Rates and Correlates of Mental Health Symptoms in Currently Competing Elite Athletes from the Australian National High-Performance Sports System
Abstract
Aims Elite athletes are at risk of mental ill-health via exposure to sports-related stressors and the overlap in competitive playing years with the peak age of onset of mental ill-health. Despite this risk, there is a paucity of robust empirical data on mental health symptoms in currently competing athletes. The purpose of this study was to assess the prevalence and correlates of mental health symptoms in a representative, national sample of elite athletes and to compare rates against published community norms.Methods A cross-sectional, anonymous, online survey was administered to all categorised (e.g. highest level) athletes, aged 17 years and older, registered with the Australian Institute of Sport (n = 1566). Main outcomes were self-reported scores on validated measures of psychological distress, probable 'caseness' (i.e. the experience of mental health symptoms that would usually warrant a need for care by a health professional), risky alcohol consumption, body weight and shape dissatisfaction, self-esteem, life satisfaction and problem gambling. Correlates of outcomes included demographic, individual vulnerability (e.g. social support, coping style) and sport-related variables.Results The participation rate was 51.7% (n = 810), of whom 749 athletes completed most or all outcomes measures. Compared to published community norms, athletes were significantly more likely to report 'high to very high' psychological distress (9.5% vs 17.7%, respectively) and to meet the threshold for 'probable caseness' (19% vs 35%). In contrast, athletes reported significantly lower rates of risky alcohol consumption, problem gambling and body dissatisfaction compared to community norms, and conversely higher self-esteem and life satisfaction. The adjusted odds of psychological distress and caseness were increased in athletes who reported prior treatment for a mental health problem (OR = 1.28-2.84), inadequate social support (OR = - 2.59 to 0.37) and more recent adverse life events (OR = 0.61-1.32); while, the odds of risky alcohol consumption were lower in female athletes (OR = - 1.36) and para-athletes (OR = - 1.20).Conclusions In a representative and national sample of currently competing elite athletes, inclusive of gender and para-status, psychological distress and probable caseness were elevated relative to community norms, although other aspects of functioning were as good as, if not better than, community peers. Sports medicine and mental health professionals working with elite athletes should screen for psychological distress in athletes who may otherwise appear to be well-functioning, to provide timely, optimal treatment.
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Research has primarily examined mental health outcomes of elite athletes, with comparatively less research focusing on coaches.
“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 [18]
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“This avoidance coping-style is common in elite sports settings and is correlated with psychological distress (Purcell et al., 2020).”
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MethodMental health help-seeking preferences and behaviour in elite male rugby players
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BackgroundSelf-citationSelf-Compassionate Motivation and Athlete Well-Being: The Critical Role of Distress Tolerance
Walton, C. C., Lewis, K. J., Kirby, J. N., Purcell, R., Rice, S., & Osborne, M. S. (2022) · Journal of Clinical Sport Psychology · doi:10.1123/jcsp.2022-0009 · Cited by 10 · see citing works
“For example, a recent study from Purcell et al. (2020) demonstrated that when compared with published community norms, elite Australian athletes were signi fi cantly more likely to report “ high to very high ” psychological distress (9.5% vs. 17.7%, respectively).”
InfluentialSelf-citationSport Psychiatry and Its Research Agenda
Currie, A., & Purcell, R. (2021) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2021.04.007 · Cited by 8 · see citing works
Self-citationBalcombe, L., & Leo, D. D. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.97799 · Cited by 7 · see citing works
Henderson, A. R., Harris, S. A., Kirkham, T., Charlesworth, J., & Murphy, M. (2023) · Sports Medicine - Open · doi:10.1186/s40798-023-00587-3 · Cited by 7 · see citing works
“Recently an association between concussion and mental health outcomes in elite athletes has even been reported [15].”
BackgroundAndersson, M. J., Kenttä, G., Claesdotter‐Knutsson, E., & Håkansson, A. (2024) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-024-00989-0 · Cited by 7 · see citing works
“…survey administered to 749 male and female elite athletes in Australia indicated that only those who had sustained two concussions during their lifetime endorsed elevated mental health symptoms and psychological distress, not those who reported one nor three or more concussions [26].”
BackgroundAdvancing elite athlete mental health treatment with psychedelic-assisted psychotherapy
Walton, C. C., & Liknaitzky, P. (2020) · Journal of Applied Sport Psychology · doi:10.1080/10413200.2020.1848941 · Cited by 6 · see citing works
“Australian elite athletes than in the general population (Purcell et al., 2020), while another showed 52% of Swedish elite athletes had experienced mental health problems at some point with a 12% point prevalence (Åkesdotter et al.”
BackgroundA Survey of the Mental Health of UK Olympic and Paralympic Sport Athletes
Leyland, S., Currie, A., Elizabeth Board, Mistry, A., Jaques, R., & Ranson, C. (2022) · Journal of Athlete Development and Experience · doi:10.25035/jade.04.02.03 · Cited by 6 · see citing works
“K-10 has recently been used in comparable studies with elite athletes from the Australian Institute of Sport where high or very high distress was observed in 16.5% (Gulliver et al., 2015) and 17.7% (Purcell et al., 2020) of the athletes surveyed.”
BackgroundMethodResultInfluentialWang, W., Schweickle, M. J., Hägglund, K., & Vella, S. A. (2025) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2025.102851 · Cited by 6 · see citing works
“For example, a cross-sectional study has shown that elite athletes in Australia were significantly more likely to report ‘high to very high ’ psychological distress than the general population norms (17.7 % vs 9.5 %, respectively) (Purcell et al., 2020).”
InfluentialMcKeen, M., & Stevinson, C. D. (2025) · Sports Medicine · doi:10.1007/s40279-025-02216-3 · Cited by 5 · see citing works
“Collectively, these findings suggest that the mental health of officials warrants greater attention, alongside the consideration given to other groups in the competitive sport domain such as current and former athletes [11–15] and coaching staff [16–18].”
Prevalence of mental health symptoms in Singapore elite athletes
Li, J. Z., Lim, H. B. T., Lou, S. S., Tun, M. H., & Lai, S. F. F. (2025) · Singapore Medical Journal · doi:10.4103/singaporemedj.smj-2024-253 · Cited by 5 · see citing works
Pilkington, V., Walton, C. C., Gwyther, K., Rice, S., Butterworth, M., Burattin, N., Boland, S., Cross, G., & Purcell, R. (2025) · Journal of Applied Sport Psychology · doi:10.1080/10413200.2025.2467267 · Cited by 6 · see citing works
“The AIS developed and established the service in 2018, in collaboration with leading mental health researchers, psychologists and knowledge translation experts (see Rice et al., 2020 for description of the establishment process).”
Self-citationMiles and Maternity: A Survey of Long-Duration Exercise During Pregnancy
Bains, G., Hayman, M., Kolker, S., & Davenport, M. H. (2025) · Sports Medicine · doi:10.1007/s40279-025-02223-4 · Cited by 4 · see citing works
“Additionally, the K10 has been noted for having a strong predictive value for post-year mental disorders, including serious and less serious mental illness, and has been utilized in a variety of populations, including athletes [16, 23].”
Scope of the Problem of Mental Health Symptoms and Disorders in Elite Athletes
Rice, S., Walton, C. C., OLIVE, L. S., Reardon, C. L., & Purcell, R. (2022) · Springer eBooks · doi:10.1007/978-3-031-08364-8_1 · Cited by 4 · see citing works
Self-citationLyon-Monk, O., Arnold, R., Williams, S., Cleave, L. J., Cumming, S., Currie, A., Wass, J., & Moore, L. J. (2025) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2025.10.002 · Cited by 3 · see citing works
Modeling and Analysis of Influencing Factors of Competitive Performance of Wushu Athletes
Li, W. (2022) · Wireless Communications and Mobile Computing · doi:10.1155/2022/4408506 · Cited by 3 · see citing works
Darroch, F., Smith, S. V. M., Sheppard-Perkins, M. D., Giles, A. R., & Wykes, D. (2023) · Frontiers in Sports and Active Living · doi:10.3389/fspor.2023.1001127 · Cited by 3 · see citing works
“’s (66) findings, the presence of adequate social support (including partners) can significantly reduce the manifestation of mental health challenges or psychological distress in the lives of elite athletes.”
BackgroundPurcell, R., & Currie, A. (2024) · Springer eBooks · doi:10.1007/978-3-031-69328-1_12 · Cited by 2 · see citing works
Self-citationPhysical activity (PA) during pregnancy in Greece
Mitrogiannis, I., Chatzakis, C., Skentou, C., Makrydimas, S., Katrachouras, A., Efthymiou, A., Ζαγοριανάκου, Ν., & Makrydimas, G. (2025) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2025.01.028 · Cited by 2 · see citing works
Mental health symptoms and disorders in elite athletes: A systematic review
Guszkowska, M. (2025) · Acta kinesiologica · doi:10.51371/issn.1840-2976.2025.19.s1.1 · Cited by 2 · see citing works
Mitrogiannis, I., Chatzakis, C., Skentou, C., Koutalia, N., Makrydimas, S., Efthymiou, A., & Makrydimas, G. (2023) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2023.10.022 · Cited by 3 · see citing works
Exploration of the COVID-19 mental health implications in elite disabled athletes
Amos, B., & Tibbert, S. J. (2024) · Journal of Sports Sciences · doi:10.1080/02640414.2024.2370151 · Cited by 2 · see citing works
“The observed psychological distress was based on cognitive models, which suggested that an intolerance to insecurity and uncertainty may exacerbate symptoms in athletes susceptible to this disorder due to increased worrying (Da Silva et al., 2020; Purcell et al., 2020; Thielsch et al., 2015).”
Ojio, Y., Yamada, K., Amemiya, R., Kawamura, S., Rice, S. M., & Purcell, R. (2025) · Sports Psychiatry · doi:10.1024/2674-0052/a000116 · Cited by 2 · see citing works
Self-citationTrejos, A. M. B., Rúgeles, Á. G. V., Santana, B. S. E., Valencia, D. C. O., & Lemus, N. M. R. (2023) · Edu-física com · doi:10.59514/2027-453x.3010 · Cited by 2 · see citing works
Ojio, Y., Yamada, K., Amemiya, R., Kawamura, S., Rice, S., & Purcell, R. (2024) · Research Square · doi:10.21203/rs.3.rs-5315778/v1 · Cited by 2 · see citing works
Self-citationThe Emergence of the Pandemic: High-Performance Coach and Athlete Experiences
Dehghansai, N., Mazhar, A., Pinder, R. A., Baker, J. R., & Renshaw, I. (2022) · Adapted Physical Activity Quarterly · doi:10.1123/apaq.2022-0021 · Cited by 1 · see citing works
Disordered eating attitudes, depressive symptomatology and alcohol consumption in young athletes
Perko, U., & Černelič-Bizjak, M. (2023) · Annales Kinesiologiae · doi:10.35469/ak.2022.358 · Cited by 1 · see citing works
EFEITOS DO ESTRESSE MENTAL SOBRE O DESEMPENHO DE ATLETAS DE ALTO RENDIMENTO
da Silva, M. F. L., & Farias, E. R. (2023) · Editora Científica Digital eBooks · doi:10.37885/230412720 · Cited by 1 · see citing works
Ojio, Y., Izawa, S., Watanabe, Y. W., Oliffe, J. L., & Rice, S. M. (2026) · International Journal of Sport and Exercise Psychology · doi:10.1080/1612197x.2026.2620797 · Cited by 1 · see citing works
Self-citationEstresse mental em atletas de elite: Uma revisão sistemática
Farias, E. R., & da Silva, M. F. L. (2021) · Research Society and Development · doi:10.33448/rsd-v10i7.16838 · Cited by 1 · see citing works
Relationshp Between Sleep Quality, Mood State, and Performance of Elite Air-Rifle ShootersPreprint
Lü, J., An, Y., & Qiu, J. (2021) · Research Square · doi:10.21203/rs.3.rs-1145112/v1 · Cited by 1 · see citing works
First Trial of the Player Development Program by the Japan Rugby Football Playersʼ Association
KAWAMURA, S., Horiguchi, M., ONUMA, K., YAMASHITA, S., & Ojio, Y. (2022) · Journal of Japan Society of Sports Industry · doi:10.5997/sposun.32.4_481
Ciências do Esporte e Educação Física: contribuições contemporâneas em pesquisa
Santos, M. B. D., Souza Neto, O. A. D., Souza, P. C. D., Carneiro, P. G., Cassiano, C. S. S., Marques, W. R. A., Júnior, J. B. M., Souza, F. A. G., Cunha, M. A. T., Berg, R. D. S., et al. (2023) · Editora Científica Digital eBooks · doi:10.37885/978-65-5360-399-8
Qambar, G. (2021) · THE ASIAN BULLETIN OF BUSINESS AND SOCIAL SCIENCE RESEARCH · doi:10.62019/abbssr.v1i1.22
“The most essential message from this method is that individuals with mental health difficulties need further treatment (19).”
MethodManap, M. ‘. A., & Nazarudin, M. N. (2023) · International Journal of Academic Research in Business and Social Sciences · doi:10.6007/ijarbss/v13-i12/20301
Graeme, L. G., Hall, K., OLIVE, L. S., Greenwood, C. J., Couston, N., Mattingley, S., Francis, L. M., Hoare, E., Rice, S., Bos, J., et al. (2024) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2023-001799
“At the elite level, mental ill-health is suggested to be equally or more prevalent than in the general population (see Purcell et al and Gouttebarge et al 3 4 for research on Australian athletes from multiple sports and systematic review and meta-analysis).”
BackgroundSelf-citationOjio, Y., & Kawamura, S. (2025) · Discover Mental Health · doi:10.1007/s44192-025-00162-0
Winther, S., de Terte, I., Wood, W., Beable, S., Wilson, K., & Hamilton, B. H. (2025) · Journal of Clinical Sport Psychology · doi:10.1123/jcsp.2024-0008 · Cited by 1 · see citing works
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Big dreams and high demands: The mental health challenges of elite youth athletes
Tamminen, K. A., Sutcliffe, J., & Walton, C. C. (2024) · doi:10.64628/aam.pgt63gfpc
Ercan, S., Büyüklüoğlu, G., Büyüklüoğlu, N., Yıldız, Y. A., Aktaş, B. S., & Örsçelik, A. (2025) · The Physician and Sportsmedicine · doi:10.1080/00913847.2025.2592532
“However, depression and anxiety are particularly common after injury and at the end of a sporting career [10–12].”
Association of exercise type and levels with depressive symptoms in a Korean population
Park, J. H., Lim, J.-Y., & Park, H. (2025) · BMC Sports Science Medicine and Rehabilitation · doi:10.1186/s13102-025-01449-z
Additional file 2 of The Mental Health of Elite-Level Coaches: A Systematic Scoping Review
Frost, J., Walton, C. C., Purcell, R., Fisher, K., Gwyther, K., Kocherginsky, M., & Rice, S. M. (2024) · Figshare · doi:10.6084/m9.figshare.25203736
Self-citationAdditional file 1 of Validating a Japanese Version of the Athlete Psychological Strain Questionnaire
Ojio, Y., Matsunaga, A., 川村, 慎., Horiguchi, M., Yoshitani, G., Hatakeyama, K., Amemiya, R., Kanie, A., Purcell, R., Rice, S. M., et al. (2021) · Figshare · doi:10.6084/m9.figshare.17162952
Self-citationHenderson, A. R., Harris, S. A., Kirkham, T., Charlesworth, J., & Murphy, M. C. (2023) · Figshare · doi:10.6084/m9.figshare.23354310
Additional file 4 of The Mental Health of Elite-Level Coaches: A Systematic Scoping Review
Frost, J., Walton, C. C., Purcell, R., Fisher, K., Gwyther, K., Kocherginsky, M., & Rice, S. M. (2024) · Figshare · doi:10.6084/m9.figshare.26679632
Self-citationAdditional file 6 of The Mental Health of Elite-Level Coaches: A Systematic Scoping Review
Frost, J., Walton, C. C., Purcell, R., Fisher, K., Gwyther, K., Kocherginsky, M., & Rice, S. M. (2024) · Figshare · doi:10.6084/m9.figshare.26679638
Self-citationAdditional file 1 of The Mental Health of Elite-Level Coaches: A Systematic Scoping Review
Frost, J., Walton, C. C., Purcell, R., Fisher, K., Gwyther, K., Kocherginsky, M., & Rice, S. M. (2024) · Figshare · doi:10.6084/m9.figshare.25203625
Self-citationAdditional file 3 of The Mental Health of Elite-Level Coaches: A Systematic Scoping Review
Frost, J., Walton, C. C., Purcell, R., Fisher, K., Gwyther, K., Kocherginsky, M., & Rice, S. M. (2024) · Figshare · doi:10.6084/m9.figshare.26679629
Self-citationAdditional file 5 of The Mental Health of Elite-Level Coaches: A Systematic Scoping Review
Frost, J., Walton, C. C., Purcell, R., Fisher, K., Gwyther, K., Kocherginsky, M., & Rice, S. M. (2024) · Figshare · doi:10.6084/m9.figshare.26679635
Self-citationPilkington, V., Rice, S. M., Walton, C. C., Gwyther, K., OLIVE, L. S., Butterworth, M., Clements, M., Cross, G., & Purcell, R. (2022) · Figshare · doi:10.6084/m9.figshare.20250493
Self-citationAndersson, M. J., Kenttä, G., Claesdotter‐Knutsson, E., & Håkansson, A. (2024) · Figshare · doi:10.6084/m9.figshare.27093439
Triplett, A. N., Anderson, T., Post, E. G., Bartley, J. D., Shilt, J. S., Dugan, E. L., Donaldson, A. T., Finnoff, J. T., & Adams, W. M. (2026) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2025-002831
Estévez, A., Llanos, M., & Diego, G. A. (2026) · Psychology Health & Medicine · doi:10.1080/13548506.2026.2659696
OLIVE, L. S., Hoare, E., Macdougall, H., Hunt, D., Hall, K., Purcell, R., Reardon, C. L., & Berk, M. (2026) · British Journal of Sports Medicine · doi:10.1136/bjsports-2025-110580
Self-citationChen, K., & Xing, Y. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1832397
“Athlete mental health support should adopt a diversified strategy (Henriksen et al., 2020; Schinke et al., 2024; Åkesdotter et al., 2020; Purcell et al., 2020; Gouttebarge et al., 2021; Mountjoy et al., 2023), incorporating mindfulness as one option in the toolkit.”
Mental Health Challenges and Help Seeking Behavior Among Athletes
John, H., Pottengal, S., & Baikady, R. (2026) · Springer eBooks · doi:10.1007/978-3-030-68127-2_659-1
Fadare, S. A., Juhn-Agsak, T. S., Barahimin, E. A., Oyda, A., Pangandaman, H. K., & Langcoy, R. N. (2026) · Futurity Medicine. · doi:10.57125/fem.2026.06.30.05
Eating disorders and associated mental symptoms in Swedish elite athletes and a comparison group
Ejderstedt, F., Karlsson, M., Edlund, B., Ahlgren, M., Pojskić, H., & Melin, A. (2026) · Discover Mental Health · doi:10.1007/s44192-026-00547-9
“Previous research has shown that elite athletes experience mental health symptoms at rates comparable to or exceeding those of the general population [40, 41].”
NAIDOO, D., Chantler, J., Gouttebarge, V., van Rensburg, D. J., & MacMillan, C. (2026) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2026.07.018
Assessment of depression and suicidal thoughts among female trail runners
Hill, C., Vigne, C., Basset, P., Baud, D., & Scheer, V. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1753949
“Studies have reported a higher prevalence of depression among elite athletes compared to the general population (Gouttebarge et al., 2019; Purcell et al., 2020).”
- Authors
- Purcell, R., Rice, S., Butterworth, M., & Clements, M.
- Affiliations
- The University of Melbourne (AU)
- Corresponding author
- Purcell, Rosemary
- Venue
- Sports Medicine
- Published
- 2020-02-06
- Volume
- 50
- Issue
- 9
- Pages
- 1683-1694
- ISSN
- 0112-1642 (ISSN-L)
- 1179-2035
- OpenAlex
- W3005474290
- Cited by
- 100
- References
- 44
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 18 · 2023: 17 · 2022: 18 · 2021: 14 · 2020: 6
- FWCI
- 20.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Australian Sports Commission
- 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
- psychiatric symptoms, elite athletes, psychological distress, risky alcohol use, problem gambling, body dissatisfaction, self-esteem, life satisfaction, social support, coping styles, life events, athletes with disabilities, gender differences, mental health screening, Australian Institute of Sport, elite sport, mental health service utilization
- MeSH terms
- Body Dissatisfaction, Psychological Distress, Adolescent, Adult, Alcohol Drinking, Australia, Cross-Sectional Studies, Female, Gambling, Humans, Male, Mental Health, Social Support, Young Adult, Athletes
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