Athlete mental health help-seeking: A systematic review and meta-analysis of rates, barriers and facilitators

Athletes are vulnerable to a range of mental health symptoms, in part due to stressors within the sport environment. An early intervention framework suggests the benefits of routine screening and referral for mental health, however, greater understanding around athlete help-seeking is needed to support referral uptake. This review examined rates of formal help-seeking behaviour as well as barriers and facilitators to help-seeking in sport settings. Relevant studies were retrieved from SportDiscus, PubMed and PsycInfo, with unpublished studies identified through contacting authors. Help-seeking rates were meta-analysed and barriers and facilitators were meta-synthesised. Twenty-two studies were included. Help-seeking rates were reported in 11 studies (N = 3415) and the pooled proportion of help-seeking was 22.4 % (95 % CI 16.2-30.2, I2 = 95.7 %). Barriers were reported in 13 studies and facilitators in six, highlighting a range of sporting-specific factors, such as stigma in relation to athlete identity and sport culture, fear of deselection, and concerns around confidentiality in sport settings, in addition to lack of awareness, low mental health literacy, and negative attitudes to services. Normalising experiences of mental health in sport settings, including through role models, was a key facilitator to help-seeking. Results provide implications for sport organisations to promote help-seeking and athlete mental health, such as through the use of role models, ensuring clarity around confidentiality, stigma reduction interventions, and fostering team cultures that promote mental health. Findings also support the value of sport staff in facilitating help-seeking, and organisational culture changes to foster wellbeing.

What facilitates collegiate athletes seeking mental health care? Athletic trainers' perceptions

Objective: To assess athletic trainers' (ATs) perceptions regarding the importance of athletes' beliefs and athletic department stakeholders in facilitating help-seeking for mental health (MH) care.Participants: 534 ATs within collegiate athletic departments (M_age = 35.50 years; 64.2% women; 87.3% White).Methods: ATs were asked to indicate the extent to which they believed 10 student-athlete beliefs about MH (e.g. confidence MH treatments work) and 10 stakeholders (e.g. teammate) would facilitate student-athletes' help-seeking for MH care (1, Strongly Disagree, to 5, Strongly Agree).Results: We conducted separate two-way mixed design ANOVAs, one for each set of 10beliefs and 10 stakeholders; each was significant (p's < .002). The ATs perceived confidentiality as the most facilitative belief and viewed ATs as the most facilitative stakeholder.Conclusions: ATs differentiate among student-athletes' beliefs and stakeholders on how facilitative each might be in help-seeking, suggesting pathways for improving MH climate within athletic departments through education and policies.

Go, go …. You'll be happier. Psychological variables among cyclists during COVID-19 lockdowns

COVID-19 lockdowns involved radical changes in the habits and lifestyles of many. Notably, athletes saw their training routines altered. The relationship between lockdown effects and psychological variables was analysed using a sample comprising 1032 cyclists (average age: 42.97 years, s.d. = 8.94), taking part in the first cycling competition after lockdown. The target variables included psychological variables such as frustration tolerance, subjective vitality, autonomy self-determination, and affective status, as well as sociodemographic and training habits-related variables. The results showed that the constructs under analysis are related. Pre- and post-competition psychological variables were measured, and no significant differences were detected, except concerning subjective vitality. A regression analysis model was designed to analyse the impact of frustration tolerance, autonomy self-determination, and affective status on subjective vitality. The results reveal a lineal relationship (F = 71.789, p < .001) between subjective vitality and a set of independent variables: positive affects; health status; km of training per year; and frustration tolerance, which explain 46.7% of variance. Finally, since the variable that measures subjective vitality was shown to be significant, mediation analyses were undertaken to answer our hypothesis, following the results of the exploratory analysis. The results suggest that frustration tolerance has a direct effect on subjective vitality, and that this relationship is mediated by positive affects, health status, and km of training per year. It is concluded that exercising increases subjective vitality, which is affected by frustration tolerance, positive affects, health status and km of training per year. In addition, it can be argued that these three variables mediate the relationship between frustration tolerance and subjective vitality. Finally, it is worth stressing that, given the positive effects of exercise not only in physical health but also in psychological, social and personal wellbeing, self-determined attitudes in training should be encouraged, as this promotes self-efficacy and self-satisfaction, in both training and competition settings.

The effects of injury, contextual match factors and training load upon psychological wellbeing in English Premier League soccer players via season-long tracking

The study aimed to track psychological wellbeing (PWB) across two consecutive soccer seasons examining the effects of injury, illness, training load (TL) and contextual match factors (playing status, match selection and individual win rate). Furthermore, examine PWB prior to injury or illness event. Thirty-two English Premier League (EPL) soccer players completed the "Warwick-Edinburgh Mental Wellbeing Scale" every two weeks. No differences were found for group averaged PWB across the seasons (52.2 ± 0.3 vs. 51.8 ± 1.1) (p > 0.05). Previous 7-day TL measured using GPS (session duration, total distance, explosive distance, low-intensity distance, high-speed distance (HSD) and sprint distance (SD)) were not related to current PWB (p > 0.05). Yet, previous 14-day HSD (r (385) = -0.095) and 21-day SD (r (385) = 0.100) were related to current PWB (p < 0.05). Only 100% (vs. 0%) win rate in the previous 14-days to the questionnaire revealed a higher current PWB score (52.7 ± 4.7 vs. 50.9 ± 5.6 (p < 0.05)). PWB did not differ prior to an injury or illness event, when players were injured or had low contextual match factors at time of questionnaire or previous match, and the previous 7-days (p > 0.05). In conclusion, PWB fluctuations across the season are associated with prior TL and multiple negative results. But prior PWB was not linked to injury or illness events. Implications for prioritising interventions to improve PWB during periods of chronic high intensity TLs and losing streaks, monitoring PWB, and use in injury and illness prediction are discussed.HighlightsPsychological wellbeing responses, as measured by the "Warwick-Edinburgh Mental Wellbeing Scale" did not change significantly at a group level between the phases of the two seasons.Prior training load was associated with wellbeing scores, specifically previous 14-day high-speed distance and 21-day sprint distance.Psychological wellbeing scores were only affected by win/loss rate in the previous 14-days.These findings highlight the importance of timely interventions to improve wellbeing in periods of negative results, and the recommendation of longitudinally monitoring wellbeing.

Stigma, attitudes, and intentions to seek mental health services in college student-athletes

Objective: To investigate predictors of mental health help-seeking as well as identify topics for which college student-athletes are most likely to seek help. Participants: Student-athletes (N = 328) from three Division II and III universities. Method: Participants completed a survey packet on stigma, attitudes, and intentions toward seeking mental health services as well as willingness to seek help for specific topics. Results: Structural equation modeling indicated public stigma was significantly related to self-stigma, self-stigma was related to attitudes, and attitudes were related to intentions. Using logistic regression analysis, self-stigma and attitudes were associated with an increased likelihood of having sought mental health services in the past. Comment: These results can be used to help sport psychologists and other mental health staff develop programing that might increase service use among student-athletes. Using a multifaceted approach that decreases stigma and improves attitudes could have the most meaningful effect on encouraging service use.

Tackle Your Feelings: Experience of Help-Seeking for Mental Well-Being Concerns in Professional Rugby Union Players

Limited research into professional rugby union players’ experiences of seeking formal support for their mental health exists, despite comparable rates of mental health issues among elite rugby players with the general population. This qualitative study explored professional players’ actual experiences of accessing Rugby Players Ireland’s mental well-being service, via separate focus group discussions with professional players (n = 5) and player development managers (n = 4) who refer players into the service. An inductive reflexive thematic analysis identified three themes detailing players’ (a) journey to disclosure of their mental health difficulties, (b) their expectations and engagement with the well-being service, and (c) participants’ reflections on mental health experiences in a high-performance environment. Embedding mental health as a key component of player development in high-performance environments, improving mental health literacy, normalizing mental health experiences, and encouraging help-seeking would help promote player well-being and support holistic development alongside sporting performance.

Mental Toughness, Sport-Related Well-Being, and Mental Health Stigma Among National Collegiate Athletic Association Division I Student-Athletes

Mental toughness has been associated with factors related to psychological well-being, but little is known about its relationship with stigma toward mental health and mental health help-seeking. This study investigated the relationship between mental toughness, sport-related well-being, and personal stigma toward mental health in a sample of 154 National Collegiate Athletic Association Division I student-athletes. The moderating effect of mental toughness on the relationship between public stigma and self-stigma toward mental health help-seeking was also explored. Mental toughness was significantly and positively associated with sport-related well-being, but not significantly related to personal stigma toward mental health. Moderation analysis indicated that mental toughness was not a significant moderator of the relationship between public stigma and self-stigma, but higher levels of mental toughness were significantly associated with lower levels of stigma toward mental health help-seeking. Building mental toughness may be a way to increase well-being and to reduce stigma toward help-seeking in student-athletes.

Exploring Talent Cultivation of College Student-Athletes for New Ventures and Entrepreneurial Psychology of New Venture Entrepreneur

To further promote the development of new ventures, sufficient research and analysis have been conducted on the managers (especially, new venture entrepreneurs) and employees of new ventures. In this study, the case investigation is adopted to study the psychological stress of new venture entrepreneurs, the psychological capital of college athletes and the cultivation of employability. The research results show that there is no significant difference in career guidance curriculum and employability among students with different academic performances (p > 0.05), but there is a significant difference in psychological capital among students with different academic performances (p < 0.05). The career guidance curriculum, employability, and psychological capital have different correlation degrees. The career guidance curriculum has a significantly positive impact on the employability of students, and psychological capital plays a mediating role in the impact of the career guidance curriculum on employability. The analysis of the psychological stress of new venture entrepreneurs indicates that the stress of the dimension of resource requirements is the least. Meanwhile, the psychological stress of new entrepreneurs has a positive impact on new venture performance. The research content is fully considered, which can provide a scientific and effective reference for the follow-up research.

How Does a Sport Psychological Intervention Help Professional Cyclists to Cope With Their Mental Health During the COVID-19 Lockdown?

All around the world in March, due to COVID-19, competitive sport calendars were suddenly canceled, jeopardizing the training programs of athletes. Moreover, in Italy, the government banned all non-essential travel across the entire country from the beginning of March. Consequently, Italian cyclists were banned from leaving their homes and therefore unable to perform their ordinary training activities. The Italian Association of Professional Cyclists (ACCPI) early on during that period noticed that several cyclists were experiencing a worrying decrease in their mental well-being and asked the authors to set up an online Sport Psychology Intervention (SPI) during lockdown to enhance the athletes' mental health. Through a number of unprecedented events and considerations, the aim of the current investigation was to assess the Italian cyclists' mental health during the lockdown and its changes after the SPI. We validated the Italian version of the Sport Mental Health Continuum Short Form (Sport MHC-SF)-presented in Study 1-and then applied it to a sample of Italian professional cyclists-presented in Study 2-prior to and after the SPI. To achieve these objectives, the reliability and construct validity of the Italian version of the Sport MHC-SF were tested in Study 1. RM-MANOVA tests were run to evaluate the effect of SPI on cyclists in Study 2. A total of 185 Italian athletes were involved in the validation of the MHC in Study 1 and 38 professional cyclists in Study 2. Results from Study 1 suggested a three-factor higher order model of Sport MHC-SF [Model fit: χ²(df) = 471.252 (252), p < 0.000; CFI = 0.951; RMSEA = 0.049; RMR= 0.048]. MCFA showed that the default model kept invariance among groups of athletes (i.e., female, male, individual, and team sports). Results from Study 2 highlighted that professional cyclists who followed the SPI were able to cope better with psychological stressors, showing improved well-being compared to the athletes that did not. No significant differences were found for emotional and social well-being. The present multi-study paper contributes to the theoretical field with a validated measure of Sport MHC-SF translated in the Italian language and culture. It also provides practical implications related to cases of reduced mental health due to injury, illness, or similar situations of home confinement in the future.

Perfectionism and Attitudes Toward Sport Psychology Support and Mental Health Support in Athletes

Attitudes toward help-seeking will contribute to whether athletes ask for support for performance and mental health issues when needed. While research outside of sport has found perfectionism is related to negative attitudes toward help-seeking, no studies have examined the relationship in sport. The authors provided the first test of whether perfectionism predicted attitudes toward both sport psychology support and mental health support. One hundred and sixty-six collegiate athletes completed measures of perfectionism and attitudes toward sport psychology support and mental health support. Multiple regression analyses revealed that perfectionistic concerns positively predicted closedness and stigma toward sport psychology support and mental health support, and negatively predicted help-seeking toward mental health support. However, perfectionistic strivings negatively predicted stigma toward sport psychology support and mental health support, and positively predicted confidence in sport psychology support and help-seeking toward mental health support. Athletes higher in perfectionistic concerns are less likely to seek support when required.

Barriers and Facilitators to Help-Seeking for Mental Health Difficulties Among Professional Jockeys in Ireland

A large proportion of jockeys report symptoms associated with mental health difficulties (MHDs), yet most do not seek help from professional mental health support services. Due to the paucity of literature in this field, this study sought to explore jockeys’ barriers to, and facilitators of, help-seeking for MHDs. Twelve jockeys participated in semistructured interviews, subsequently analyzed via reflexive thematic analysis. Barriers to help-seeking included the negative perceptions of others (stigma and career implications), cultural norms (masculinity and self-reliance), and low mental health literacy (not knowing where to seek help, minimization of MHDs, negative perceptions of treatment, and recognizing symptoms). Facilitators to help-seeking included education (exposure to psychological support at a younger age), social support (from professionals, jockeys, family, and friends), and media campaigns (high-profile disclosures from jockeys). Findings are consistent with barrier and facilitator studies among general and athletic populations. Applied recommendations and future research considerations are presented throughout the manuscript.

College students' attitudes, stigma, and intentions toward seeking online and face-to-face counseling

OBJECTIVE(S)

To investigate differences in public stigma, self-stigma, attitudes (value and discomfort), and intentions to seek help between online and face-to-face counseling. To identify a difference in the relationship between these variables and both counseling modalities.

METHOD

An online survey completed by 538 college students from one university in the Southeastern United States. The sample included 412 females and 126 males with a mean age of 20.21 years (standard deviation [SD] = 1.26).

RESULTS

Significantly higher levels of self-stigma and discomfort toward online counseling were reported. Significantly higher value and intentions were reported toward face-to-face counseling. Self-stigma was positively related to public stigma, value was negatively related to self-stigma, and intentions toward seeking help was positively related to value.

CONCLUSIONS

Results suggest face-to-face counseling is seen as a more favorable method of service delivery compared to online counseling. Value toward online counseling is an important predictor for seeking this type of help.

The Relationships Among Self-Compassion, Stigma, and Attitudes Toward Counseling in Student-Athletes

Although factors involved with help-seeking have been widely studied in the general college population, college student-athletes have received less attention. The purpose of this study was to examine the moderating role of self-compassion on the relationship between public and self-stigma, and how self-stigma was associated with attitudes toward seeking counseling. A sample of 243 student-athletes from NCAA Divisions I and III participated in the study. Using structural equation modeling, self-compassion was not found to moderate the relationship between public and self-stigma. However, public stigma was positively associated with self-stigma, and self-stigma was negatively associated with attitudes toward counseling. A multigroup analysis did not find differences between males and females for the model. The results of this study have implications for professionals who work with college student-athletes and suggest that efforts should aim to reduce stigma and examine alternative factors that might improve attitudes toward mental health help-seeking.

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.