The same is true for physical appearance. Athletes may find it challenging to adjust to weight gain, loss of muscle mass, and decreased stature, which can be part of aging.
In retirement, athletes are especially vulnerable to health conditions such as cognitive impairment and osteoarthritis. They are at high risk of developing mental health issues including depression, substance addiction, eating disorders, and anxiety.
According to research, the amount of control an athlete has over retirement affects how well they adjust to the situation. Athletes who plan to retire tend to manage better than those who were forced to retire due to injury or changes in performance.
Studies show that athletes who lead well-rounded, well-balanced lives throughout their careers adjust better to retirement. Throughout an athlete’s career, programs and trainers can encourage athletes to expand their interests and values, prepare for specific health issues, and plan for retirement.
Benefits of Getting Outside
Nature can calm your mind, lift your mood, and reduce stress. Discover how time outside supports mental health—and simple ways to make it part of your day.
Common Treatments for Athlete Mental Health
As the American Psychological Association (APA) points out, mental health treatment for athletes addresses athletes’ performance and emotional well-being, considers the social aspects of sports participation, and looks at sports teams and organizations through a systemic lens.
Performance Psychology
Performance psychology has emerged as a valuable tool in sports training. Not only does the methodology help players on the field, but it also focuses on the positive mental skills needed to succeed.
Through cognitive skills training, the goal of performance psychology is to help athletes stay calm under pressure and remain confident and in control of situations. Examples of performance psychology exercises are:
- Visualization techniques
- Goal setting
- Mindfulness
- Positive self-talk
- Relaxation techniques
Psychotherapy
For mental health concerns frequently experienced by athletes, such as anxiety, mild depression, anger, and sports-related adjustment issues, psychotherapy (talk therapy) is often the first line of treatment.
Through psychotherapy, therapists may counsel athletes on topics including motivation, career transitions and identity, sexual identity, overtraining, and burnout.
There are various forms of psychotherapy including cognitive behavior therapy, motivational enhancement therapy, and more.
Cognitive Behavior Therapy
Cognitive behavior therapy (CBT) helps patients understand how thoughts, feelings, and behaviors are closely connected. Among other skills, mental health professionals help patients identify and change unhelpful thinking patterns, gain a better understanding of their own and others’ behaviors, and develop problem-solving skills.
Clinicians may use CBT to help athletes set goals, remain focused, stay calm when stressed, and develop leadership skills. Athletes may find CBT helpful because they may already appreciate the therapy’s emphasis on structure, goal setting, practice, and self-reliance.
CBT is often used to treat:
- Substance use disorders
- Insomnia
- Anxiety
- Anger
- Depression
- Chronic pain
- Stress
Motivational Enhancement Therapy
Motivational enhancement therapy (MET) addresses patients’ ambivalence toward necessary change and helps them move forward with healthy behaviors. Clinicians navigate this process by asking open-ended questions, affirming positive insights, practicing reflective listening, and summarizing athletes’ perspectives.
MET is often used to treat:
- Substance addiction
- Tobacco cessation
- Medication adherence
Psychodynamic Therapy
Psychodynamic therapy focuses on the roots of emotional suffering. Mental health professionals can help athletes make connections between past experiences and current thoughts, behaviors, and relationships.
In psychodynamic therapy, the relationship between the provider and patient is used as a lens through which patients can understand other relationships and experiences in their lives. By developing insight through this process, athletes can reduce symptoms and be more prepared to manage the stresses of their sport.
Psychodynamic therapy is helpful for a range of conditions including:
- Anxiety
- Panic
- Depression
- Stress-related physical ailments
Medication
Depending on the condition being treated and the type of medication in question, medication can help regulate mood, reduce stress, increase attention, and promote regular sleep. As with non-athletes, a preferred treatment plan for athletes may involve a combination of talk therapy and medication.
Athletes have special considerations when it comes to medication. Prescription drugs can interfere with sports agencies’ anti-doping regulations. Medication can create side effects, such as weight gain, tremors, and sedation, which can interfere with performance. Clinicians should follow best practices when prescribing medication. Prescribers should work closely with athletes to monitor medication regimens as well as mitigate any side effects.
Group Therapy
Group therapy is often recommended, along with individual psychotherapy and/or medication. Athletes involved in team sports may be especially responsive to group therapy with its familiar structure of a group/team and a leader/coach.
Couples/Family Therapy
Mental health professionals can help athletes and their partners/families gain an understanding of the impact of family life on an athlete’s performance. They can also help athletes and families gain insight into how an athlete’s mental health symptoms can affect the family.
For professional and even amateur athletes, dedication to a sport can become their sole priority, placing relationships with partners, children, and others at risk. Family therapy can help athletes and their loved ones recognize patterns, set priorities that benefit the well-being of the relationship, and find a balance between the athletic career and family life.
