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The Mental Health of Elite Athletes: A Narrative Systematic Review
Open accessAbstract
BACKGROUND: The physical impacts of elite sport participation have been well documented; however, there is comparatively less research on the mental health and psychological wellbeing of elite athletes. OBJECTIVE: This review appraises the evidence base regarding the mental health and wellbeing of elite-level athletes, including the incidence and/or nature of mental ill-health and substance use. METHODS: A systematic search of the PubMed, EMBASE, SPORTDiscus, PsycINFO, Cochrane and Google Scholar databases, up to and including May 2015, was conducted. RESULTS: The search yielded a total of 2279 records. Following double screening, 60 studies were included. The findings suggested that elite athletes experience a broadly comparable risk of high-prevalence mental disorders (i.e. anxiety, depression) relative to the general population. Evidence regarding other mental health domains (i.e. eating disorders, substance use, stress and coping) is less consistent. These results are prefaced, however, by the outcome of the quality assessment of the included studies, which demonstrated that relatively few studies (25 %) were well reported or methodologically rigorous. Furthermore, there is a lack of intervention-based research on this topic. CONCLUSION: The evidence base regarding the mental health and wellbeing of elite athletes is limited by a paucity of high-quality, systematic studies. Nonetheless, the research demonstrates that this population is vulnerable to a range of mental health problems (including substance misuse), which may be related to both sporting factors (e.g. injury, overtraining and burnout) and non-sporting factors. More high-quality epidemiological and intervention studies are needed to inform optimal strategies to identify and respond to player mental health needs.
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“To date, research has primarily examined the mental health outcomes of elite athletes [15–18], with comparatively less research focusing on understanding these psychological experiences among coaches [19].”
From The Mental Health of Elite-Level Coaches: A Systematic Scoping Review (2024) · cites this paper as [17]
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Sportpsychiatrie und -psychotherapie
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“However, it is being neglected that the athletic environment often includes unique stressors caused by high-pressure circumstances, constant mental efforts, demands, and limitations which may negatively impact mental health (Rice et al., 2016).”
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“Factors such as pressure created by success-oriented sports, high demand, and intense training periods can adversely affect the mental health of elite athletes (Rice et al., 2016).”
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“Stressors, in sport, often impact the way athletes feel, think, and behave in athletic field (Fraser-Thomas and Côté, 2009; Rice et al., 2016).”
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“A comprehensive understanding of athlete well-being, through accurate assessment, is important for advancing models of support and management of elite Para and Olympic athletes (Rice et al. 2016).”
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“Mental health, well-being and quality of life have received greater attention from the sports community, especially when the focus is athletes (Chang et al., 2020; Nowak et al., 2021; Poucher et al., 2021; Rice et al., 2016).”
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Sato, S., Kinoshita, K., Kondo, M., Yabunaka, Y., Yamada, Y., & Tsuchiya, H. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1171309 · Cited by 19
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“Individuals experiencing symptoms of mental illness that do not meet the criteria for a specific diagnosis are on the rise (Rice et al., 2016; Shapiro et al., 2016; Sullivan et al., 2019).”
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“…findings might be useful in helping practitioners (e.g., coaches, sport psychologists) and sporting organisations better identify elite athletes who may be at elevated risk of physical and mental health problems and might benefit from timely intervention and adequate support (Rice et al., 2016).”
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Zhang, L. (2023) · Revista Brasileira de Medicina do Esporte · doi:10.1590/1517-8692202329012022_0551 · Cited by 11
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“While the incidence of mental health issues within the athletic population is similar to the one found in the general population (Gulliver et al., 2015; Rice et al., 2016), some elements of elite sport participation, such as overtraining and performance pressures, have been shown to increase an athlete susceptibility…”
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Oguro, S., Ojio, Y., Matsunaga, A., Shiozawa, T., Kawamura, S., Yoshitani, G., Horiguchi, M., & Fujii, C. (2023) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2023-001586 · Cited by 12
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“Concerns relating to mental health and well-being in sport have received wide attention in recent years although scientific research has arguably focused upon athletes [1, 2].”
BackgroundBarbeau, A., Héroux, I., Ryan, G., & Thouin-Poppe, L.-É. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1386229 · Cited by 12
“A meta-analysis comprising 60 studies on elite or semi-elite athletes revealed that factors such as overtraining, injuries, pressure, and the distinctive experiences encountered by athletes seem to influence the potential benefits derived from engaging in sports (Rice et al., 2016).”
BackgroundClaussen, M. C., Burger, J. W., Menon, R., Nishida, M., Koh, E. B. Y., Nahman, C., Whitehead, J., Edwards, C. D., Baron, D. A., & Glick, I. D. (2024) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/sms.14697 · Cited by 13
Fatt, S. J., George, E. S., Hay, P., JEACOCKE, N. A., & Mitchison, D. (2024) · Sports Medicine - Open · doi:10.1186/s40798-024-00791-9 · Cited by 11
Werner, K. (2024) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2024.1505372 · Cited by 13
Ojio, Y., Amemiya, R., Oliffe, J. L., & Rice, S. (2025) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2024-002275 · Cited by 11
Self-citationMcGreary, M., Birch, P. D. J., Eubank, M. R., & Whitehead, A. E. (2020) · Qualitative Research in Sport Exercise and Health · doi:10.1080/2159676x.2020.1829013 · Cited by 11
“This is primarily due to the potential negative impact of stressors on athlete well-being and performance (Rice et al. 2016; Swettenham et al. 2018).”
BackgroundMental Health Prevalence in NCAA Division III Collegiate Athletes
Valster, K., Cochrane-Snyman, K. C., Jones, K., & Smith, D. (2022) · Journal of Athlete Development and Experience · doi:10.25035/jade.04.01.04 · Cited by 11
Psychological characteristics of athletes in regional training center
Prasetiyo, R., Bayu, W. I., & Darisman, E. K. (2022) · JOURNAL SPORT AREA · doi:10.25299/sportarea.2022.vol7(2).7323 · Cited by 11
“family problems), which have the potential to increase the risk of mental decline in athletes (Rice et al., 2016).”
BackgroundInfluentialMental Health in Youth Elite Athletes
Walton, C. C., Rice, S., & Purcell, R. (2022) · Springer eBooks · doi:10.1007/978-3-031-08364-8_22 · Cited by 11
Self-citationDepressive Disorders in Athletes
Beable, S. (2023) · Clinics in Sports Medicine · doi:10.1016/j.csm.2023.06.011 · Cited by 15
Elsey, C. (2019) · Qualitative Research in Sport Exercise and Health · doi:10.1080/2159676x.2018.1564691 · Cited by 11
“The prevalence of mental health issues within elite sporting environments has received a great deal of attention with some research indicating that prevalence is comparable with that of the general population (Rice et al. 2016; Junge and Feddermann-Demont 2016).”
BackgroundPeraita‐Costa, I., González, A. L., Marí-Bauset, S., Marí-Sanchis, A., Marí-Sanchis, S., & Morales‐Suárez‐Varela, M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17030929 · Cited by 13
“As a consequence, the presence of certain risk factors such as addiction to exercise, substance abuse [14], injuries, eating disorders [15] and burnout syndrome [16] is not infrequent [17–19].”
BackgroundProblem Gambling in the Fitness World—A General Population Web Survey
Håkansson, A., Entezarjou, A., Kenttä, G., Fernández‐Aranda, F., Jiménez‐Múrcia, S., & Gunnarsson, B. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17041342 · Cited by 11
“While these groups may seem to have a health-oriented lifestyle, an increasing attention has been paid to psychological distress and mental disease in sports athletes [46], which likely has implications also for individuals who are on a sub-athlete level but still with a high degree of involvement in physical exercise…”
BackgroundLi, B., Ding, C., Fan, F., Shi, H., Guo, L., & Yang, F. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00822 · Cited by 11
Donohue, B. C., Gavrilova, E., Danlag, A., Perry, J. E., Kuhn, C., Allen, D. N., & Benning, S. D. (2020) · Psychology in the Schools · doi:10.1002/pits.22458 · Cited by 16
“…extant study results usually indicate slightly higher or about the same psychiatric symptom severity for athletes as compared with non-athletes (Gorczynski et al., 2017; Gulliver et al., 2015; Martens et al., 2006; Reardon & Factor, 2010; Rice et al., 2016; Sundgot-Borgen & Torstveit, 2004).”
ResultConceptualizing the Dissolution of a Social Marketing Sponsorship
Dickson, G., O’Reilly, N., & Walker, M. (2018) · Journal of Global Sport Management · doi:10.1080/24704067.2018.1441738 · Cited by 11
“Elite athletes are identifiable as role models or ambassadors (Rice et al., 2016), and their actions and words are capable of influencing consumer behaviors (Lee & Koo, 2015; Tzoumaka, Tsiotsou, & Siomkos, 2016).”
BackgroundSocial Media Usage Among Elite Athletes: An exploration of athlete usage during major events
Hayes, M. (2019) · Griffith Research Online · doi:10.25904/1912/3836 · Cited by 12
Mascaro, L., Drummond, S. P. A., Leota, J., Boardman, J. M., Hoffman, D., Rajaratnam, S. M. W., Aidman, E., & Facer-Childs, E. R. (2023) · Frontiers in Physiology · doi:10.3389/fphys.2023.1118822 · Cited by 10
“health support (amongst other resources) for women athletes throughout their career (Rice et al., 2016; Walton et al., 2021).”
BackgroundMental health literacy and psychological outcomes in dual-career athletes
Usenik, J., & Kranjec, E. (2025) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2025.1609042 · Cited by 15
Advancements in research on psychological and emotional aspects of student-athletes
Mao, Z. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1645177 · Cited by 26
“Moreover, research by Rice et al. (2016) indicated that performance stress, injury stress, coach behavior, team dynamics, and public expectations could all contribute to emotional distress in student athletes.”
Athletes’ psychological strain, negative emotions, and suicidal ideation: a mixed methods study
Hu, C., Huang, W., Zhang, W. W., Qin, J., & Zhang, J. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-08099-6 · Cited by 10
“Previous research has shown that adverse life events experienced by athletes, such as competition failure and injury-related distress, can directly lead to psychological strain [71–73].”
Kuok, A. C. H., Chio, D. K. I., & Pun, A. C. H. (2021) · Health Psychology Report · doi:10.5114/hpr.2021.107073 · Cited by 18
“Rice et al. (2016) claimed that there was less research but increasing concern for the mental health/well-being of elite-level athletes.”
BackgroundMcGinty-Minister, K., Champ, F. M., Eubank, M. R., Littlewood, M. A., & Whitehead, A. E. (2023) · Managing Sport and Leisure · doi:10.1080/23750472.2023.2239259 · Cited by 10
“That the only method of enhancing clubs’ MHL is through research demonstrating that mental health can positively impact performance despite the overwhelming evidence of mental illness in elite athletes (Kuettel & Larsen, 2019; Rice et al., 2016) indicates practitioners are fighting an uphill battle.”
Beebe, K. E., Petrie, T. A., Kiefer, H. R., Slavin, L. E., & Arnold, M. L. (2023) · Journal of Clinical Sport Psychology · doi:10.1123/jcsp.2022-0047 · Cited by 12
Chyi, T., Lu, F. J. H., Hsieh, Y.-C., Hsu, Y.-W., Gill, D. L., & Fang, B.-B. (2023) · Perceptual and Motor Skills · doi:10.1177/00315125231216329 · Cited by 13
“…and coaching (Arnold et al., 2013) as well as burnout (Lin et al., 2022), substance abuse (de Grace et al., 2017), and mental health concerns (Rice et al., 2016), practitioners, coaches, and sports professionals must manage athletes ’ stressors to help athletes train and compete in a safe…”
BackgroundPsychological Aspects of Training Highly Qualified Athletes in Kazakh Kuresi Wrestling
Bekbossynov, D. A., Tazabayeva, K. A., Silybaeva, B. M., Akzhalov, B. T., & Кокораевна, А. А. (2023) · Retos · doi:10.47197/retos.v52.100508 · Cited by 10
“…be present, but dubiousness and disbelief in one's own achievements and capabilities should be eliminated since this lowers self-confidence and desire to win, which are very important for a highly qualified athlete and are the main indicators of their readiness for competition (Rice et al., 2016).”
BackgroundSport Psychology: Principles and Practices for Sports Medicine Physicians
Grunberg, N. E., Doorley, J. D., & Barry, E. S. (2024) · Current Sports Medicine Reports · doi:10.1249/jsr.0000000000001167 · Cited by 11
Navigating athlete mental health: Perspectives from performance directors within elite sport
Prior, E., Papathomas, A., & Rhind, D. J. A. (2024) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2024.102661 · Cited by 10
Fiedler, R., Geber, J., Reichert, M., & Kellmann, M. (2024) · Scientific Reports · doi:10.1038/s41598-024-77418-2 · Cited by 20
A systematic review of sport-based adolescent mental health awareness programmes
Sullivan, N., Breslin, G., McLaughlin, M., Shannon, S., Leavey, G., & Dempster, M. (2025) · PLoS ONE · doi:10.1371/journal.pone.0315315 · Cited by 13
“Other systematic reviews have been conducted on sport and mental health, mostly focused on elite athletes, with similar messages that mental health awareness can be incorporated into sport settings [18–21].”
Sustainable Elite Youth Sports: A Systematic Scoping Review of the Social Dimensions
Schubring, A., Bergentoft, H., Zachrisson, A. L., Jaczina, K., Lundvall, S., Jacobsson, J., Barker‐Ruchti, N., Gojanovic, B., Lindsey, I., Loland, S., et al. (2025) · Sustainable Development · doi:10.1002/sd.3526 · Cited by 10
Jia, H., Kim, D., & Kim, K. R. (2025) · Behavioral Sciences · doi:10.3390/bs15081019 · Cited by 22
“However, this competitive nature may also induce anxiety and psychological stress, potentially leading to negative mental states among athletes (Rice et al., 2016).”
Edwards, C. D. (2021) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2021.04.011 · Cited by 10
Fernández, X., Priego-Ojeda, M., Ros‐Morente, A., & Mora, C. A. (2022) · Retos · doi:10.47197/retos.v44i0.91642 · Cited by 23
“Some studies (Gorczynski, Coyle & Gibson, 2017; Rice et al., 2016) show that elite athletes have an increased risk of suffering from mental health problems and experiencing depression and anxiety.”
BackgroundKosirnik, C., Philippe, R. A., & Pomini, V. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.887099 · Cited by 16
Wu, C., & Liu, G. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.963155 · Cited by 10
“It shows that physical education has a positive role in promoting mental health (Mcardle et al., 2007; Carson et al., 2016; Fisher et al., 2016; Rice et al., 2016; Chen et al., 2021).”
Background
Metadata
- Authors
- Rice, S. M., Purcell, R., De Silva, S., Mawren, D., McGorry, P. D., & Parker, A. G.
- Affiliations
- The University of Melbourne (AU)
- Orygen (AU)
- Corresponding author
- Rice, Simon M.
- Venue
- Sports Medicine
- Published
- 2016-02-20
- Volume
- 46
- Issue
- 9
- Pages
- 1333-1353
- ISSN
- 0112-1642 (ISSN-L)
- 1179-2035
- PMC
- PMC4996886
- OpenAlex
- W2278084024
- Cited by
- 1,205
- References
- 110
- Citations by year
- 2026: 175 · 2025: 161 · 2024: 157 · 2023: 148 · 2022: 155 · 2021: 129 · 2020: 105 · 2019: 74 · 2018: 64 · 2017: 27 · 2016: 10
- FWCI
- 10.78
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Sports Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Victoria University Research Repository (Victoria University) (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Swinburne figshare (Swinburne University of Technology) (submittedVersion, cc-by)
- Funders
- Society for Mental Health Research (Early Career Fellowship)
- Topics
- Social Sciences › Psychology › Developmental and Educational Psychology › Sport Psychology and Performance
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- elite athletes, mental health, psychological well-being, anxiety, depression, eating disorders, substance use, stress coping, burnout, overtraining, injuries, mental health interventions
- MeSH terms
- Adaptation, Psychological, Anxiety, Feeding and Eating Disorders, Competitive Behavior, Depression, Humans, Mental Health, Risk Factors, Stress, Psychological, Incidence, Substance-Related Disorders, Athletes
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