The Mental Health of Elite Athletes: A Narrative Systematic Review

“However, there was a tendency for higher vulnerability to these conditions in athletes involved in sports requiring a particularly lean body shape [21, 35, 38– 40] and in female athletes [41–43]—the latter being consistent with the findings of general population studies [87].”

“Such models should capitalise on an early-intervention framework [102–104], ensuring early detection and prompt access to high-quality, evidence-based interventions.”

“Importantly, the mental health of hard-to-engage populations, such as young men [107] and older men [108, 109], could be targeted.”

“The ways by which athletes appraise and cope with these stressors can be a powerful determinant of the impact the stressors have on both their mental health and their sporting success [18].”

“Three reported a higher incidence of eating disorder or body dissatisfaction in elite athletes relative to controls [36], especially in sports emphasising leanness or lower body weight [21, 35].”

“While the included studies focused specifically on elite-level competition at the national or international level, differences between the included sports in terms of training, remuneration, media pressure and other salient variables must be considered [89].”

“…that physical activity has a positive effect on mental health [6, 7], a review has found that intense physical activity performed at the elite athlete level might instead compromise mental wellbeing, increasing symptoms of anxiety and depression through overtraining, injury and burnout [8].”

“Mahoney and Avener [80] Quantitative; crosssectional, observational Psychological factors and cognitive strategies 12 (12:0) Gymnastics; USA Self-verbalisations and certain forms of mental imagery differentiated Olympic-level and nonOlympic-level gymnasts.”

“Given that stigma, poor mental health literacy and negative past experiences of mental health help seeking are key barriers for elite athletes [12], more welldesigned studies, drawing on larger samples, are needed.”

“Such an understanding is required to provide guidance for sport practitioners—including coaches, medical staff and sport psychologists—in developing the coping abilities of elite athletes and, in turn, improving their emotional wellbeing [20].”

“Although high-profile performers are increasingly open to talking about their experience of mental health issues (MHIs) (Arvinen-Barrow, 2016), suffering from MHIs is still stigmatized in many sports (Bär and Markser, 2013; Rice et al., 2016; Roberts et al., 2016; Sebbens et al., 2016).”

“Elite athletes report mental health symptoms at rates consistent with or higher than the general community, 1–3 with levels differing according to mental health symptomatology (eg, depression, disordered eating, substance misuse), type of sport (eg, individual vs team) and sex.”

“The level-based eligibility criteria have been widely used in other systematic reviews of elite athletes [22, 27, 36].”

“According to the current literature (24), high performance athletes are more vulnerable than the general population to mental disorders, especially anxiety and depression.”

“Collaborative efforts between sport staff and mental health professionals would be beneficial (Purcell et al., 2019; Rice et al., 2016).”

“In the context of mental wellbeing, this finding is important, as personal development has been associated to reduced depressive moods and improved self-esteem and self-confidence for young males and young athletes alike [22,94,95].”

“Three systematic reviews indicated that higher disordered eating was associated with greater risk of injury in elite athletes, although few studies were included in each of these reviews (elite athletes [34]; dancers [36]; retired elite athletes [37]).”

“Whilst a body of research findings regarding mental health in elite athletes is available [13, 14], few empirical observations exist for recreational athletes.”

“Current athletes experiencing injury, illness, social/relationship issues, illness of family members, burnout and loss of a coach have responded similarly to former athletes and are particularly at risk for DE development at these transitioning times [45, 48].”

“While there can be positive benefits, elite participants may experience stressors and challenges that are unique to the sporting context (Rice et al., 2016).”

“Previous research with traditional sports athletes has shown the importance of understanding risk factors associated with the development of mental illness (Rice et al., 2016; Beable et al., 2017) and physical injury (Ivarsson et al., 2017; Tooth et al., 2020).”

“Three recent reviews of research have identified risk factors of depression in athletes (Frank, Nixdorf, & Beckmann, 2015; Rice et al., 2016; Wolanin, Gross, & Hong, 2015).”

“by reducing or buffering against burnout) (Rice et al., 2016).”

“2021, 14, 324. https://doi.org/10.3390/jrfm14070324 https://www.mdpi.com/journal/jrfm (Rice et al. 2016) and may experience depression and anxiety (Gouttebarge et al. 2015, 2016; Schuring et al. 2017), leading some to take their lives post-retirement (Coverdale 2020; Hong 2018).”

“Despite a small number of reviews of athlete mental health research (e.g. Breslin et al., 2017; Liddle et al., 2017; Rice et al., 2016; Vella et al., 2021), no study to date has included grey literature alongside peer-reviewed empirical research.”

“A surge in research exploring the mental health of elite athletes has shown that they are as likely, and in some cases more likely, to experience poor mental(1) health than their non-athlete peers (Moesch et al. 2018; Rice et al. 2016).”

“Additionally, athletes feel stigmatized coming forward with a mental illness diagnosis (Rice et al., 2016; Souter et al., 2018; Uphill et al., 2016).”

“Research on the mental health of athletes has grown rapidly in recent years [1,2].”

“However, one may look to a recent systematic review and meta-analysis of anxiety in elite athletes for preliminary guidance (Rice et al., 2016).”

“Athletes may attach stigma to the acknowledgement of mental health problems (Reardon & Factor, 2010; Rice et al., 2016).”

“Gambling has not been a prime concern so far, but there is rising concern within the sports community about mental health problems among athletes, and strategies for approaching such problems have recently been formulated (Foskett & Longstaff, 2018; Moesch et al., 2018; Rice et al., 2016).”

“Athletes experience an elevated risk of high-prevalence mental disorders such as depression, anxiety, eating disturbances, and substance abuse; in addition, it seems that there is a positive association among athletic participation and EA, as well as among all the abovementioned conditions and psychological distress,…”

“The information about mental health and wellbeing of elite athletes is limited by a paucity of high-quality, systematic studies; nevertheless, athletes are probably vulnerable to a range of mental health problems [13].”

“To date, meta-analyses that estimate the prevalence of mental health symptoms in elite athletes, ranging from 19% for general psychological distress and/or alcohol misuse, through to 34% for anxiety/ depression [2, 3], have mostly involved athletes from non-para-sports (e.”

“Like any other athletes, Chinese collegiate athletes are also vulnerable to anxiety, depression, and other psychological distress (Hong, 2004; Lu et al., 2016; Rice et al., 2016; Sun et al., 2020).”

“…others, stress can have subsequent detrimental e ff ects on athletes ’ (visuomotor) performance (Nieu-wenhuys & Oudejans, 2017; Vine et al., 2016), personal and athletic development (Ber-geron et al., 2015; Wylleman & Lavallee, 2004), and mental wellbeing (Kegelaers et al., 2022; Rice et al., 2016).”

“While most reviews concluded that the prevalence of mental health problems of elite athletes is similar to non-athletes or the general population [1, 5–9], studies have also shown that the prevalence of depression, anxiety disorders and eating disorders varies substantially between different types…”

“Dissemination of mental health information would also be valuable amongst a range of stakeholders - including coaching and administration staff, and families - and not just individuals; consistent with calls for including a broader range of stakeholder into athlete support programmes (Rice et al. 2016; Torregrosa, Reg…”

“⇒ There is community and scholarly shift towards understanding neurodiversity from a strengths-based approach, which recognises differences in cognition, social learning and other behaviours as variations in the context of human neurodevelopment.”

“A recent meta-analysis estimated that 34% of current elite athletes experience depression or anxiety, 26% experience sleep disturbance and 20% experience psychological distress [8]—prevalence rates that are at least comparable to those in the general population (see also [5, 9, 10]).”

“Research does indeed show that elite athletes’ experiences of high expectations and competitive pressure increase their vulnerability to burnout, poor mental health, and risk-taking behaviours (Gustafsson, Hassmén, Kenttä, & Johansson, 2008; Hughes & Leavey, 2012; Rice et al., 2016; Safai, Baker, & FraserThomas, 2014).”

“…frameworks, such as those involving mental health awareness, may lead to the prevention and early detection of mental disorders in youth, and thus may be important to consider incorporating into youth sport programmes to facilitate mental health (Hurley et al., 2018; Rice et al., 2016).”

“Multiple studies have found a similar prevalence of mental health conditions in elite athletes as compared to the general population [21,22].”

“However, recent evidence suggests athletes experience rates of mental illness comparable to, or higher than, their non-athlete peers (see Donohue et al., 2018; Reardon & Factor, 2010; Rice et al., 2016), who between the ages of 18-36 years have a 30% annual incidence of mental health issues (U.”

“Furthermore, research outlines that both occupations experience significant mental health concerns including depression, anxiety, burnout, and post-traumatic stress disorder (PTSD), and these conditions directly interfere with their ability to perform and execute their occupational responsibilities (Rice et al., 2016;…”

“In the absence of such a specific focus (Reardon and Factor, 2010; Markser, 2011; Bär and Markser, 2013; Rice et al., 2016), the prevalence and nature of mental health issues faced cannot yet be precisely estimated (Doherty et al., 2016; Roberts et al., 2016).”

“Although there have been important systematic reviews regarding the physical health of football players, little research has been devoted to their mental health [25].”

“disturbances(17) and musculoskeletal pain(18)—issues that traditional sports professionals share, too.(19) However, unlike esports players (except for a study on differences among League of Legends players),(20) athletes as members of a distinct social/vocational group are relatively well studied.”

“, anxiety, depression) relative to the general population (Rice et al., 2016).”

“…parallel with articles published in this research topic, recent research has advanced our knowledge of the prevalence of psychological disorders in elite sport, highlighting mental health issues among elite sport performers (e.g., Rice et al., 2016; Gouttebarge et al., 2017; Hagiwara et al., 2017).”

“org/lice 35% of elite athletes suffer from psychological issues (disordered eating, burnout, depression, or anxiety) [3].”

“Some athletes, such as those experiencing an injury, may be at an increased risk of experiencing symptoms of a mental disorder than nonathletes (Rice et al., 2016).”

“20 In a study of celebrity, Rockwell and Giles (2008) refer to the notion of ‘character splitting’ as a defense mechanism, a psycho-social strategy to explain how celebrities present an image of themselves that can be contrasted to a more ‘authentic’ understanding of who they ‘really’ are, and how they actually feel.…”

“Football is known for its fast-paced and powerful actions [2,3], which might contribute to players’ increased risk of injuries [4].”

“In a negative context, the importance of environment is illustrated by the increasing incidence of mental health disorders in professional athletes, illustrating the power of environmental stress factors to override the antidepressant effects of even large quantities of physical activity (97).”

“68 As a parallel issue, while interest in (elite) athletes’ mental health and its impact on 69 performance and wellbeing has rapidly grown (Rice et al., 2016; Schaal et al., 2011), less 70 attention has been paid to young and developing athletes (Hill, MacNamara, Collins, & 71 Rodgers, 2016).”

“This research has focused on specific sporting groups, primarily athletes [35] and coaches [36], with minimal attention to others from the wider sport workforce and in particular sport officials.”

“While it has been previously indicated that high-performance athletes are at risk for mental health problems (Rice et al., 2016), the incidence of jockeys displaying depressive symptoms, in particular professional jockeys, appear to be substantially higher than what is seen in other athletes…”

“There is growing interest in elite athlete mental health, which is reflected in a rapidly developing evidence-base (Rice et al., 2016; Gouttebarge et al., 2019; Reardon et al., 2019; Kuettel and Larsen, 2020; Poucher et al., 2021).”

“, family issues) that potentially increase athletes’ risk for mental illness (Sarkar and Fletcher, 2014; Rice et al., 2016).”

“The increased risk-taking behaviour can also interact with one’s regular life, leading to negative effects on mental health [29, 42] and could also reflect personality traits of individuals with addiction to mountaineering.”

“…lists from the included studies in the current study and we also examined studies included in previously published reviews focused on mental health in athletes (i.e. Breslin et al., 2022; Kegelaers et al., 2022; Prior et al., 2022; Rice et al., 2016; Stillman et al., 2019; Sutcli ff e et al., 2021).”

“The multitude of performance-related stressors, such as internal and external demands to achieve success coupled with stressors such as injury, inter-personal relationships, and fatigue may exacerbate poor mental health in athletes (Rice et al., 2016).”

“There is a noted stigma about reporting mental health symptoms in both ex-footballer and general population samples, which may result in choosing to suppress, ignore and not seek further help when needed.(6) 35 40 Furthermore, when compared with another general population study, the prevalence of depression (7%–9%) an…”

“Additionally, the environment of athletes may affect mood states [20].”

“…on mental health in professional sport and has found that professional athletes are just as likely as the general population to develop mental health issues, with an elevated risk for those facing injury, retirement, or performance failure (e.g., Castaldelli-Maia et al., 2019; Rice et al., 2016).”