MENTAL HEALTH IN ELITE ATHLETES

Mental and physical health are intimately correlated, as mental health symptoms and disorders increase the risk of physical injuries and delay physical recovery.

Among elite athletes, mental disorders are common and may consequently impair physical performance. An International Olympic Committee Work Group has recently evaluated this topic to provide a series of recommendations that we will briefly treat in our entry. They reviewed literature, and considered elite athletes those competing at professional, Olympic or collegiate levels.

A 5% of male elite athletes from team sports experienced burnout or alcohol consumption problems, with as much as 45% reporting symptoms of anxiety and depression. Overall the incidence of mental health disorders in elite athletes ranged between 5 and 35%, and 10 to 25% among collegiate athletes. The incidence was worse if suffering from musculoskeletal injuries, surgeries, decreased sport performance or excessive perfectionism.

This data is somehow contradictory, as usually sport participation at amateur level is related with a protective effect on mental health symptoms, while having also antidepressant effects.

There is a whole set of mental health symptoms: sleep disorders, depression, anxiety, post-traumatic stress disorder, eating disorders, attention-deficit/hyperactivity, bipolar and psychotic disorders, substance abuse or behavioural addictions, among others.

Prevalence of depressive symptoms in elite athletes looks similar than in general population, although elite athletes may not recognise depressive symptoms or may not seek support. Worth pointing out that female athletes may be twice as likely to report depressive symptoms as males.

Symptoms of mental health issues are also present in former elite athletes. Transitioning from an active lifestyle is not always easy, and some preparation for post sport life should be encouraged.

Although the first line treatment is usually psychotherapy, more severe cases may need medication, whose side effects could potentially impact negatively athletic performance.

Guidelines for mental health optimisation in elite athletes (see also image)

• Facilitate access to mental healthcare facilities
• Attend to cross cultural differences and increase data on bipolar and psychotic disorders, mental health emergencies and athletes with disabilities.
• Understand early symptomatic stages before becoming fully developed disorders.
• Expanded mental health screening using optimal assessment methodologies and screening
• A better understanding of physiological recovery from injury or illness.
• Additional strategies for prevention and to overcome stigmas linked to mental health help seeking.
• Promote a healthy environment for sports practice and competition, trying to avoid sponsorship from companies linked to adverse health outcomes in elite athletes.
• Better understanding of the sport as a society subculture to pursue a positive mental health outcome.

Conclusions

• The IOC pretends to improve mental health in elite athletes, therefore improving their quality of life and serve as a role model for society.
• To do so, they want to give mental health symptoms and disorders an approach like other medical illnesses and musculoskeletal injuries, with well-informed professionals.
• Mental and physical health are closely related, and elite athletes should have access to appropriate interdisciplinary care.

Bibliography

Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis.

Gouttebarge V, Castaldelli-Maia JM, Gorczynski P, Hainline B, Hitchcock ME, Kerkhoffs GM, Rice SM, Reardon CL.

Br J Sports Med. 2019 Jun;53(11):700-706. doi: 10.1136/bjsports-2019-100671.

Mental health in elite athletes: International Olympic Committee consensus statement (2019).

Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, Budgett R, Campriani N, Castaldelli-Maia JM, Currie A, Derevensky JL, Glick ID, Gorczynski P, Gouttebarge V, Grandner MA, Han DH, McDuff D, Mountjoy M, Polat A, Purcell R, Putukian M, Rice S, Sills A, Stull T, Swartz L, Zhu LJ, Engebretsen L.

Br J Sports Med. 2019 Jun;53(11):667-699. doi: 10.1136/bjsports-2019-100715.

Infographic: Mental health in elite athletes. An IOC consensus statement.

Reardon CL, Hainline B, Aron CM, Baron D, Baum AL, Bindra A, Budgett R, Campriani N, Castaldelli-Maia JM, Currie A, Derevensky JL, Glick ID, Gorczynski P, Gouttebarge V, Grandner MA, Han DH, McDuff D, Mountjoy M, Polat A, Purcell R, Putukian M, Rice SM, Sills A, Stull T, Swartz L, Zhu LJ, Engebretsen L.

Br J Sports Med. 2020 Jan;54(1):49-50. doi: 10.1136/bjsports-2019-101087. Epub 2019 Jul 15.