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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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“Consequently, such problems still need to be addressed as it can have a debilitating effect on the performance of players and the outcome of matches (Rice et al., 2016).”
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“…reviews have suggested that this might be due to biological differences, such as females being more sensitive to stress (Küttel & Larsen, 2020; Rice et al., 2016), a growing body of research shows that there are many possible risk factors that may contribute to mental health dif fi culties in…”
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“…fi c factors include injury, poor performances, forced or unplanned retirement, interpersonal con fl ict or abuse, excessive physical/ training demands, and media pressure (Poucher et al., 2019; Reardon et al., 2019; Rice et al., 2016; Simpson et al., 2021; Walton, Rice, Hutter, et al., 2021).”
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“Achieving long-term improvements in these capacities, and subsequently enhancing performance, necessitates the maximisation of adaptations while minimising the risk of overreaching and injuries (Rice et al., 2016; Schwellnus et al., 2016; Winsley & Matos, 2011).”
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“All four issues were purposefully selected due to their abundance of contemporary literature (e.g., Rice et al., 2016; Woodman & Hardy, 2003) and featured curriculum content within the sport psychology educational programmes.”
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“However, males are more prone to anger [29] and are more reluctant to seek help for mental health problems [30] than females.”
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“[3,4], in order to improve the quality of teams’ activities and to reduce injuries [5].”
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“Current and retired elite athletes are reporting high rates of wellbeing related concerns (Rice et al., 2016) and with this increased awareness, sport organizations and governments are recognizing that a duty of care toward the athletes who represent our nations is imperative (Reardon et al.”
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“Elite athletes are more vulnerable than the general population to anxiety and depression [56].”
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“Rice et al (2016) found that there was a lot of exercise and training, or various sports injuries, or even anorexia, that the patients were unsuccessful.”
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“+e most common mental health conditions are depression (19% (95% CI, 14%–25%)) and binge eating disorder (17% (95% CI, 13%–21%)) [7].”
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“This non-exhaustive list of demands can go unanswered, but if ignored, these demands present significant risk factors for mental and physical illness (Rice et al., 2016).”
BackgroundClinical Commentary: Depression and Anxiety in Adolescent and Young Adult Athletes
Putukian, M., & Yeates, K. O. (2023) · Journal of Athletic Training · doi:10.4085/1062-6050-0658.22 · Cited by 9
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“7 As such, further work to decrease gender stereotyping and draw attention to issues related to male athletes with DE/ED is likely to enhance the experience of all athletes.”
Saraiva, M., Oliveira, S., Coimbra, M., & Ferreira, C. (2024) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2024.2308861 · Cited by 7
“However, possible negative outcomes have been highlighted, especially at a competitive level (Rice et al., 2016).”
Lane, D. S. (2024) · Mental Health & Prevention · doi:10.1016/j.mhp.2024.200364 · Cited by 8
Information seeking in a time of war: coping with stress in Lithuania during the Russia/Ukraine war
Wilson, T. D., & Macevičiūtė, E. (2025) · Journal of Documentation · doi:10.1108/jd-06-2024-0156 · Cited by 7
Hurst, P., & Kavussanu, M. (2025) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2025.2477163 · Cited by 12
“Coaches adopting such an approach can lead athletes to refrain from speaking up about concerns for their well-being (Rice et al., 2016, 2022; Walton et al., 2024), which in turn could result in poor mental health (e.g., depression, anxiety) and maladaptive behaviours (e.g., disorder eating,…”
Effects of group mindfulness intervention on high-level distance runners: a quasi-experimental study
Kelemen, B., Tóth, R., Benczenleitner, O., & Tóth, L. (2025) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2025.1556404 · Cited by 15
Exploring the barriers to athlete personal development within UK Olympic and Paralympic sport
Holden, J., Wagstaff, C. R. D., Wadey, R., & Brown, P. (2025) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2025.102966 · Cited by 7
A taste of ambrosia: Do Olympic medalists live longer than Olympic losers?
Kovbasiuk, A., Ciechanowski, L., & Jemielniak, D. (2024) · Scandinavian Journal of Public Health · doi:10.1177/14034948231219833 · Cited by 7
“Some studies indicate higher mental disorder prevalence among professional athletes relative to the general population [5].”
Steinfeldt, H., Dallmeyer, S., & Breuer, C. (2024) · European Sport Management Quarterly · doi:10.1080/16184742.2024.2302824 · Cited by 7
“Other studies looked at certain areas of an athlete’s life that are factors of overall well-being, such as physical health (Macdougall et al., 2016), mental health (Rice et al., 2016), goals (Adie et al., 2010) and career experiences (Gledhill & Harwood, 2015).”
Cao, B., Guo, Y. Q., Lü, M., Wu, X., Deng, F., Wang, J., & Huang, R. (2024) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2024.102678 · Cited by 7
de Subijana, C. L., Pons, J., & Mallett, C. J. (2024) · Journal of Sports Sciences · doi:10.1080/02640414.2024.2425908 · Cited by 9
“The MH of elite athletes is of particular concern since this career path is associated with a higher risk of experiencing MH problems (e.g., Reardon et al., 2019; Rice et al., 2016).”
Pruna, R., & Bahdur, K. (2016) · Journal of Novel Physiotherapies · doi:10.4172/2165-7025.1000317 · Cited by 8
Narrative Tensions in Strained Junior Elite Performers’ Experiences of Becoming Elite Performers
Haraldsen, H. M., Abrahamsen, F. E., Solstad, B. E., & Halvari, H. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.645098 · Cited by 8
Hong, H. J., & Fraser, I. A. (2022) · Journal of risk and financial management · doi:10.3390/jrfm15010017 · Cited by 9
“…athletes (Lavallee 2005); it has been reported that the mental health of high-performance athletes can be negatively affected by them (Lavallee and Robinson 2007; Park et al. 2013) with accompanying depression and anxiety (Gouttebarge et al. 2015, 2016; Rice et al. 2016; Schuring et al. 2017).”
BackgroundHofmann, C. G., & Claussen, M. C. (2022) · Praxis · doi:10.1024/1661-8157/a003845 · Cited by 7
Rodrigues, A. F. D. A., Barbosa, L. N. F., Gomes, P. C. D. S., & Nóbrega, F. A. F. (2022) · Revista Brasileira de Medicina do Esporte · doi:10.1590/1517-8692202329012021_0385 · Cited by 7
The prevalence of common mental health problems and associated psychosocial issues in elite swimmers
Howarth, H., Evans, G., Krüger, P., Dilkes, E., Bell, G., & Kipps, C. (2023) · Sports Psychiatry · doi:10.1024/2674-0052/a000035 · Cited by 9
“Much of the research intomental health in elite athletes is focussed on sporting populations competing in varyingdisciplines, yet data from one sport may not be applicable to others [9].”
BackgroundOftadeh-Moghadam, S., Weston, N. J. V., & Gorczynski, P. F. (2023) · The Sport Psychologist · doi:10.1123/tsp.2022-0142 · Cited by 7
Primer Encuentro Ibérico+ de Psicología del Deporte. Barcelona, febrero de 2024
Peris-Delcampo, D., Teques, P., & Palmi, J. (2023) · Revista de Psicología Aplicada al Deporte y el Ejercicio Físico · doi:10.5093/rpadef2023a7 · Cited by 7
Mental Health in Equestrian Sport
Butler, H., Shanmuganathan-Felton, V., & Taylor, J. A. (2018) · Journal of Clinical Sport Psychology · doi:10.1123/jcsp.2018-0002 · Cited by 7
“…research within sport and mental health literature has offered some insight 84 into the pressures and unique challenges athletes negotiate whilst also the 85 consequences for, and on, mental health and psychological wellbeing (Gulliver et al., 86 2015; Hughes & Leavey, 2012; Rice et al., 2016).”
BackgroundElite Academy Soccer Players’ Perceptions Towards Cognitive Behavioral Therapy
Wilkins, L., Sweeney, J., Zaborski, Z., Nelson, C., Tweddle, S., Beukes, E. W., & Allen, P. M. (2018) · Journal of Clinical Sport Psychology · doi:10.1123/jcsp.2018-0026 · Cited by 7
Pike, E. C. J. (2018) · Emerald Group Publishing Limited eBooks · doi:10.1108/s1476-285420180000011002 · Cited by 7
Schinke, R. J., Henriksen, K., Petersen, B., Wylleman, P., Si, G., Zhang, L., McCann, S. C., & Papaioannou, A. G. (2021) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2021.1892940 · Cited by 11
“…aforementioned gap has and, in many instances, still contributes to social (i.e., lack of social and emotional support in time of need) and structural (i.e., lack of access forethought, leading to efficient access to care resources) stigma surrounding athlete mental ill-health (Rice et al., 2016).”
BackgroundMental Strength and Coping Strategy of Confined Athletes Dealing with COVID-19
Moutaraji, I. E., Lotfi, S., & Talbi, M. (2021) · International journal of human movement and sports sciences · doi:10.13189/saj.2021.090319 · Cited by 7
“on the mental health of elite athletes, which highlighted the presence of a high prevalence of a risk similar to the mental disorders of elite athletes compared to the general population [5].”
BackgroundSport Management Faculty Members’ Mentorship of Student-Athletes
Warner, S. M., Stokowski, S. E., Fridley, A., & Kim, K. (2022) · Sport Management Education Journal · doi:10.1123/smej.2021-0009 · Cited by 7
Non-shoulder Injuries in Swimming: A Systematic Review.
Hill, L., Mountjoy, M. L., & Miller, J. (2022) · PubMed · doi:10.1097/jsm.0000000000000903 · Cited by 6
“These demands may compromise athlete mental health and trigger symptoms of anxiety and depression compounded by overtraining, injury, and eating disorders/disorder eating.(84,86) Therefore, it is important to screen athletes with significant injuries for mental healthsequelae.”
BackgroundWomen's sports injuries: A bibliometric study of research trends and future perspectives
Eldos, A., Perumbalath, S., & Vinu, W. (2024) · Apunts Sports Medicine · doi:10.1016/j.apunsm.2024.100469 · Cited by 7
Exploring stakeholders' perspectives on esports players’ wellbeing and career prospects
Hong, H. J. (2025) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2025.100589 · Cited by 12
“These challenges do require proactive and protective measures and interventions for their mental and physical health and wellbeing (Rice et al., 2016).”
Stress-Resistenz-Trainings für Topathleten
Sallen, J. (2017) · Springer eBooks · doi:10.1007/978-3-662-49322-9_25 · Cited by 6
How Coaches Can Prevent and Address Alcohol Consumption Among Student-Athletes
Chow, G. M., Bird, M. D., Soendergaard, S., & Yang, Y. (2019) · Journal of Clinical Sport Psychology · doi:10.1123/jcsp.2018-0083 · Cited by 6
Tredinnick, L., & McMahon, S. (2019) · Sport in Society · doi:10.1080/17430437.2019.1624723 · Cited by 8
Smith, A. J., Buadze, A., Claussen, M. C., Seifritz, E., & Liebrenz, M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1041891 · Cited by 6
“Further, SUD rates (15) and aggressive behaviors (14, 21), alongside athletes’ susceptibility to interpersonal violence and abuse (16), might also invoke cross-jurisdictional issues.”
BackgroundBu, D., Han, Z., Zhang, C., Liu, J., Huang, Z., Liang, W., Wang, A., & Su, N. (2023) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2023.2269156 · Cited by 7
“According to previous systematic reviews, professional athletes experience depression, anxiety, sleep disturbances and post-traumatic stress disorder at roughly equivalent rates to those of the general population (Gorczynski et al., 2019; Rice et al., 2016).”
Mental health risk and protective factors in Australian cricket
Pankow, K., Sutcliffe, J., Conyers, D., Robinson, L. D., Schweickle, M. J., Liddelow, C., & Vella, S. A. (2024) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2024.2310103 · Cited by 10
“…included in Küttel and Larsen’s (2021) review were women or female athletes and only 3 of the 43 studies focused on females or women exclusively (compared to 12 focused exclusively on males/men), which is a common trend in mental-health-and-sport research (Rice et al., 2016; Walton et al., 2022).”
Ehnold, P., Lotzen, L., & Schlesinger, T. (2024) · Soccer and Society · doi:10.1080/14660970.2024.2333020 · Cited by 6
Malinowska, Z., Hadjieva, I.-M., Majsiak, J., & Jurek, J. M. (2024) · Journal of Coaching and Sports Science · doi:10.58524/002024334800 · Cited by 6
“Increased stress levels may contribute to the increased prevalence of mental health problems, with research demonstrating that up to 35% of elite athletes may suffer from eating disorders, burnout, depression, and anxiety (Rice et al., 2016).”
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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