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

High prevalence of harmful drinking habits and gambling among professional rugby players: mental health symptoms and lifestyle risks among New Zealand Super Rugby players-a cross-sectional survey

Objectives

Determining the prevalence of mental health and lifestyle risk factors (smoking, alcohol consumption, recreational drug use, gambling, family violence and anger management) in New Zealand (NZ) male professional rugby players.

Study design

Cross-sectional survey of mental health symptoms and lifestyle risk factors in male professional rugby players in NZ.

Methods

Players from all five NZ men's Super Rugby Franchises were invited to complete an online questionnaire (SportCHAT) measuring demographic status and mental health symptoms. Descriptive and interferential statistical analyses were used to identify the most prevalent mental health and lifestyle risk factors.

Results

105 players participated in the study (response rate 52.5%). 51.4% of players were either at moderate or high risk for alcohol-related harm (defined as potential health, social, legal or financial problems linked to alcohol consumption). In comparison, 4.8% reported recreational drug use and 5% reported smoking tobacco. Twenty players (19%) reported engaging in gambling, with five of these reporting problematic gambling. 21% of players reported symptoms of depression, but none reached the 'mild depression' threshold of the Patient Health Questionnaire for Depression. Younger players (aged 20-29) were more likely to report symptoms of depression than older players (aged 30-39). The prevalence of anxiety symptoms was 17.1%. 66.7% of these players reported minimal symptoms (GAD-7 score 0-4) and 33.3% reported mild symptoms (GAD-7 score 5-9). Family violence was reported by 2.9% of respondents, while 12.4% reported issues with anger management. There were no significant differences between ethnic groups.

Conclusion

There is a higher prevalence of alcohol misuse and gambling, but lower reported rates of depression and anxiety symptoms in this cohort when compared with the general population.

Sex Differences in Mental Health Symptoms in Elite Athletes: A Systematic Review and Meta-analysis

CONTEXT

Mental health is a growing area of concern for elite athletes.

OBJECTIVE

To determine the sex differences in mental health symptoms in elite athletes.

DATA SOURCES

PubMed, EMBASE, and Cochrane Library databases were used.

STUDY SELECTION

Included studies included comparisons of mental health symptoms of athletes by sex.

STUDY DESIGN

Systematic review and meta-analysis were conducted following the PRISMA guidelines.

LEVEL OF EVIDENCE

Level 2a.

DATA EXTRACTION

The rate ratio (RR) was calculated as the rates in female and male athletes. Data were pooled using a random-effects model.

RESULTS

Of 1945 articles identified, 60 articles were included. Male athletes reported higher alcohol misuse (RR, 0.74; CI, 0.68-0.80), illicit drug abuse (RR, 0.82; CI, 0.75-0.89), and gambling problems (RR, 0.14; CI, 0.08-0.25). Female athletes reported higher overall anxiety (RR, 1.17; CI, 1.08-1.27), depression (RR, 1.42; CI, 1.31-1.54), distress (RR, 1.98; CI, 1.40-2.81), and disordered eating (RR, 2.19; CI, 1.58-3.02). Sleep disturbances were reported at similar rates in male and female athletes (RR, 1.13; CI, 0.98-1.30).

CONCLUSION

Female and male athletes have significant differences in reported mental health symptoms. Female athletes are more likely to report anxiety, depression, distress, and disordered eating, while male athletes report more alcohol misuse, illicit drug abuse, and gambling. Monitoring and evaluation of mental health is a necessary part of any sport, including access to resources. Longitudinal studies following athletes over time to determine the development and causation for mental health symptoms should be included in future research directions.

Aligning categories of mental health conditions with intervention types in high-performance sports: A narrative cornerstone review and classification framework

Epidemiological studies suggest that psychiatric disorders are as prevalent amongst high-performance athletes as in general populations, challenging the myth of invulnerability. Despite efforts of sport organisations to highlight the significance of athletes' mental health, it is still many times tough to combine the sport performance ethos with a discourse on mental health. This narrative cornerstone review examines challenges related to definitions and classifications of athlete mental health in high-performance sports and how these influence assessments and the implementation of interventions. We discuss challenges with concept creep and psychiatrisation and outline their consequences for sport healthcare professionals. Based on this, we present a framework that aligns different categories of athlete mental health conditions (from the reduction of wellbeing to psychiatric disorders) with intervention types (from the provision of supporting environments to pharmacotherapy). We conclude that researchers and sport practitioners need to carefully consider conceptual creep and the risk of pathologising normal and healthy, albeit emotionally aversive, reactions to athlete lifeworld events when assessing athlete mental health. A clear separation of terminology denoting the athlete's resources to handle the lifeworld (including salutogenic factors) and terms describing psychiatric conditions and their management is necessary to avoid misguidance in intervention planning.

How Mental Health Affects Injury Risk and Outcomes in Athletes

CONTEXT

The importance of mental health among athletes is becoming more recognized and valued. Athletes experience symptoms of depression, anxiety, and related mental health disorders at rates similar to those of the general population, but because athletes face unique cultural and environmental pressures, such disorders are exacerbated in the context of an injury. Furthermore, we review the less well-known evidence that mental health disorders in athletes are associated with an increased risk of injury. We discuss the increasing awareness of the deficiencies in mental health support for athletes, which has been especially highlighted during the COVID-19 pandemic as well as in prominent professional and Olympic athletes, and describe both internal and external barriers to appropriate care.

EVIDENCE ACQUISITION

We searched PubMed for pertinent peer-reviewed studies.

STUDY DESIGN

Clinical review.

LEVEL OF EVIDENCE

Level 5.

RESULTS

There is a known psychological response to injury that can prolong recovery from musculoskeletal injury; conversely, mental health disorders in athletes are not only associated with an increased injury risk but also portend poorer outcomes subsequently, including prolonged recovery times, increased rates of injury recurrence, decreased rates of return to sport, and reduced performance upon return. Because of inherent barriers to appropriate care of athletes, including identification, stigma, and resource availability, there are currently various ongoing efforts nationally to create and implement initiatives regarding athlete mental health screening, support systems, and directed interventions to address the inextricably linked physical and mental health of athletes.

CONCLUSION

Athletic injury negatively impacts the mental health of athletes. Likewise, mental health can and does influence athletic performance and is also intimately tied to the risk of athletic injury, thus creating a complex cycle with inability to separate physical and mental health.

Depressive Disorders in Athletes

Depressive disorders in athletes are thought to be at least as common as the general population. However, athletes have a unique set of risk factors that can affect the likelihood of developing depression. Screening tools have been developed specifically for athletes such as the Sport Mental Health Assessment Tool (SMHAT). The management of the depressed athlete should involve an individualized approach, with methods such as counseling, interpersonal therapy, or cognitive behavioral therapy being used. Some may require antidepressant medication. Depressive disorders are also linked to sucidality in athletes, and the team physician and sporting organisation should have a crisis management plan in place for mental health emergencies. Tackling the stigma that remains in sport is a key part to improving mental wellbeing for all athletes.

Neuro-ophthalmologic and blood biomarker responses in ADHD following subconcussive head impacts: a case-control trial

Introduction

This clinical trial aimed to determine the influence of attention-deficit/hyperactivity disorder (ADHD) on neuro-ophthalmologic function and brain-derived blood biomarkers following acute subconcussive head impacts.

Methods

The present trial consisted of age- and sex-matched samples with a ratio of 1:1 between two groups with a total sample size of 60 adults (age ± SD; 20.0 ± 1.8 years). Soccer players diagnosed with and medicated daily for ADHD were assigned into an ADHD group (n = 30). Soccer players without ADHD were assigned into a non-ADHD group (n = 30). Participants performed 10 soccer headers with a soccer ball projected at a velocity of 25mph. King-Devick test (KDT), near point of convergence (NPC), and serum levels of NF-L, tau, GFAP, and UCH-L1 were assessed at baseline (pre-heading) and at 2 h and 24 h post-heading.

Results

There were no statistically significant group-by-time interactions in outcome measures. However, at baseline, the ADHD group exhibited lower neuro-ophthalmologic functions compared to the non-ADHD group (NPC: p = 0.019; KDT: p = 0.018), and persisted at 2 h-post (NPC: p = 0.007; KDT: p = 0.014) and 24 h-post heading (NPC: p = 0.001). NPC significantly worsened over time in both groups compared to baseline [ADHD: 2 h-post, 1.23 cm, 95%CI:(0.77, 1.69), p < 0.001; 24 h-post, 1.68 cm, 95%CI:(1.22, 2.13), p = 0.001; Non-ADHD: 2 h-post, 0.96 cm, 95%CI:(0.50, 1.42), p < 0.001; 24 h-post, 1.09 cm, 95%CI:(0.63, 1.55), p < 0.001]. Conversely, improvements in KDT time compared to baseline occurred at 2 h-post in the non-ADHD group [-1.32 s, 95%CI:(-2.55, -0.09), p = 0.04] and at 24 h-post in both groups [ADHD: -4.66 s, 95%CI:(-5.89, -3.43), p < 0.001; Non-ADHD: -3.46 s, 95%CI:(-4.69, -2.23), p < 0.001)]. There were no group-by-time interactions for GFAP as both groups exhibited increased levels at 2 h-post [ADHD: 7.75 pg./mL, 95%CI:(1.41, 14.10), p = 0.019; Non-ADHD: 7.91 pg./mL, 95%CI:(1.71, 14.14), p = 0.015)] that returned to baseline at 24 h-post. NF-L levels increased at 2 h-post heading in the ADHD group [0.45 pg./mL, 95%CI:(0.05, 0.86), p = 0.032], but no significant NF-L changes were observed in the non-ADHD group over time.

Discussion

Ten soccer headers elevated GFAP levels and NPC impairment in both groups. However, persisting group difference in NPC, blunted KDT performance, and increased NF-L levels in the ADHD group suggest that ADHD may reduce neuro-ophthalmologic function and heighten axonal response to soccer headers.

Clinical trial registration

ClinicalTrials.gov, identifier ID: (NCT04880304).

Initial examination of the mental health disorders: screening instrument for athletes

Introduction

There is a need to psychometrically develop assessment instruments capable of screening mental health disorders in athlete populations. The current study was conducted to determine reliability, validity and clinical utility of the Mental Health Disorders Screening Instrument for Athletes (MHDSIA).

Methods and results

259 collegiate athletes completed the MHDSIA. Factor analysis determined a single factor with good internal consistency, and this factor was positively correlated with an established measure of psychiatric symptomology (Symptom Checklist 90-R), demonstrating its concurrent validity. An optimum clinical cutoff score (i.e., 32) was determined using Receiver Operating Characteristic (ROC) analyses to assist appropriate mental health referrals.

Discussion

Results suggest the MHSIA is a reliable, valid, and relatively quick and easy to interpret screen for the broad spectrum of mental health disorders in collegiate athletes. As expected, NCAA athletes reported lower MHDSIA scores than club and intramural athletes, while males reported similar severity scores as females.

Athletes are not at greater risk for death by suicide: A review

INTRODUCTION

Suicide represents a major mental and public health issue. Elite athletes share certain individual and environmental characteristics that may increase their risk for mental illnesses, ultimately leading to suicide. This notion conflicts with the general perception of athletes, being the healthiest representatives of society.

METHODS

A comprehensive literature search was carried out through PubMed and Embase databases for relevant publications.

RESULTS

Recent calls for investigating suicidality among athletes resulted in a considerable amount of literature providing some evidence regarding lower rates of suicide among professional and high-performance athletes as well as similar incidence and prevalence of mental conditions, which are known as risk factors for suicide. Nevertheless, special attention is required in this population as predisposing and precipitating factors might differ from classical features of suicidality in the general population. Sports physicians, sports psychiatrists, and other mental health professionals in elite sports should be aware of early signs of affective disorders, risk of recreational drug abuse, misuse of performance-enhancing medications, sport-specific environmental stressors, serious physical injuries, and presence of physical or mental illness, all of which may increase suicidality. Traumatic brain injury (TBI) is with suicide with higher severity correlated with increased risk. Compared to active athletes, former athletes may have higher rates of suicide due to common life stressors occurring after sports retirement.

CONCLUSIONS

The findings suggest a multidisciplinary approach to suicidality in elite athletes, the main goal of which should be the reduction of suicide-related morbidity and mortality. Further research is required to clarify the existing gaps in the current knowledge of the issue. While having lower rates of suicide, athletes share some similar (affective disorders, drug abuse, mental and physical illness) and unique factors (misuse of performance-enhancing substances, sports-related stressors, sports injuries, TBI) putting them at risk of suicide during active career and retirement.

Effect of mindfulness-based programmes on elite athlete mental health: a systematic review and meta-analysis

OBJECTIVE

To determine the effectiveness of mindfulness-based programmes (MBPs) on the mental health of elite athletes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Eight online databases (Embase, PsycINFO, SPORTDiscus, MEDLINE, Scopus, Cochrane CENTRAL, ProQuest Dissertations & Theses and Google Scholar), plus forward and backward searching from included studies and previous systematic reviews.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included if they were randomised controlled trials (RCTs) that compared an MBP against a control, in current or former elite athletes.

RESULTS

Of 2386 articles identified, 12 RCTs were included in this systematic review and meta-analysis, comprising a total of 614 elite athletes (314 MBPs and 300 controls). Overall, MBPs improved mental health, with large significant pooled effect sizes for reducing symptoms of anxiety (hedges g=-0.87, number of studies (n)=6, p=0.017, I ²=90) and stress (g=-0.91, n=5, p=0.012, I ²=74) and increasing psychological well-being (g=0.96, n=5, p=0.039., I ²=89). Overall, the risk of bias and certainty of evidence was moderate, and all findings were subject to high estimated levels of heterogeneity.

CONCLUSION

MBPs improved several mental health outcomes. Given the moderate degree of evidence, high-quality, adequately powered trials are required in the future. These studies should emphasise intervention fidelity, teacher competence and scalability within elite sport.

PROSPERO REGISTRATION NUMBER

CRD42020176654.

Poorly Managed Stressors Contributing to an Affective Disorder in a High-Performance Athlete: A Case Report

Recently, there has been an increase in awareness about mental illness, especially among professional athletes. This has brought to focus the important roles that sports psychiatrists and other allied health professionals play in professional sports. It has also exposed the limitations of sports psychiatry, especially the shortage of sports psychiatrists. Professional athletes are subjected to multiple stressors during their careers, resulting in significant mental health outcomes. If not adequately addressed, stress can cause performance slumps and poorer outcomes, which in turn exacerbates stress in a vicious cycle. We present the case of a former male athlete with multiple physical, somatic, and psychosocial stressors that predisposed him to develop mental illness. This case highlights the potential consequences of a lack of early recognition and management of physical and psychosocial stressors in athletes, which can contribute to psychological illness and potentially lead to adverse medical outcomes such as repeat hospitalization and homelessness.

Depression, Anxiety, and Help-Seeking Among NCAA Division III Athletes at a Historically Women’s College

This study explored depression, anxiety, and help-seeking at a National Collegiate Athletic Association Division III historically women’s college in the United States, while taking into account gender identities outside of male and female. An online survey including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and help-seeking measures were completed by 109 student-athletes. Participants’ ages ranged from 18 to 22. Within the sample, 59.7% of participants identified as LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, among other identities) and 8.3% identified as genderqueer/gender-nonconforming. A total of 33.0% of the participants reported symptoms of depression, while 28.5% reported symptoms of anxiety. Genderqueer/gender-nonconforming athletes reported higher rates of anxiety than athletes who identified as women. Higher rates of depression and anxiety were related to higher levels of formal help-seeking. The results indicate that student-athletes at a historically women’s college may be experiencing higher levels of depression and anxiety than student-athletes in other contexts and have more positive views toward help-seeking. Student-athletes who identify outside of the gender binary may be at higher risk for anxiety.

A longitudinal examination of changes in mental health among elite Canadian athletes

This study explored how athletes' symptoms of mental disorders changed over the course of pandemic year. Predictors of baseline levels and changes in symptoms of mental disorders were also examined. Surveys were completed four times throughout a year by Canadian athletes training for the 2020 Olympics/Paralympics (n_time1 = 186, n_time2 = 142, n_time3 = 123, n_time4 = 108). Surveys included demographics questions, measures of perceived stress, training load, social support, coping, self-esteem, depression, anxiety, and disordered eating. Data were analysed using descriptive statistics and latent growth modelling. The prevalence of mental disorder symptoms was high at baseline and there was no significant change over time. Scores for the three disorders were significantly correlated. Female athletes had higher scores for disordered eating at baseline. Higher levels of perceived stress predicted higher scores on mental disorder measures. Longitudinal tracking of symptoms of mental disorders among elite athletes is important because it allows researchers to explore whether disorder symptomologies change; rates of mental disorder symptoms were high at baseline and stayed high over the course of a year. More research is needed to explore possible gender differences in rates of disorder symptoms, and to understand how those symptoms change over time.

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.

Sports person psychological behaviour signal analysis during Thfeir activity session

Mental well-being is a significant resource for athletes about their success and growth. Athletes are now facing additional risk factors in mental health in the sporting community, such as heavy workout loads, rough races, and demanding lifestyles. The great difficulty is to diagnose conditions and acquire sport and exercise features that contribute to daily or long-term practice to detrimental emotional reactions. In this paper, the sports activity session monitoring system (SASMS) has been proposed using wearable devices and EEG signal by monitoring the sports person’s heart rate and psychological behaviour. The proposed SASMS mental-health analysis focused on model spectrum forms representing the best results, mental illness, and mental health. The paper’s key conclusions concerned with the athletes’ performance, occupational and personal advancement of athletes in mental health problems, strategies intended to track and sustain athletes’ mental health, and outflow of different mental illness types. This research’s findings provide the basis for implementing actions that promote a healthy emotional state in the sport to enhance activity and fitness.

Common mental disorders among Irish jockeys: prevalence and risk factors

OBJECTIVE

Jockeys compete in a sport, horseracing, renowned for its physical and psychological demands. Previous research has identified that common mental disorders (CMDs) may be prevalent among this unique population of athletes. The aim of the present study was to further explore the prevalence of CMDs among jockeys and to test for associations with potential risk factors.

METHODS

An anonymous survey was distributed to professional jockey online. Self-report screening tools for four CMDs (psychological distress, depression, generalized anxiety, and adverse alcohol use) were included alongside predictor variables from questionnaires assessing for burnout, career satisfaction, social support, and the contemplation of retirement. Binary logistic regression was used to explore associations between CMDs (present versus not present) and risk factors. Eighty-four professional jockeys completed the questionnaire (response rate = 52%).

RESULTS

In total, 79% of jockeys met the threshold for at least one CMD. Prevalence (%) of CMD varied as follows: adverse alcohol (61%), depression (35%), generalized anxiety (27%), and psychological distress (19%). Burnout, career (dis)satisfaction, lower levels of social support, and the contemplation of retirement increased the odds of meeting the criteria for CMDs.

CONCLUSION

The findings indicate that jockeys report CMD symptoms at comparable rates to athletes in other sports. The study was the first to highlight potential risk factors as predictors of CMDs among jockeys, including burnout, career satisfaction, and the current contemplation of retirement. Screening tools for the risk factors demonstrated may, therefore, provide useful in the early identification of CMDs among jockeys. The development of jockey-specific assessment tools, education programmes, and interventions may help better understand and support the mental health of jockeys.

Mental health difficulties among professional jockeys: a narrative review

Introduction

Emerging academic literature and high-profile disclosures of mental health difficulties and mental illness from current and former professional jockeys suggest that further exploration of the mental health of jockeys is required. To date, a comprehensive review of jockeys’ mental health has yet to be conducted.

Objectives

To examine the existing literature related to jockeys’ mental health, including the prevalence of symptoms associated with mental health difficulties and help-seeking.

Design

A narrative review of the literature was conducted with articles screened from inception until January 2021.

Results

Sixteen studies were included in the narrative review. Studies covered a range of mental health difficulties which included mood (depression), anxiety, distress, disordered eating and substance misuse. Rates of help-seeking among jockeys were also explored. Results indicated that jockeys reported higher levels of depressive and anxiety symptoms compared with other elite athletes. Substance misuse, in particular adverse alcohol use, also appears greater among jockeys than other elite athletes. Distress symptoms appear comparable with other elite athletes. Risk factors for mental health difficulties included injury, perceived stress, athlete burnout, career dissatisfaction and the contemplation of retirement. Weight-making negatively impacts jockeys’ mood and attitudes towards eating, with lower competitive riding weights associated with more disordered eating attitudes. Moreover, help-seeking from mental health professionals appears low.

Conclusion

The review identifies a high prevalence of symptoms of mental health difficulties among professional jockeys. Applied recommendations and future research considerations are proposed throughout the review article.

Depressive Symptoms and Trust of Healthcare Provider in Rural Adolescents: Relationships and Predictors

The purpose of this study was to evaluate associations among depressive symptoms, trust of healthcare provider, and health behavior in adolescents who live in a rural area. Two hundred twenty-four adolescents aged 14-19 years old attending public high school in the Midwestern United States were surveyed. Results showed a diagnosis of depression, trust of healthcare provider, health awareness, and stress management predicted depressive symptoms in adolescents living in a rural area. Healthcare providers should take extra care to promote trust in the healthcare provider-patient relationship with adolescents and to follow guidelines for annual screening of adolescents for depressive symptoms. Nursing implications include adolescent psychoeducation to improve health awareness and stress management.

What Lies Beneath: Exploring Different Depressive Symptoms Across Selected Risk Factors in Icelandic Team Sport Athletes

The aim of the study was to explore the prevalence of specific symptoms of depression in athletes and to test differences in the likelihood of athletes exhibiting these symptoms across age, sex, type of team sport, and level of competition. A sample of Icelandic male and female team sport athletes (N = 894, 18–42 years) was included in the study. Of the athletes exhibiting clinically significant depressive symptoms on the Patient Health Questionnaire-9, 37.5% did not exhibit core symptoms of depression. Compared with males, females were significantly more likely to exhibit depressed mood, feelings of worthlessness/guilt, and problems with sleep, fatigue, appetite, and concentration. Within males, differences were mostly related to neurovegetative aspects of depression (sleep and appetite), whereas in females, differences were related to cognitive/emotional aspects (e.g., depressed mood, guilt/worthlessness). The findings underline the importance of exploring specific symptoms of depression to provide a richer understanding of depressive symptomology in athletes.

Biological and Socio-Cultural Factors Have the Potential to Influence the Health and Performance of Elite Female Athletes: A Cross Sectional Survey of 219 Elite Female Athletes in Aotearoa New Zealand

Health is a pre-requisite for optimal performance yet the parameters which govern health and performance of elite female athletes are little understood. The aim of this study was to quantify the health status of elite female athletes, and understand sociocultural factors influencing that status. The survey addressed demographic, health and athletic performance history, training load, contraceptive use, sport-specific appearance and performance pressures, and communication barriers. Three hundred and fifty-seven elite New Zealand female athletes were recruited to complete an on-line survey. Two hundred and nineteen athletes completed the survey. Oligomenorrhea/amenorrhea had been diagnosed in only 12% of athletes compared with 50% of athletes not on hormonal contraception who reported symptoms consistent with this diagnosis. Stress fractures and iron deficiency were common and associated with oligomenorrhoea/amenorrhea (P = 0.002), disordered eating (P = 0.009) or menorrhagia (P = 0.026). Athletes involved in individual sports (P = 0.047) and with higher training volumes (P < 0.001) were more likely to report a medical illness. Seventy-three percent of athletes felt pressured by their sport to alter their physical appearance to conform to gender ideals with 15% engaging in disordered eating practices. Barriers to communicating female health issues included male coaches and support staff, and lack of quality information pertaining to health. Elite female athletes may fail to reach peak performance due to specific health issues and undiagnosed pathology. Sociocultural factors influence the effectiveness of support of female's health and performance. Organizational and cultural change is required if elite female athletes are to combine optimal health with best performance.

Resilience, well-being, depression symptoms and concussion levels in equestrian athletes

Purpose

This paper aims to conduct the first cross-sectional survey on depression, Resilience, well-being, depression symptoms and concussion levels in equestrian athletes and to assess whether past concussion rates were associated with depression, resilience and well-being.

Design/methodology/approach

In total, 511 participants from Canada, Republic of Ireland, UK, Australia and USA took part in an international cross-sectional, online survey evaluating concussion history, depression symptoms, resilience and well-being.

Findings

In total, 27.1% of athletes met clinically relevant symptoms of major depressive disorder. Significant differences were shown in the well-being and resilience scores between countries. Significant relationships were observed between reported history of concussion and both high depression scores and low well-being scores.

Practical implications

Findings highlight the need for mental health promotion and support in equestrian sport.

Social implications

Results support previous research suggesting a need for enhanced mental health support for equestrians. There is reason to believe that mental illness could still be present in riders with normal levels of resilience and well-being.

Originality/value

This study examined an understudied athlete group: equestrian athletes and presents important findings with implications for the physical and mental health of this population.

Update on integrative treatment of psychiatric symptoms and disorders in athletes

Primary objective: In this review, we detail the issues and disorders athletes present with, guidelines for making diagnostic formulations and treatment goals, and strategies for delivering integrated treatment attuned to the athlete and their team and/or sport. In addition, we highlight special issues associated with athletes and their families. Reasoning: Data suggests athletes experience comprable incidence and prevalence rates to the general population of psychiatric disorders. The mental and physical demands placed on athletes are unique and may increase their susceptibility to certain mental health problems. The current literature regarding integrative interventions in athletes is sparse and largely anecdotal. We provide a summary of the scientific evidence from a literature review conducted by the IOC Consensus Committee on Mental Health in Elite Athletes, reviews and expert clinical strategies recommended by the authors of four books on sports psychiatry written since 2012, and our own review of the literature related to psychotherapy with elite and non-elite- athletes. Main outcomes and results: At the moment there are no randomized controlled trials assessing the use of psychotherapy or medication for mental illness in athletes to guide treatment. Controlled studies examining psychological interventions in collegiate athletes have demonstrated improvements in mental health symptomology. Although these studies were limited to collegiate athletes they assist in providing a foundation for elite athletes as well. For the assessment and management of the mental health needs of athletes' to be on a par with their physical needs, more high-quality scientific epidemiological and treatment intervention studies are needed. Conclusions: Development of specific models of psychiatric intervention for athletes with significant psychopathology and impairment appears to be warranted. These interventions should include individual, family/marital, and group psychotherapy with or without medication using evidence-based treatments.

Mental Blocks in Artistic Gymnastics and Cheerleading: Longitudinal Analysis of Flikikammo

Flikikammo is a troubling phenomenon in which athletes lose the ability to perform previously automatic backward moving gymnastics skills as a normal part of a routine. To better understand the effects of flikikammo over time, the confidence, perceived pressure, physical well-being, energy, and stress levels of gymnasts (n = 6) and cheerleaders (n = 4) were assessed weekly over 10 weeks. Half of the participants reported experiencing flikikammo at the start of the study, and half served as age, skill level, and sport-matched controls. Athletes with flikikammo indicated that pressure from coaches and higher energy levels were related to more severe flikikammo. For participants under the age of 18, higher levels of life stress positively correlated with flikikammo, but for those over 18, higher life stress was negatively correlated with flikikammo. These findings highlight the complexity of flikikammo and suggest that complex solutions may be needed to address flikikammo issues.

Me, Myself, and My Thoughts: The Influence of Brooding and Reflective Rumination on Depressive Symptoms in Athletes in the United Kingdom

Individual differences in vulnerability to depression are still underexplored in athletes. We tested the influence of different brooding and reflective rumination profiles (i.e., repetitive thought processes in response to low/depressed mood) on the odds of experiencing clinically relevant depressive symptoms in competitive athletes (N = 286). The Patient Health Questionnaire–9 and the Ruminative Responses Scale–short form were utilized to measure depression and rumination, respectively. Compared to athletes with a low brooding/reflection profile, athletes with a high brooding/reflection profile had significantly higher odds of experiencing clinical levels of depressive symptoms (OR = 13.40, 95% CI = 3.81–47.11). A high reflection/low brooding profile was not, however, related to increased odds of depressive symptoms. Future research could extend our findings by exploring determinants of ruminative tendencies, especially brooding, in athletes. Furthermore, psychological interventions targeting rumination could be examined as a potential prevention and treatment approach to tackling depressive symptoms in athletes.

The prevalence of depressive symptoms in high-performance athletes: a systematic review

Objective: To provide an up-to-date overview of the prevalence of depressive symptoms in high-performance athletes and describe the tools used to assess for these in order to identify knowledge gaps and potential future research priorities. Data sources: PubMed, EMBASE, SPORTDiscus, PsychINFO, and Cochrane were systematically searched from December 1993 to December 2018. Peer-reviewed original research articles reporting the prevalence of depression among high-performance athletes aged ≥ 17 years were included. Study selection: Sixteen studies satisfied the inclusion criteria, and seven had a low risk of bias. Data extraction: The Center for Epidemiologic Studies Depression Scale (CES-D) was the most commonly used tool to assess for depressive symptoms. The prevalence of those with high depression symptom cutoff scores ranged from 6.7% to 34.0%. Data synthesis: Higher levels of competition, injuries, > 3 concussions, and female sex were identified as potential risk factors for depression. Female athletes and athletes playing individual sports had high risk of having elevated depression symptom scores. Conclusions: Prevention of mental illness in high-performance sports is a novel and emerging field of research interest. This review highlights the prevalence of high depression symptom scores among high-performance athletes. The data collection methods, sample size, sport and athlete population, and tools used to assess depression vary across studies; thus, findings cannot be generalized. This review establishes the need for data collection enhancements with robust longitudinal study designs and standardized depression assessment tools to guide the development of evidence-based mental wellbeing interventions.

Associations Between Psychological Profiles and Performance Success Among Professional Taekwondo Athletes in China: A Multidimensional Scaling Profile Analysis

Sport psychology research has long sought to uncover the determinants of the optimal psychological state for peak performance. Persistent inquiries in this work include whether there is a set of ideal psychological and emotional factors that are required to achieve optimal performance and, if there are, what are they and how are they related to optimal performance. To answer these questions, the current study aimed to identify potential profiles of personality and emotional traits based on a sample of professional Taekwondo athletes from China. In addition, the study also aimed to examine the utility of the profiles in predicting successful athlete performance. Using multidimensional scaling (MDS) profile analysis, two latent profiles of personality and emotional traits were identified that indicate four subtypes of athletes. Regression analyses were conducted to examine how the identified profiles were associated with performance success. The results seemed to suggest that Taekwondo athletes with more performance success were more likely to have a profile of positive personality and emotional traits, while athletes with less performance success were likely to have somewhat elevated levels of self-control, extraversion, and aggression. Knowledge of athletes' personality profiles will help sport psychologists develop suitable interventions to enhance athletes' performance success. In concluding, the results are discussed in the context of athlete psychosocial development. The study added further evidence about the association between psychological and emotional factors and successful Taekwondo athletes.

Elite coaches have a similar prevalence of depressive symptoms to the general population and lower rates than elite athletes

Objective

The primary aim of this study was to estimate the prevalence of depressive symptoms and life stress in elite coaches. The secondary aim was to explore the associations of depressive symptoms and life stress with demographic and lifestyle variables.

Methods

National-level coaches were invited to participate in an online survey. Depressive symptoms were measured by the Centre for Epidemiological Studies Depression Scale-Revised (CESD-R). Life stress was measured using daily life hassle frequency and severity scores calculated from the Daily Hassles Questionnaire, with associations evaluated using linear regression.

Results

Of 110 potential participants, 69 completed and two partially completed surveys were received. The majority of respondents were male (77%), coaching individual sports (70%) and aged under 50 (71%). Overall, 14% of coaches reported at least moderate depressive symptoms according to the CESD-R. Those contemplating retirement were more likely to show depressive symptoms. Reported life stress was higher in females and in those contemplating retirement. There was a strong association between life stress and the odds of experiencing depressive symptoms (p=0.006).

Conclusions

Depressive symptoms are as prevalent in elite coaches as in general population, with potential risk factors including high levels of life stress and impending retirement.

Self-Efficacy and Depression in Boxers: A Mediation Model

BACKGROUND

Depression has become one of the most common problems faced by athletes. In many mental health problems, its production and development mechanisms and influencing factors have received full attention from researchers, whereas boxers' depression has received limited attention. This study explored the relationship between boxers' self-efficacy and depression, as well as the effect of self-control as a mediating factor.

METHODS

This study used the athlete self-efficacy scale (ASES), the self-control scale (SCS), and the Center for Epidemiologic Studies depression scale (CES-D). Using a large number of randomly selected samples, a total of N=231 boxers (age: M =20.28, SD = 2.60, ages around 18 to 32; the total number of years of exercise: M = 6.07 years, SD = 2.90, years around 1 to 15; 144 male) of Chinese national athletes participated the study.

RESULTS

Self-efficacy and self-control were negatively correlated with depression; self-efficacy was positively correlated with self-control. In addition, self-control played a partial mediation role between self-efficacy and depression among boxers.

CONCLUSION

Above all, an important way to improve and prevent the depression of Chinese boxers maybe enhance their level of self-efficacy and self-control.

Elite Athletes Coping With Depression: A Qualitative Study

Little is known about the coping strategies used by elite athletes suffering from mental health issues. Therefore, this study examined coping strategies implemented by elite athletes facing clinical depression. Semi-structured interviews were conducted with four elite athletes and analysed using Interpretative Phenomenological Analysis (IPA). Results present a broad picture of how elite athletes tried to cope with depression using a range of coping strategies. Among the different strategies highlighted, talking, seeking professional help and social support were particularly emphasized by the participants. Surprisingly, however, only one participant reported transferring the skills and strategies learned on her way to the top to many other aspects of her everyday life such as coping with her depression. Findings, therefore, suggest that athletes should be encouraged to transfer and make the most of the skills learned throughout their sport career to deal with their daily life. Future research perspectives and implications are discussed.

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.

Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment

OBJECTIVE

To summarise the literature on the barriers to athletes seeking mental health treatment and cultural influencers of mental health in elite athletes.

DESIGN

Systematic review DATA SOURCES: PubMed, Cochrane, Scopus, SportDiscus (Ebsco), and PsycINFO (ProQuest) up to November 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Qualitative and quantitative original studies of elite athletes (those who competed at the professional, Olympic, or collegiate/university levels), published in any language.

RESULTS

Stigma, low mental health literacy, negative past experiences with mental health treatment-seeking, busy schedules, and hypermasculinity are barriers to elite athletes seeking mental health treatment. Cultural influencers of mental health in elite athletes include: (1) the lack of acceptance of women as athletes; (2) lower acceptability of mental health symptoms and disorders among non-white athletes; (3) non-disclosure of religious beliefs; and (4) higher dependence on economic benefits. Coaches have an important role in supporting elite athletes in obtaining treatment for mental illness. Brief anti-stigma interventions in elite athletes decrease stigma and improve literary about mental health.

CONCLUSION

There is a need for various actors to provide more effective strategies to overcome the stigma that surrounds mental illness, increase mental health literacy in the athlete/coach community, and address athlete-specific barriers to seeking treatment for mental illness. In this systematic review, we identified strategies that, if implemented, can overcome the cultural factors that may otherwise limit athletes seeking treatment. Coaches are critical for promoting a culture within elite athletes' environments that encourages athletes to seek treatment.

Chronic traumatic encephalopathy in sports: a historical and narrative review

My objectives are to review: 1) a brief history of sport-related concussion (SRC) and chronic traumatic encephalopathy (CTE), 2) the evolution of CTE in American professional football, 3) the data regarding SRC/CTE as they relate to depression and suicide, 4) the data on the neurocognitive effects of subconcussion/repetitive head trauma (with emphases on heading the ball in soccer and early exposure to football), 5) the evidence related to SRC and neurodegenerative diseases, 6) the published studies of CTE, 7) the NINDS neuropathological criteria for CTE, 8) public beliefs about SRC/CTE, and 9) the scientific questions regarding CTE.

Depression and anxiety symptoms in 17 teams of female football players including 10 German first league teams

BACKGROUND

Information on the prevalence of mental health problems of elite athletes is inconclusive, most probably due to methodological limitations, such as low response rates, heterogeneous samples.

AIMS

To evaluate the prevalence and risk factors of depression and anxiety symptoms in high-level female football players.

METHODS

Female football players of 10 German first league (Bundesliga) and 7 lower league teams were asked to answer a questionnaire on players' characteristics, the Center of Epidemiologic Studies Depression Scale (CES-D) and the Generalised Anxiety Disorder (GAD-7) scale.

RESULTS

A total of 290 players (184 first and 106 lower league players) took part in the study. The CES-D score indicated mild to moderate symptoms of depression in 48 (16.6%) and severe symptoms in 41 (14.1%) players. The GAD-7 score indicated an at least moderate generalised anxiety disorder in 24 (8.3%) players. The prevalence of depression symptoms and generalised anxiety disorders was similar to the female general population of similar age. However, significantly more second league players reported symptoms of depression than first league players, and thus the prevalence of depression symptoms in second league players was higher than in the general population. Only a third of the 45 (15.7%) players who stated that they currently wanted or needed psychotherapeutic support received it.

CONCLUSION

The prevalence of depression and generalised anxiety symptoms in elite football players is influenced by personal and sport-specific variables. It is important to raise awareness of athletes' mental health problems in coaches and team physicians, to reduce stigma and to provide low-threshold treatment.