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].”

“Anxiety, eating disorders, drug use disorders, sadness, and psychological anguish are some of the mental stressors and problems that arise from athletic culture [2,3].”

“It has been suggested that athletes who compete in disciplines where low weight is important have a higher risk of presenting an ED than athletes from other disciplines [2,13].”

“The environment of professional sport can often cause or exacerbate existing mental health disorders (Roberts et al., 2016), and athletes are generally at higher risk of developing mental health disorders while experiencing performance failure (Rice et al., 2016), as was the case with C.T.”

“Mental health researchers are largely in agreement that an athlete’s mental health needs are paramount to physical wellbeing, and that it is both physical and mental wellbeing that are likely to contribute to optimizing athletic performance (Rice et al., 2016; Reardon et al., 2019).”

“Evidence supports the hypothesis that athletes can be more resilient than nonathletes (13, 14).”

“For example, the psychological impacts of injury, overtraining and burnout, intense public and media scrutiny, and managing ongoing competitive pressure (Rice et al., 2016).”

“…mental health is not protected, the athlete may be at risk of developing mental health symptoms and subsequent disorders, which may lead to injury, poor performance, early retirement, and potential risk of harm to self and others (Purcell et al., 2019; Reardon et al., 2019; Rice et al., 2016).”

“Notably, top-tier athletes are prone to a spectrum of mental health challenges (Rice et al., 2016), which could appear as anxiety, depression (Gouttebarge et al., 2016; Schuring et al., 2017), or, in severe cases, even lead to suicides (Hong, 2018).”

“In times of normality, the causes of depressive symptoms could be the loss of devotion and commitment to competition following an injury or retirement from sports [22,23].”

“These findings align with studies reporting heavy alcohol use among elite athletes but contrast other studies suggesting mental health symptoms are equally prevalent in elite athletes and the general population [3, 10–12].”

“High-performance sport, in particular, has been linked to negative outcomes such as anxiety, depression, and stress (e.g. Rice et al., 2016).”

“Current evidence indicates similar rates of mental health problems in athletes compared with the general population (Gouttebarge et al., 2019; Reardon et al., 2019; Rice et al., 2016).”

“We did not, however, assess other factors that could have explained the observed differences, such as injury or concussion (Rice et al., 2016), overtraining (Peluso & Andrade, 2005), or burnout (Gerber et al.”

“…mentales en el deporte (Bär y Markser, 2013; Gorczynski et al., 2016; Gouttebarge et al., 2016) y la identificación de condiciones e indicadores de “normalidad” o salud mental en los deportistas (Rice et al., 2016), mediante el uso de conceptos como la resiliencia (Asma Hosseini y Besharata, 2010).”

“Susceptibility to MHDs in elite athletes is multidimensional with contributions from both sport-specific and non-sport-specific factors (Hughes & Leavey 2012; Rice et al., 2016).”

“Eating disorders were the most prevalent mental health symptom in the present sample (Rice et al., 2016).”

“The systematic review conducted by Rice et al. (2016) demonstrated that HP athletes are vulnerable to mental health disorders connected with inappropriate training loads, high psychological demands, and injuries.”

“…has demonstrated a significant positive correlation between optimal mental states and athletic performance, wherein effective regulation of emotional reactivity and anxiety enhances decision making and attentional control-key determinants of athletic success (Raglin, 2001; Rice et al., 2016).”

“Interest in the mental health of elite athletes has rapidly grown during the past years [ 1 , 2 ].”

“Our finding is consistent with other studies that have found that female athletes with ED symptoms score higher on the weight pressure scale than those without ED symptoms [28, 63–65].”

“Competitive sport, even sometimes from an early age, subjects the athlete to great pressure that takes him away from the center of something that should be the essence of the practice of any sport: his health (Hoare, et al., 2022; Rice et al., 2016; Santana et al., 2023; Williams et al., 2020).”

“This increasing prevalence highlights mental health challenges as a growing area of concern in the field of sport (Rice et al., 2016).”

“Conversely, avoidant coping—characterized by withdrawal, denial, or disengagement—has been strongly linked to burnout risk and diminished resilience over time (Rice et al., 2016).”

“Regarding elite athletes, as we mentioned before, there are various sport-specific factors such as overtraining, burnout, injuries, and retirement that could lead to athletes’ mental health disorders [10].”

“Sports psychologist [40].”

“…given participants were located across states and territories and based on the research team’s knowledge surrounding key demands of elite sporting roles, including frequent national and international travel and scheduling difficulties (Frost et al., 2024; Moesch et al., 2018; Rice et al., 2016).”

“…on athlete wellbeing, including excessive use of painkillers (Overbye, 2021), burnout (Gustafsson et al., 2017; Hilpisch et al., 2024), injury mismanagement (Law and Bloyce, 2019; Murphy and Waddington, 2007), disordered eating and mental health issues (Fatt et al., 2024; Rice et al., 2016).”

“…continuous competitive pressures to perform have shaped athletes’ self-identities and self-worth towards increasing their susceptibility to mental illness, including the risk of depression and suicidal behaviour (Rao et al., 2015; Rice et al., 2016; Roberts, Baker, Reeves, Jones, & Cronin, 2018).”

“Athletes experience mental health problems through a combination of generic and sports-specific factors (2,9).”

“As the restrictions in the COVID-19 pandemic situation varied from country to country, the situations of athletes in each country were not the same nor comparable [21].”

“This finding of female sex as a risk factor for mental health issues in the NCAA Division I athlete population has been mirrored in the general population during the pandemic [2,3], corroborating previous research showing that athletes’ susceptibility to mental health is similar to the larger population [13,14].”

“…over-representation of mental health issues among elite athletes, their predisposition to social isolation during periods of injury, and the short-termed, transient, and insecure nature of careers at the elite level (Dessauvagie, 2018; Du Preez et al., 2017; Lane et al., 2020; Rice et al., 2016).”

“This significant developmental period in combination with the stressors and adversities that are specific to student-athletes, amplifies their risk for mental health problems (Gucciardi et al., 2017; Rice et al., 2016).”

“, 2017), coaches (Donovan et al., 2002; Ferguson et al., 2018; Rice et al., 2016; Vaughan et al., 2004; Zourbanos et al., 2010), and teammates (Dams-O'Connor et al.”

“These negative impacts are more frequent in elite athletes who are expected to perform at a high level in competitions [5–7].”

“These results can be caused by the findings of Rice et al. (2016) who suggested that elite athletes experience a broadly comparable risk of high-prevalence mental disorders (i.e. anxiety, depression) relative to the general population.”

“ity at the life stage most conducive to having a child, and finishing with concerns about changing the body image during pregnancy (where the body is sometimes considered a model), and losing certain control over it [28, 29].”

“Key factors include the psychological impacts of injury, overtraining and burnout; intense public and media scrutiny; and managing ongoing competitive pressures to perform [19].”

“Sensible investigations into the prevalence of mental health complaints are immediately needed to guide the efforts of prevention, early diagnosis, and effective management of mental health complaints in athletes [6].”

“Despite the possibility that regular physical activity might confer mental health benefits to athletes [45], current evidence is inconclusive regarding whether adolescent athletes are consistently at lower risk for specific mental disorders compared to their non-athlete peers [46, 47].”

“Similarly, understanding the individual factors and processes (e.g. coaching relationships) that contribute to maintaining overall mental health and well-being in highly demanding sports contexts has gained significance [30–32].”

“There is a need for sports medicine practitioners, psychiatrists, and psychologists to have specific screening tools that can be used to monitor the health of athletes while accounting for these unique stressors [5,11,16–18].”

“Running in particular can help athletes self-treat their depression symptoms, but in some cases, the severity of the depressive episode or risk factors outweigh the benefits of aerobic exercise (Rice et al., 2016).”

“The elite sports environment exposes athletes to unique stressors, including performance expectations, organizational challenges (e.g., frequent travel, homesickness), and personal issues (e.g., family conflicts) [50,51].”

“Thus, more epidemiological studies and intervention are required to adopt optimal coping strategies in order to respond to the mental health needs of athletes (Gulliver et al., 2015; Rice et al., 2016).”

“In fact, athletes’ mental health and well-being has received increased attention in the sports community (Chang et al., 2020; Giles et al., 2020; Oliveira et al., 2022; Rice et al., 2016), and literature has highlighted that it is important to explore factors that may influence their mental health, well-being and perf…”

“Eine systematische Übersichtsarbeit, welche 60 Studienergebnisse verglich und zusammenfasste, kam zu dem Ergebnis, dass Leistungssportler*innen im Vergleich zur Allgemeinbevölkerung häufiger Angst- und depressive Symptome aufweisen [7].”

“The results of other studies also indicated that non-professional and professional sportspersons have the same signs of psychological distress [4].”

“…high demand conditions), academic (e.g., maintaining academic eligibility to be able to compete), physical (e.g., training load, risk of injury), and athletic (e.g., pressure/expectation to always perform at the highest level; Arnold & Fletcher, 2012; Gouttebarge et al., 2019; Rice et al., 2016).”

“…understanding across genders, particularly as female footballers may experience and navigate mental health stigma differently (Perry et al., 2022; Rice et al., 2016). as outlined by Prinz et al. (2016) career-time prevalence of depressive symptoms was 32.3% among elite female footballers, with…”