Sport psychiatry and psychotherapy. Mental strains and disorders in professional sports. Challenge and answer to societal changes

Sports psychiatry: a desideratum on sports arena!

The emerging field of sports psychiatry has been developing steadily in recent years. This is not just a health concern but is likely to impact sporting performance and achievement significantly. An overview of sports psychiatry is provided. Psychiatric disorders of all varieties can and do present in sporting populations. Sports psychiatry keeps evolving to drive forward the importance of good mental health in sport as in life.

Psychological and Mental Sequelae in Elite Athletes with Previous SARS-CoV-2 Infection: A Systematic Review

During the COVID-19 pandemic, many athletes from several sporting disciplines were infected with the SARS-CoV-2. The aim of this systematic review is to summarize the current scientific evidence on the psychological sequelae and mental health of elite athletes who have been infected by the virus. The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement; three databases were searched: PubMed, ISI Web of Knowledge, and Scopus. The initial search resulted in 2420 studies; after duplicate removal and screening by title and abstract, 41 articles were screened by full-text. A total of four eligible articles were included in the review. All included articles measured depression and anxiety in athletes who had suffered from COVID-19, while in three papers levels of stress were measured. Overall, the only two questionnaires used in more than one study were the DASS-21 and the APSQ. In our systematic review, we highlighted that mental and psychological health in elite athletes has the same importance as physical health. This statement suggests that these examinations should be introduced and performed during the competitive sports' medical examinations conducted at the start of the sporting season, which currently consists only of the examination of physical parameters. Due to lack of studies on the topic, the results of our review show that mental health in athletes with a history of SARS-CoV-2 infection is an issue that requires more investigation, considering the evidence of clinical consequences. The importance of post-infection psychological sequelae is significant in assessing possible repercussions on the athletes' sporting performance.

Exploring the Perceived Impact of the COVID-19 Pandemic Social Distancing Measures on Athlete Wellbeing: A Qualitative Study Utilising Photo-Elicitation

Countries all over the globe have implemented mandatory social distancing measures in an attempt to suppress and control the spread of the Coronavirus disease (COVID-19). This enforced period of isolation, disruption to normal training routines and competition cancellation, could be having an adverse effect on the mental health and wellbeing of athletes. This study sought to explore the perceived impact of the COVID-19 social distancing measures on athlete wellbeing. Fourteen elite athletes who were unable to train or compete due to government imposed lockdown measures were recruited to participate in this qualitative study. Utilising the photo elicitation method, participants were asked to take a series of photographs that represented their experiences as athletes living in lockdown. These photographs were used to guide discussions in follow up unstructured interviews. Reflexive inductive thematic analysis identified three main themes that captured athletes' experience of social distancing measures and the implications for their wellbeing: (1) threats to wellbeing; (2) adapting routines and maintaining motivation; and (3) reflecting on participation in competitive elite sport. The initial sudden loss of sport in the athlete's lives posed a threat to their wellbeing, but over the duration of the lockdown period the athletes developed numerous strategies to protect their wellbeing. Furthermore, their time away from sport encouraged them to reflect on their athletic identity and to make life changes that would protect their wellbeing during the rest of the lockdown period and when they returned to sport. A number of immediate practical recommendations are offered for athlete support personnel working with athletes during the crisis, these include developing self-care strategies and social networks, adapting routines, setting new goals and encouraging the pursuit of dual-careers. Future research is encouraged to investigate how practitioners can deliver effective psychological support through tele-consulting, and to consider whether their support is best focused on therapeutic counselling or mental skills training during the pandemic.

Let's Talk About Mental Health and Mental Disorders in Elite Sports: A Narrative Review of Theoretical Perspectives

The objective of this article is to discuss: (a) the various theoretical perspectives on mental health and mental health disorders adopted in sport psychology, and (b) how the adoption of these various theoretical perspectives in studies might impact upon the interpretations and conclusions in research about the mental health of participants in elite sports. Well-being as a target construct, holistic models, the single continuum or stage models, and Keyes' dual-continuum model of mental health are described, together with a sports psychiatric view of mental health. The strengths and limitations of various mental health perspectives are discussed. We conclude that mental health is a complex construct and that the sport psychology literature, much like the clinical psychology literature, has struggled to reach a consensus regarding a definition or a feasible approach to investigating mental health. For the researcher, it becomes important to make explicit the underlying theoretical perspective adopted and the operationalization upon which conclusions about elite athletes' mental health are based so that an increased knowledge base with high scientific credibility can be established and consolidated over time.

Increased interhemispheric synchrony underlying the improved athletic performance of rowing athletes by transcranial direct current stimulation

To explore the mechanism of transcranial direct current stimulation (tDCS) on the improved performance of professional rowing athletes. Twelve male professional rowing athletes were randomly divided into two groups (low-stimulation group, 1 mA, n = 6; high-stimulation group, 2 mA, n = 6), and they accepted tDCS for two consecutive weeks while undergoing regular training (20 min each time, five times a week, totally ten times). The assessments of depression, anxiety, executive function, fatigue perception, lactate threshold power (LTP) and isokinetic muscle strength as well as the collection of functional magnetic resonance imaging (fMRI) data were performed at baseline and at follow-up (the end of the fourth week). The voxel-mirrored homotopic connectivity (VMHC) value was calculated in the whole brain. After stimulation, there were significant increases in executive function and athletic performance. Analysis of variance (ANOVA) analysis indicated time factor, stimulation intensity factor had a main effect on LTP and 60RK, respectively. There was no significant difference of VMHC value between the high- and low-stimulation groups at baseline. Comparing with low-stimulation group, significant increased VMHC values of the bilateral middle temporal gyrus (MTG), precentral gyrus and superior frontal gyrus (SFG) were found in high-stimulation group at follow-up. Correlation analyses showed that in high-stimulation group, the VMHC values of bilateral MTG and SFG were both positively correlated with the measures of athletic performance. tDCS may contribute to the improvement of athletic performance in professional rowing athletes, and the increased interhemispheric coordination may be involved in the mechanism of the improved athletic performance.

Doping among high school students: findings from the French ESPAD survey

BACKGROUND

The increasing use of doping by youth is a growing public health concern. The present study aimed to calculate robust estimates of the prevalence of doping among French high school students and study factors related to the use of licit vs. banned agents.

METHODS

The European School Project on Alcohol and other Drugs (ESPAD), a nationally representative school-based survey, was distributed across France from April to May 2015, generating a final sample size of 6642 students. Multilevel modelling was used to examine covariates of doping to enhance athletic performance in sport in this population.

RESULTS

Overall, 2.3% of students used banned agents, and 6.1% used licit and banned substances to improve athletic performance. Significant gender differences existed for both, with males more prone to doping than females. Our findings provide support for the existing gateway hypothesis that nutritional supplementation leads to doping banned agents. Multilevel modelling revealed the presence of both school and class-level influences on individual use of licit substances, vs. solely class-level factors impacting the use of banned agents, suggesting a strong peer-effect.

CONCLUSIONS

These findings support the need to engage in early doping prevention through high schools. Programmes should draw attention to the role of licit substances, including nutritional supplementation, in the progression to using banned agents and encompass the continuum of adolescent risk taking through a behaviour-based approach to doping prevention.

Management of mental health emergencies in elite athletes: a narrative review

Mental health emergencies require a rapid, effective response. We searched the literature on mental health emergencies in athletes and found five papers. None of these addressed elite athletes. Nonetheless, common mental health emergencies may present in the sports environment and may place the athlete and others at risk. Sports teams and organisations should anticipate which emergencies are likely and how medical and support staff can best respond. Responses should be based on general non-sporting guidelines. We stress the importance of clinicians following standard procedures.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Young Pacific Male Rugby Players' Perceptions and Experiences of Mental Wellbeing

Recent studies and increased media reporting across Australasia have linked young Pacific maleelite athletes to depression, suicide, and other adverse mental health-related events. Despite these accounts,little is known about the way this group experience emotions and mental wellbeing. The aim of this studywas to explore young Pacific male athletes' perceptions and experiences of emotions and mental wellbeing.This qualitative study involved 20 face-to-face interviews with young Pacific males (16⁻24 years) engaged inelite rugby union and rugby league programmes in Auckland, New Zealand. The results identified thatathletes defined mental wellbeing in a holistic and relational manner and perceived and mental wellbeing asthe culmination of several interconnected factors, including: Family support, reciprocating family support,living a 'well-balanced' life, athletic performance, and personal development away from sports. Themaintenance of a well-balanced athletic identity and positive social relations were deemed central tosustaining mental wellbeing for these young men.

Essentials for Best Practice: Treatment Approaches for Athletes With Eating Disorders

Eating disorders (EDs) and disordered-eating behaviors (DEBs), pose a high risk of morbidity and mortality, threatening physical health, emotional health, and overall quality of life. Unfortunately, among athletes, prevalence rates continue to increase. This document summarizes the challenges of establishing and navigating the multidisciplinary care needed to effectively treat EDs and DEBs among athletes. The benefits of timely and frequent communication within the multidisciplinary treatment team (MDTT) are emphasized and discussed. Authors advise who should be selected as members of the MDTT and suggest that all personnel, including athletic coaches, athletic trainers, physical therapists, and certified fitness professionals be ED-informed and ED-sensitive. Vital components of care are noted including use of a variety of evidence-based psychotherapeutic modalities, interventions which target emotional regulation, and prioritize values based compassionate care. Authors caution that performance decrements and medical/physiological changes are not always easily observable in individuals with EDs and DEBs and therefore, attuned, consistent, and ongoing monitoring is needed. Consensus regarding previously established parameters for return to play and careful titration of physical activity throughout the ED recovery process are suggested as important for preserving health, preventing re-injury, or relapse and facilitating successful return to sport participation.

Researching Eating Disorders and Body Image in Sport: Challenges and Recommendations

The number of studies examining eating disorders and body image in sport has increased, although several major challenges associated with conducting this research must be addressed to continue growth. In this paper, we describe these challenges based on our professional experiences and the academic literature. Mistrust of researchers and the area of study, communication gaps, and factors that affect data quality are among the strong barriers discussed. However, we suggest that these challenges may be addressed by building stronger partnerships between researchers and practitioners and offer critical steps for developing meaningful professional relationships that will help move the field forward.

Assessment of Athletes With Eating Disorders: Essentials for Best Practice

It is estimated that 1.6 million people in the United States are currently diagnosed with an eating disorder. Eating disorders (EDs) have high rates of morbidity and mortality and remain the most severe mental illness. Unfortunately, rates of EDs and disordered eating behaviors (DEBs) among athletes appear to be increasing. In this study, authors summarize ED-related risks that pose compromises in psychological and social functioning, medical health, and overall quality of life. The importance of early detection and formal evaluation in preserving the athlete’s health, well-being and sustaining successful sport participation, and performance are highlighted. Athlete-specific factors, which challenge the ease and accuracy of ED detection and assessment, are noted. The recommended components of effective ED assessment are identified, including use of self-report measures and clinical interviews conducted by ED certified and licensed professionals. The importance of being well informed in tenets of ED awareness, prevention and supporting early detection, and referral for formal ED assessment are noted. Conclusions reflect the vital roles that both the multidisciplinary sport personnel and the sport environment/culture play in reducing the serious health risks of DEBs and EDs. Each is needed to protect an athlete’s well-being while fostering safe and successful sport participation.

Learning From Elite Athletes' Experience of Depression

Sport has become increasingly aware of the challenges associated with Mental Disorders and, to a greater extent, mental health issues (MHIs). This study sought to explore in depth the subjective experiences of elite athletes who suffered from a specific clinical MHI, namely depression. In addition, we explored their perceptions of the prevalence and stigma surrounding MHIs in elite sport environments. Data were collected from four elite athletes (1 female and 3 males; 2 team and 2 individual sports) using semi-structured interviews and analysed using Interpretative Phenomenological Analysis. Participants described both sport and non-sport related triggers in regard to their depression (e.g., institutional mistreatment and bullying, injuries, previous MHI, and miscarriage), as well as a range of behaviour, performance (e.g., decline), and personality changes compared to their normal functioning. Although the participants stressed the widespread prevalence of MHIs in elite sport, they also acknowledged the stigma associated with MHIs in high-level sport environments and its detrimental role for athletes. This study has important practical and diagnostic implications, and highlights the need for further research to assess the extent and scope of clinical MHIs in sport as well as to inform the care for this unique population.

Psychological Attributes of Ultramarathoners

INTRODUCTION

As the popularity of ultramarathon participation increases, there still exists a lack of understanding of the unique psychological characteristics of ultramarathon runners. The current study sought to investigate some of the psychological and behavioral factors that are involved in ultramarathon running.

METHODS

We obtained information from participants of the Bear Chase Trail Race via an online survey. This race is a single-day, multidistance race consisting of a 10 k, half marathon, 50 k, 50 mi, and 100 k run in Lakewood, Colorado, at a base altitude of 1680 m with total altitude in climbs ranging from 663 to 2591 m. We correlated information from the Exercise Addiction Inventory and the Patient Health Questionnaire-2 and demographic information with race finish times.

RESULTS

Out of 200 runners who started the race, 98 (48%) completed the survey. Over half of the runners were men (61.2%), and the average age was 39.0 years (SD±8.9; range 21-64 years). A number of respondents (20%) screened positive for exercise addiction concerns. Approximately 20% of our sample screened positive for depressive symptoms (Patient Health Questionnaire-2 score >3). The majority of participants reported receiving strong social support from current partners with regard to their ultramarathon running training time and goals.

CONCLUSIONS

Although only a screening, the number of positive screens on the Exercise Addiction Inventory suggests use of screening measures with an ultramarathon running population. Athletes with positive screening tests should be fully evaluated for depression and exercise addiction because this would enable appropriate athlete support and treatment referral.

Service Providers' Attitudes Toward Athletes With Eating Disorders

OBJECTIVE

This study explored the nature and extent of Athlete Support Personnel's (ASP's) attitudes and beliefs toward athletes with symptoms of anorexia nervosa (AN) compared with those with symptoms of depression.

DESIGN

A cross-sectional study with a survey instrument.

SETTING

Sport and Exercise Science Professional Bodies and Associations in the Republic of Ireland, Northern Ireland, and mainland United Kingdom.

PARTICIPANTS

One hundred fifty-two ASP.

MAIN OUTCOME MEASURES

Participants read 2 vignettes describing a fictional female athlete with symptoms of AN or depression after which they completed an on-line survey examining attitudes toward such athletes.

RESULTS

Significant differences in patterns of responses were found between the 2 mental health conditions. The athlete with AN was viewed as significantly more difficult to communicate with F(1,148) = 18.17, P = 0.000, η = 0.11, more likely to be using her disorder to gain attention F(1,148) = 21.69, P = 0.000, η = 0.13, personally responsible for her condition F(1,148) = 10.10, P = 0.00, η = 0.06, and less likely to recover F(1,148) = 23.03, P = 0.000, η = 0.14 than the athlete with depression. Male service providers were more likely to believe that the athletes depicted were attention seeking F(1,148) = 10.69, P = 0.001, η = 0.07 and only had themselves to blame for their mental health condition F(1,148) = 12.97, P = 0.000, η = 0.08.

CONCLUSIONS

Athlete support personnel report stigmatizing attitudes toward athletes with eating disorders such as AN. Male service providers hold greater negative attitudes toward athletes with mental health conditions.

SHARPSports mental Health Awareness Research Project: Prevalence and risk factors of depressive symptoms and life stress in elite athletes

OBJECTIVES

Our study aims to estimate the prevalence of symptoms of depression and daily life hassles in elite athletes.

DESIGN

A cross-sectional prospective epidemiological study design.

METHODS

An online anonymous survey was administered during a 2-month period from May to July 2015. Athletes 18 years of age (or older) who were members of the High Performance Sport New Zealand programme were invited to participate. Of 370 potential participants, 187 completed responses were received (51%). Symptoms of depression were measured by the Centre for Epidemiological Studies Depression Scale-Revised (CESD-R). Life stress was measured by the Daily Hassles Questionnaire.

RESULTS

Overall 21% (n=39) of participants reported symptoms consistent with depression. Only 2 of the 39 athletes were currently taking an anti-depressant medication. Those contemplating retirement, partaking in individual sport, and who were less than 25 years old had significantly increased odds of experiencing depression. Reported life stressors were higher in females, in those who play an individual sport and those in a centralised programme. There was a significant correlation between higher levels of life stress and experiencing depressive symptoms.

CONCLUSIONS

This study highlights that depressive symptoms are prevalent in elite athletes with multiple potential risk factors identified including high life stress. These variables warrant further exploration to enable the early identification of athletes with depressive symptoms, screening and support for elite athletes.

Is Elite Sport (Really) Bad for You? Can We Answer the Question?

Elite athletes are not immune to mental health issues. Yet, quality research on mental health in elites has so far been limited. Thus, while research on mental health emphasises the prevalence and nature of disorders in the general population, its extent in elite performers remains unclear. Indeed, the prevalence of mental conditions cannot be accurately calculated in elite athletes due to a lack of diagnostic criteria and screening tools specifically adapted to this unique population. Researchers and practitioners are, therefore, confronted with biases reflecting the use of clinical norms and instruments initially developed for the general population. Furthermore, without considering the athlete persona as well as the sport culture in which elites play, there is a risk of under- or over-estimating the prevalence of mental health issues in high-performance environments. Due to the unique characteristics surrounding an elite athlete's life, we therefore suggest a change of perspective: moving from the usual normal-versus-pathological to a functional-versus-dysfunctional approach. Implications for future research and practice are discussed, most notably examining practitioners' expertise in diagnosing and treating elite performers.

Psychiatric disorders: The psychiatrist's contribution to sport

Athletes experience a range of mental health problems with at least an equivalent prevalence to the general population. This chapter explores the psychiatrist's role in sport, along a pathway of mental healthcare from 'upstream' prevention, screening, and early detection of mental stress to 'downstream' assessment, treatment, rehabilitation, and recovery from mental illness. At each stage on this pathway the psychiatrist has a broad spectrum of bio-psycho-social strategies to employ in clinical practice. Upstream, the importance of psychological resilience is described along with the concept of mental 'pre-habilitation' (a term usually associated with the prevention of physical injury). Alongside these preventative measures, early detection is improved by education, increased awareness, and by the use of effective mental health screening measures. Further downstream ready access to psychiatric expertise and good collaboration between the psychiatrist and the world of sport improve access to treatment, delivery of that treatment, rehabilitation, and return to sport during recovery.

Stress-related psychological factors for back pain among athletes: Important topic with scarce evidence

Health issues represent a frequent problem for athletes, as this particular demographic is repeatedly confronted with physically and psychologically stressful situations. Back pain (BP) materialises as comparatively common health problem being regarded as functionally limiting and psychologically straining burden for athletes. According to research conducted on athletes with BP, biomechanical and physiological mechanisms emerge as influential, whereas stress-related psychological factors appear to be neglected. For athletic injuries, the essential impact of psychological processes on injury occurrence and return from injury has already been corroborated. Hence, the aim of this literature review is to: (1) introduce a conceptual differentiation between injuries and BP; (2) summarise the results obtained regarding stress-related psychological aspects for injuries; and (3) connect the injury research to the state-of-the-art evidence regarding stress-related factors for BP among athletes. A distinction between injuries and BP could be established based on previous definitions, despite the fact that a considerable overlap between both concepts prevails. Injuries can be attributed to a physical origin, whereas BP frequently lacks this physical criterion. For BP, our enquiry yielded four studies including psychological measures of stress - with two studies specifically examining the association between BP and psychological stress among athletes longitudinally. Abundant findings from the general population support the importance of considering psychological and specifically stress-related factors in BP prevention and rehabilitation, but evidence related to the athletic field remains elusive. Further scientific investigations with a wider methodological approach are needed to deepen the knowledge about the crucial relationship between psychological stress, BP, and athletes.

Nutzung sportpsychologischer, psychotherapeutischer und psychiatrischer Angebote durch deutsche Kadersportlerinnen und -sportler

Zusammenfassung. Spitzensportlerinnen und -sportler sind in ähnlicher Häufigkeit von psychischen Problemen betroffen wie die Normalbevölkerung. Dabei kann die Nutzung sportpsychologischer Angebote als Prävention verstanden werden, während die Inanspruchnahme von psychotherapeutischer oder psychiatrischer Hilfe die Behandlung von (sub-)klinischen Störungen zum Inhalt hat. In der vorliegenden Studie wurde eine vergleichsweise große Stichprobe von deutschen Kaderathletinnen und -athleten hinsichtlich ihrer Nutzung sportpsychologischer, psychotherapeutischer und psychiatrischer/klinischer Angebote befragt. Insgesamt ergab sich eine Nutzungsrate von 48% für die sportpsychologischen und 11% für die therapeutischen Angebote. Es zeigte sich, dass mehr Frauen als Männer auf alle Angebotsformen zugriffen, und ältere Personen eher als jüngere. Profisportlerinnen und -sportler bzw. Angehörige der Sportfördergruppen nutzten alle Angebotsformen vermehrt. Die Studie macht deutlich, dass die deutschen Kaderathletinnen und -athleten zwar bereits sportpsychologische, psychotherapeutische und psychiatrische Angebote wahrnehmen, dass die Akzeptanz aber in verschiedenen Gruppen (z.B. Männer, Jugendliche) noch verbesserbar ist, um im Sinne eines psychisch gesunden Leistungssports alle vorhandenen Ressourcen auszuschöpfen.

Influence of Competition Day on Cognitive Control and HRV in Young Male Gymnasts

Sartor, F, Capuzzoni, S, Rospo, G, La Torre, A, Vailati, F, and Vailati, E. Influence of competition day on cognitive control and HRV in young male gymnasts. J Strength Cond Res 31(7): 1982-1993, 2017-In gymnastics, high levels of executive attention and physical and coordinative capacities are required. However, training planning does not usually account for dynamic alterations in cognitive capacity. This study investigated whether cognitive capacity was altered by the approach of a competition. Ten elite male gymnasts (16 ± 2 years, 57.3 ± 16.1 kg, 1.64 ± 1.27 m) were monitored for sleep, life demands, rating of perceived exertion (RPE), and pain, starting 5 days before the competition and up to 5 days after it. Stroop task performance and concomitant heart rate variability (HRV) were monitored 5 days and 1 day before the competition and then 1 and 5 days after. Sleep and life demands were not affected by the competition. Localized pain ranged from mild to moderate levels throughout the observation period. It weakly correlated with RPE (r = 0.241, p = 0.010) and moderately with number of errors (NoEs) (r = 0.639, p = 0.047). The RPE was higher for the competition day (p = 0.002). Median reaction times during the Stroop task were higher in the period preceding the competition (p < 0.001) for similar NoEs. The HRV during the congruent stimuli task showed higher root mean square differences of successive beats, portion of normal to normal intervals exceeding 50 milliseconds, and high frequency after the competition (p ≤ 0.05). Poincare plot SD2 showed a positive correlation with Stroop task NoEs (r = 0.590, p < 0.001). In conclusion, the period preceding an important competition affected cognitive performance and HRV in young male gymnasts. A practical implication of this study is that training loads could be adjusted according to mental stress before a competition.

Antecedents and consequences of burnout in athletes: Perceived stress and depression

Background/Objective: The aim of this study was to investigate the relationship among perceived stress, burnout and depression in a sample of athletes. It was hypothesized that stress is an antecedent of burnout and depression a possible consequence of both stress and burnout. Method: A sample of 453 athletes participated in the study. Stress and depression were measured with Depression Anxiety Stress Scales (DASS) and athlete burnout with Athlete Burnout Questionnaire (ABQ). Data analysis was conducted under the approach of structural equation modelling (SEM). Results: The direct effects of stress on burnout and depression were .66 and .24, respectively, and the direct effect of burnout on depression .53, all of them significant (p<.001). Stress accounted for 43% of the variance of burnout, and jointly stress and burnout for 50% of the variance of depression. Indexes of overall model fit were: χ 2 (224)= 520.881 (p < .001), χ 2 /df = 2.32, Goodness of fit index (GFI) = .91, Comparative fit index (CFI) = .89, Root mean square error of approximation (RMSEA) = .054 (90% confidence interval, .048-.060), and Standardized Root Mean Square Residual (SRMR) = .063. Conclusions: This study provides evidence of the relationship among stress, burnout and depression in an only model.

Blurred lines: Performance Enhancement, Common Mental Disorders and Referral in the U.K. Athletic Population

Through the awareness-raising efforts of several high-profile current and former athletes, the issue of common mental disorders (CMD) in this population is gaining increasing attention from researchers and practitioners alike. Yet the prevalence is unclear and most likely, under-reported. Whilst the characteristics of the sporting environment may generate CMD within the athletic population, it also may exacerbate pre-existing conditions, and hence it is not surprising that sport psychology and sport science practitioners are anecdotally reporting increased incidences of athletes seeking support for CMD. In a population where there are many barriers to reporting and seeking help for CMD, due in part to the culture of the high performance sporting environment, anecdotal reports suggest that those athletes asking for help are approaching personnel who they are most comfortable talking to. In some cases, this may be a sport scientist, the sport psychologist or sport psychology consultant. Among personnel in the sporting domain, there is a perception that the sport psychologist or sport psychology consultant is best placed to assist athletes seeking assistance for CMD. However, sport psychology as a profession is split by two competing philosophical perspectives; one of which suggests that sport psychologists should work exclusively with athletes on performance enhancement, and the other views the athlete more holistically and accepts that their welfare may directly impact on their performance. To add further complication, the development of the profession of sport psychology varies widely between countries, meaning that practice in this field is not always clearly defined. This article examines case studies that illustrate the blurred lines in applied sport psychology practice, highlighting challenges with the process of referral in the U.K. athletic population. The article concludes with suggestions for ensuring the field of applied sport psychology is continually evolving and reconfiguring to ensure that it continues to meet the demands of its clients.

Symptoms and risk factors of depression during and after the football career of elite female players

Background

The mental health of elite athletes has received increasing attention in recent years, but no study has evaluated the career–time prevalence of depression, and very few have analysed risk factors of mental health problems during or after the career.

Methods

157 (response rate 64.1%) female players who played in the German First League answered an anonymous online survey on details of their football career, stressful and helpful conditions, depression and need of psychotherapeutic support during and after the football career.

Results

The career–time prevalence of depression symptoms was 32.3%. Significant differences in the average depression score were observed for playing positions (F=2.75; p<0.05) and levels of play (F=3.53; p<0.01). About half of the players (49.7%) stated ‘conflicts with coach/management’ as an important reason for their low in moods, followed by ‘low in performance/injury’ (48.4%) and ‘too little support/acknowledgement by the coach’ (40.0%). ‘Psychological strain/stress’ (46.5%) was (after injury) the second most important reason for lows in performance. During their career, almost 40% of players wanted or needed psychological support, but only 10% received it. After their career, the percentage of players wanting or needing psychological support decreased to 24%, of whom 90% received it.

Conclusions

The high prevalence of depression symptoms in combination with low use of psychotherapy during the career shows the need for de-stigmatisation of mental health issues in elite football. Furthermore, it seems very important to educate coaches, physicians, physiotherapists and club managers to recognise and prevent mental health problems of their players.

Examining the Role of Mental Health and Clinical Issues within Talent Development

Although significant research supports the association between physical activity and mental wellbeing, current literature acknowledges that athletes are no less susceptible to mental illness than the general population. Despite welcomed initiatives aimed at improving mental health within elite sport, these programs often fail to target young athletes; an important concern given that the genesis of many mental illnesses are recognized to occur during this critical period. Given the importance of early intervention and effective treatment, and the potentially devastating consequences of clinical issues going undiagnosed, the implications for talent identification and development (TID) become obvious. With this in mind, this study sought to examine the range of mental health issues that may impact upon developing athletes and potential consequences for the development process, specific risk and protective factors associated with talent development, along with an examination of current practices concerning the identification of mental health issues in such environments. Qualitative interviews were conducted with purposively sampled clinicians (n = 8) experienced in working with adolescents and/or young athletes. Inductive content analysis was undertaken, identifying four main themes: key behavioral indicators; associated risk factors; associated protective factors; and issues around identification and diagnosis. Key behavioral indicators included behavioral change, along with behaviors associated with eating disorders, anxiety and depression. Risk factors centered on family background, the performance environment, and issues surrounding adolescence. Protective factors were primarily social in nature. Finally, a lack of awareness and understanding of clinical issues, multiple causes of symptoms, non-disclosure and the need for triangulation of assessment were identified. The need for improved identification and intervention strategies was apparent, with coaches identified as well placed to detect general “warning signs” such as behavioral change. Short of integrating trained clinicians into talent development environments, as part of a triangulation process, ecologically validated assessment tools—coupled with appropriate training and signposting—could offer a practical way of flagging potential issues in developing athletes. The need for the development of such an instrument is therefore apparent. Finally, education around the influential role of family is also recommended in order to promote the protective elements and mitigate risk factors.

Exploring Indices of Disordered Eating Literacy in Male and Female Athletes: Knowledge Gaps and Lay Beliefs as Predictors of Attitudes Toward Help-Seeking

The aim of this pilot study was to explore disordered eating (DE) literacy in male and female athletes and to examine whether any gender differences were present. A related aim was to examine the moderating effect of gender on the relationship between indices of DE literacy and attitudes toward help-seeking for DE. A nonclinical sample of 133 (37% male) athletes from a variety of sports and competitive levels were recruited to complete an online questionnaire addressing a range of topics linked to DE literacy. Chi-square analysis indicated no significant gender differences on indicators of DE literacy. Findings from the survey revealed a number of beliefs conducive to low or inappropriate help-seeking for DE. The results highlight the importance of exploring DE literacy in athletes to develop more targeted interventions for this specific population.

Sport specificity of mental disorders: the issue of sport psychiatry

The prevalence of psychiatric conditions among elite athletes is still under debate. More and more evidence has accumulated that high-performance athletes are not protected from mental disorders as previously thought. The authors discuss the issue of the sport specificity of selected mental diseases in elite athletes. Specific aspects of eating disorders, exercise addiction, chronic traumatic encephalopathy and mood disorders in the context of overtraining syndrome are examined. In particular, the interrelationship between life and work characteristics unique to elite athletes and the development of mental disorders are reviewed. Differences of clinical presentation and some therapeutic consequences are discussed. The authors suggest that the physical and mental strains endured by elite athletes might influence the onset and severity of their psychiatric disorder. Beside the existing research strategies dealing with the amount of exercise, its intensity and lack of recreation experienced by athletes, further research on psycho-social factors is needed to better understand the sport-specific aetiology of mental disorders in high-performance athletes.

The prevalence of failure-based depression among elite athletes

OBJECTIVE

To assess the prevalence of diagnosed failure-based depression and self-reported symptoms of depression within a sample of elite swimmers competing for positions on Canadian Olympic and World Championship teams.

DESIGN

A cross-sectional design.

SETTING

Assessments were conducted after the conclusion of the qualifying swimming trials.

PARTICIPANTS

The sample consisted of 50 varsity swimmers (28 men and 22 women) based at 2 Canadian universities who were competing to represent Canada internationally.

MAIN OUTCOME MEASURES

Diagnosed depression was assessed using a semistructured interview, and symptoms of depression were also assessed by the Beck Depression Inventory II. Performance was measured by changes in swimming time and athlete ranking.

RESULTS

Before competition, 68% of athletes met criteria for a major depressive episode. More female athletes experienced depression than their male peers (P = 0.01). After the competition, 34% of athletes met diagnostic criteria and 26% self-reported mild to moderate symptoms of depression. The prevalence of depression doubled among the elite top 25% of athletes assessed. Within this group, performance failure was significantly associated with depression.

CONCLUSIONS

The findings suggest that the prevalence of depression among elite athletes is higher than what has been previously reported in the literature. Being ranked among the very elite athletes is related to an increase in susceptibility to depression, particularly in relation to a failed performance. Given these findings, it is important to consider the mental health of athletes and have appropriate support services in place.

The potential role of sports psychology in the obesity epidemic

Sports psychologists play an important role in enhancing performance among athletes. In conjunction with team physicians, they can also shed light on psychological disorders common in athletes, such as mood and eating disorders, and overtraining syndrome. Sports psychologists can also lend their expertise to assist with injury prevention and recovery and compliance issues. Sports psychology has a role in helping to reverse the growing obesity epidemic among school-aged children. These professionals, working with coaches, can increase children's levels of physical activity. Cognitive-behavioral techniques could lead to enhanced enjoyment, increased participation, improved school performance, and a reduction in obesity.