Lifetime history of sexual and physical abuse among competitive athletics (track and field) athletes: cross sectional study of associations with sports and non-sports injury

IOC consensus statement: interpersonal violence and safeguarding in sport

OBJECTIVE

Interpersonal violence (IV) in sport is challenging to define, prevent and remedy due to its subjectivity and complexity. The 2024 International Olympic Committee Consensus on Interpersonal Violence and Safeguarding aimed to synthesise evidence on IV and safeguarding in sport, introduce a new conceptual model of IV in sport and offer more accessible safeguarding guidance to all within the sports ecosystem by merging evidence with insights from Olympic athletes.

METHODS

A 15-member expert panel performed a scoping review following Joanna Briggs Institute methodologies. A seminal works-driven approach was used to identify relevant grey literature. Four writing groups were established focusing on: definitions/epidemiology, individual/interpersonal determinants, contextual determinants and solutions. Writing groups developed referenced scientific summaries related to their respective topics, which were discussed by all members at the consensus meeting. Recommendations were then developed by each group, presented as voting statements and circulated for confidential voting following a Delphi protocol with ≥80% agreement defined a priori as reaching consensus.

RESULTS

Of 48 voting statements, 21 reached consensus during first-round voting. Second-round and third-round voting saw 22 statements reach consensus, 5 statements get discontinued and 2 statements receive minority dissension after failing to reach agreement. A total of 43 statements reached consensus, presented as overarching (n=5) and topical (n=33) consensus recommendations, and actionable consensus guidelines (n=5).

CONCLUSION

This evidence review and consensus process elucidated the characterisation and complexity of IV and safeguarding in sport and demonstrates that a whole-of-system approach is needed to fully comprehend and prevent IV. Sport settings that emphasise mutual care, are athlete centred, promote healthy relationships, embed trauma- and violence-informed care principles, integrate diverse perspectives and measure IV prevention and response effectiveness will exemplify safe sport. A shared responsibility between all within the sports ecosystem is required to advance effective safeguarding through future research, policy and practice.

#WhatWouldYouDo? A cross-sectional study of sports medicine physicians assessing their competency in managing harassment and abuse in sports

OBJECTIVES

To assess the clinical competence of sports medicine physicians to recognise and report harassment and abuse in sports, and to identify barriers to reporting and the need for safeguarding education.

METHODS

We implemented a cross-sectional cohort study design recruiting through social media and international sports medicine networks in 2023. The survey captured participant perceptions related to the harmfulness of harassment and abuse. The survey incorporated the reasoned action approach as a theoretical framework to design survey questions to identify attitudes and self-efficacy to detect and report suspicions of harassment and abuse and to identify barriers to reporting.

RESULTS

Sports medicine physicians (n=406) from 115 countries completed the survey. The situations of harassment and abuse presented in the survey were described by sports medicine physicians as having occurred in the 12 months before participating in the survey. Despite recognising the situations as harmful, sports medicine physicians were somewhat uncomfortable being vigilant for the signs and symptoms and reporting suspicions and disclosures of harassment and abuse (M=2.13, SD=0.67). In addition, just over one-quarter (n=101, 26.9%) was unaware of where to report harassment and abuse, and over half did not know (n=114, 28.1%), or were uncertain (n=95, 23.4%) of who the safeguarding officer was in their sports organisation. Participants identified many barriers to reporting harassment and abuse, including concerns regarding confidentiality, misdiagnosis, fear of reprisals, time constraints and lack of knowledge. Over half felt insufficiently trained (n=223, 57.6%), and most respondents (n=324, 84.6%) desired more education in the field.

CONCLUSIONS

Educational programmes to better recognise and report harassment and abuse in sports are needed for sports medicine trainees and practising clinicians. An international safeguarding code for sports medicine physicians should be developed.

Pediatric suicide: Review of a preventable tragedy

Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.

Bias and Conflict of Interest in the Underreporting of Sexual Abuse in Competitive Sports: A Literature Review

ABSTRACT

The prevalence of sexual abuse in competitive sports is increasing worldwide and requires a united call to action. The underreporting of such abuses gained media attention resulting from recent high-profile cases. In this article, we report the results of a systematic literature review, identifying root causes of underreporting sexual abuse in competitive sports. We identify that biases and conflicts of interest work against effective reporting of abuse by athletes at the individual, organizational, and cultural levels. We offer conflict of interest and bias mitigation approaches from the social science, law, business, research, and diagnostic error literature that may apply. Competitive sports organizations may use this analysis to identify barriers and improve the effective reporting of sexual abuse.

Risk factors for injury complaints leading to restricted participation in Athletics (Track and Field): a secondary analysis of data from 320 athletes over one season

OBJECTIVE

To investigate if several potential risk factors were associated with time to injury complaints leading to participation restriction in Athletics (ICPR).

METHODS

We performed a secondary analysis of data collected during 39 weeks of the 2017-2018 Athletics season in a cluster-randomised controlled trial ('PREVATHLE'). Univariate and multivariable analyses using Cox regression models were performed to analyse the association between the time to first ICPR and potential risk factors collected (1) at baseline: sex, age, height, body mass, discipline, the usual duration of Athletics training and non-specific sports training, ICPR in the preceding season (yes/no), ICPR at baseline (yes/no); (2) weekly during the season: duration and intensity of Athletics training and competition, and non-specific sports training, fitness subjective state, sleep duration and illness (yes/no); and (3) combined.

RESULTS

Data from 320 athletes were included; 138 (43.1%) athletes reported at least one ICPR during the study follow-up. The combined multivariable analyses revealed that the risk of ICPR at any given time was significantly higher in athletes with a pre-existing ICPR (hazard rate ratio, HRR 1.90, 95% CI 1.15 to 3.15; p=0.012) and lower in athletes with a higher fitness subjective state (HRR 0.63, 95% CI 0.55 to 0.73; p<0.001) and who had had at least one illness during the season (HRR 0.42, 95% CI 0.29 to 0.62; p<0.001).

CONCLUSIONS

Our results provide new insights into injury risk factors in Athletics that could help with potential injury risk reduction strategies. These could be to explore the pre-existing injury presence at the season's beginning and to monitor the fitness subjective state and illnesses occurrence during the season.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03307434.

A cross-sectional study of anxiety and depression caseness in female competitive figure skaters in Sweden

Objectives

Little is known about figure skaters' mental health. This study aimed to describe anxiety and depression caseness (defined as a screening condition qualifying for psychiatric examination) in competitive figure skaters and analyse factors associated with such caseness.

Methods

A cross-sectional study was performed in April 2019 among all competitive figure skaters in the south-eastern region of Sweden (N=400). The primary outcomes were anxiety caseness, measured using the short-form Spielberger State-Trait Anxiety Inventory and depression caseness, measured using the WHO-5 index. Multivariable logistic regression models were employed to determine the association between anxiety caseness and explanatory factors.

Results

In total, 36% (n=142) of the invited skaters participated. Only females (n=137), mean age 12.9 (SD 3.0) years) were selected for analysis. Of the participating skaters, 47% displayed anxiety caseness and 10% depression caseness. Overweight body image perception (OR 5.9; 95% CI 2.0 to 17.6; p=0.001) and older age (OR 1.2; 95% CI 1.1 to 1.4; p=0.005) were associated with anxiety caseness. Skaters reporting no caseness were younger than those reporting only anxiety caseness (mean age difference -1.9 years; 95% CI -3.1 to -0.7; p=0.001) or anxiety and depression caseness (OR -3.5 years; 95% CI -5.6 to -1.5 years; p<0.001).

Conclusion

Anxiety caseness was associated with overweight body image perception and older age in female competitive figure skaters. Older skaters reported generally worse mental health. More research on the mental health of figure skaters is warranted, considering comorbidity and focusing on those needing further assessment and support.

Beyond the medals: a cross-sectional study exploring retired elite female athletes' health

Objectives

Little is known about the impact of elite sport participation on long-term athlete health. We aimed to: (1) describe musculoskeletal, mental health, reproductive/endocrine and cardiovascular characteristics in retired elite female athletes and compare to the general population and (2) explore athletes' perceptions of their elite sport participation and its impact on health.

Methods

A 136-item online questionnaire was disseminated to Canadian elite female rowing and rugby athletes >18 years old, >2 years retired from elite competition. Matched general population data were obtained from Statistics Canada when available.

Results

Seventy-four (24% response rate) athletes (average age 45 (±9) years; retired 15 (±9) years) completed the questionnaire (30 rowing, 44 rugby athletes). During their career, 63 athletes (85%) experienced a hip/groin, knee, foot/ankle injury, or low back pain, with 42 (67%) reporting ongoing symptoms. Athletes 35-54 years reported worse knee symptoms and quality of life compared with the general population (symptom: p=0.197; d=1.15 [0.66, 1.63]; quality of life: p=0.312 d=1.03 [0.54, 1.51]) while other hip, knee and foot/ankle outcome scores were similar. Retired athletes had lower odds of anxiety (OR=0.155 [95% CI0.062 to 0.384]), greater lifetime/ever odds of amenorrhea (OR=6.10 [95%CI 2.67 to 13.96]) and gave birth when older (p<0.05). Fifty-nine (79%) recalled witnessing or experiencing at least one form of harassment/abuse during their career. Sixty athletes (81%) rated their current health as above average or excellent and 61 (82%) would compete at the same level again if given the choice.

Conclusion

These novel insights can inform future preventative efforts to promote positive elite sport-related outcomes for current, former and future female athletes.

CHARACTERISTICS OF MAJOR SPORTS INJURIES IN HIGH-PERFORMANCE ATHLETES

ABSTRACT Introduction The focus of attention in high-performance athlete injuries tends to be on physical recovery, neglecting psychological factors and their practical social impacts on the rehabilitation of the injured athlete. In this phase, giving attention to the importance of athletes’ thoughts, emotions, and motivation can speed up the biopsychosocial rehabilitation process. Objective To analyze the characteristics involved in the major sports injuries of high-level athletes to provide a reference for athletes and coaches during recovery. Methods This article analyzes through bibliographic research the characteristics of the major sports injuries in high-level athletes, including physiological, psychological, and social factors. Results The physical impact of injuries requires patience and persistence for recovery, including additional muscle strengthening to compensate for the loss of residual joint proprioception, ensuring performance recovery. Mental factors such as insecurity when returning from games, reduced self-confidence, and fear of hurting the team must be worked through in parallel in multi-professional care and during long recovery periods. Conclusion Sports injuries can occur in athletes of all levels. For elite athletes, the impact of injuries, especially severe ones that need to interrupt training or even surgery, will lead to forced suspension of training or competition, preventing the improvement of sports performance, decreasing the quality of the sports career, and may even lead to physical or psychological disability in severe cases. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

THE EFFECT OF DISTANCE LEARNING IN COLLEGES AND UNIVERSITIES ON PHYSICAL HEALTH PROMOTION IN COLLEGE STUDENTS

ABSTRACT Introduction Influenced by the traditional teaching methods of physical education, the teaching activities of athletics are exclusive to the outdoor environment, which is very common in China, resulting in many disadvantages in teaching these sports by distance, restricting career development and requiring adaptations due to current circumstances. Objective Provide a theoretical basis to further improve the level of physical health of university students and substantiate the necessary adaptations to the teaching of athletics in colleges and universities. Methods This paper reviews the physical health status of university students, raises the reasons for their decline, and analyzes the role of teaching athletics activities in promoting the physical health of university students. Results The performance of physical activities related to athletics promotes the physical health of university students. Conclusion Athletic sports play an important role in the health promotion of university students, not receiving proper care currently, lacking more attention in its promotion by responsible agents. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

Sexual Harassment and Abuse among Young Elite Athletes, Recreational Athletes, and Reference Students: A Prospective Study

PURPOSE

This study aimed to examine the 12-month prevalence and 12-month prospective change in reported sexual harassment and abuse (SHA) victimization among young elite athletes, recreational athletes, and reference students in three different social settings and to identify the perpetrators.

METHODS

In total, 919 adolescents responded to an online questionnaire in 12th grade (T1) and 13th grade (T2). The sample consisted of elite athletes ( n = 482) and recreational athletes ( n = 233) attending Norwegian elite sport high schools ( n = 26), and reference students ( n = 200) attending ordinary high schools with no sport specialization ( n = 6). Data were analyzed using independent-sample t -test, Pearson χ 2 for independence/Fisher's exact test, McNemar test, and logistic regression analysis.

RESULTS

The total 12-month prevalence of SHA was 38.6% at T1 and 35.1% at T2. Most of the participants (74.6%-85.0%) reported no change in SHA from T1 to T2. The prevalence of SHA was higher for girls compared with boys, and elite athletes reported less SHA than recreational athletes and reference students, respectively. SHA occurred most often in a free time setting. Verbal sexual harassment, nonverbal sexual harassment, and physical SHA were reported by 24.6%, 27.0%, and 14.0%, respectively. Peers were reported as perpetrators by 83.1%, trainer/teacher/health personnel by 20.1%, and "other" perpetrators by 56.4%.

CONCLUSIONS

Because one in three elite athletes and nearly one in two recreational athletes and reference students, respectively, reported SHA victimization within a 12-month period, well-targeted preventive measures are needed for both young athletes and nonathletes.

Gender-specific psychosocial stressors influencing mental health among women elite and semielite athletes: a narrative review

Elite and semielite athletes commonly experience mental health concerns and disorders. Compared with men athletes, women athletes are at greater risk of a range of psychological stressors that contribute to health concerns and mental health disorders, which can impact their career satisfaction and longevity. In order to address and improve the mental health of women athletes, it is necessary to simultaneously tackle the gender specific psychosocial stressors that contribute to mental health outcomes. This narrative review examines the gender-specific stressors that affect mental health and well-being in women athletes, some of which are modifiable. Psychosocial stressors identified include exposure to violence, be it psychological, physical or sexual in nature, which can result in a myriad of acute and long-lasting symptoms; and inequities as reflected in pay disparities, under-representation in the media, fewer opportunities in leadership positions and implications associated with family planning and motherhood. Strategies to promote mental health in women athletes should be considered, and where possible, should proactively address gender-specific stressors likely to influence mental health in order to maximise positive outcomes in women athletes.

Vulnerability and stressors on the pathway to depression in a global cohort of young athletics (track and field) athletes

This research set out to identify pathways from vulnerability and stressors to depression in a global population of young athletes. Retrospective data were collected at age 18-19 years from Athletics athletes (n = 1322) originating from Africa, Asia, Europe, Oceania, and the Americas. We hypothesised that sports-related and non-sports-related stressors in interaction with structural vulnerability instigate depression. Path modelling using Maximum likelihood estimation was employed for the data analysis. Depression caseness and predisposition were determined using the WHO-5 instrument. Thirty-six percent of the athletes (n = 480) returned complete data. Eighteen percent of the athletes reported lifetime physical abuse, while 11% reported sexual abuse. Forty-five percent of the athletes had recently sustained an injury. The prevalence of depression caseness was 5.6%. Pathways to depression caseness were observed from female sex (p = 0.037) and injury history (p = 0.035) and to predisposition for depression also through exposure to a patriarchal society (p = 0.046) and physical abuse (p < 0.001). We conclude that depression in a global population of young athletes was as prevalent as previously reported from general populations, and that universal mental health promotion in youth sports should include provision of equal opportunities for female and male participants, injury prevention, and interventions for abuse prevention and victim support.

Putting the Puzzle Back Together-A Narrative Case Study of an Athlete Who Survived Child Sexual Abuse in Sport

Denunciations of child sexual abuse (CSA) in the sport context have been increasing in the last decades. Studies estimate that between 14 and 29% of athletes have been victim of at least one form of sexual violence in sport before the age of 18. However, studies suggest that many do not disclose their experience of CSA during childhood. This finding is alarming since studies have shown that the healing process usually starts with disclosure. Moreover, little is known about the healing process of CSA experienced in the sport context. The aim of the study is to present a single case study of a CSA in sport to better understand the global experience over time from the perspective of the athlete. A narrative inquiry approach was adopted. Three non-structured interviews were conducted with the participant. Three pathways in the survivor journey have been identified through inductive thematic analysis: (a) pathway to understanding, (b) pathway to disclosure, and (c) pathway to healing. These pathways represent distinct processes but are intertwined as they are dynamic and iterative. Indeed, the survivor explained how she had been, and is still, going back and forth between them. Results are consistent with those found in the literature on CSA in the general population. It suggests that theoretical models of CSA in the general population could be applied to CSA in sport. Practical implications include a need for education and clearer boundaries in the coach-athlete relationship. Sport stakeholders also need to be better equipped to recognize the signs of sexual violence in sport. Our results indicate that qualitative research could be a potential avenue to help victims heal from CSA. It gives them the chance to talk about and make sense of their abuse in a safe space. Finally, our results demonstrate the importance of reviewing the current justice system for victims. It should be based on a trauma-informed approach that places the victim at the center of the judicial process.

Beneath the Surface: Mental Health and Harassment and Abuse of Athletes Participating in the FINA (Aquatics) World Championships, 2019

OBJECTIVE

To assess the mental health and experience of sport-related harassment and abuse of elite aquatic athletes and to analyze it in relation to gender and discipline.

DESIGN

Cross-sectional study using an anonymous survey.

SETTING

The FINA World Championships 2019.

PARTICIPANTS

Registered athletes in the disciplines of swimming, diving, high diving, water polo, artistic swimming, and open water swimming.

INTERVENTIONS

Athletes completed an online or paper-based questionnaire.

MAIN OUTCOME MEASURES

The main outcome measures included screening for depression (10-item version of the Center for Epidemiological Studies Depression Scale revised), eating disorders (Brief Eating Disorders in Athletes Questionnaire), the subjective need for psychotherapeutic support, and the experience of sport-related harassment and/or abuse.

RESULTS

A quarter (24.6%) of the 377 responding athletes were classified as depressed and 2.5% as having an eating disorder. More than 40% of the athletes stated that they wanted or needed psychotherapeutic support. Fifty-one athletes (14.9%) had experienced harassment/abuse in sport themselves, and 31 (9%) had witnessed it in another athlete. The experiences of harassment and abuse ranged from unwanted comments about body or appearance (40.2%) to rewards in sport for sexual favors (2.5%) and rape (0.3%). Athletes who had experienced harassment/abuse in sport themselves had higher average scores for depression and eating disorders, and more of them felt they needed psychotherapeutic support. Up to a third would not talk or report to anybody if they saw or experienced harassment/abuse, and less than 20% would talk to an official for help.

CONCLUSION

Targeted initiatives are required to address mental health issues and harassment and abuse in sport in the FINA aquatic disciplines.

Evolving Expectations of the Orthopedic Team Physician: Managing the Sidelines and Landmines

ABSTRACT

The role of orthopedic team physicians has evolved greatly over the past decade having been influenced by advances in sports science and performance, new surgical and biologic technologies, social media, medicolegal liability, marketing, and sexual misconduct cases by some team physicians. The great variety of events and sports that are covered from high school and collegiate to the Olympic and professional levels requires a myriad of skills outside of the traditional medical training curriculum. In the current climate of increasing media scrutiny from a 24-h news cycle it is imperative for orthopedic team physicians, whether operative or nonoperative, to continually adapt to the needs and expectations of athletes who also are patients. This is especially true in the wake of the COVID-19 pandemic. Orthopedic team physicians' responsibilities continue to evolve ensuring their relevance and necessity on the sidelines and in the training room as well as in the operative suite.

Lifetime Prevalence of Verbal, Physical, and Sexual Abuses in Young Elite Athletics Athletes

To examine prevalence of verbal, physical, and sexual abuses in young elite athletes, a cross sectional questionnaire-based survey was conducted during the World Athletics under 20 World Championships. This questionnaire aimed at distinguishing between abuses perpetrated in the context of Athletics from those which were unrelated to Athletics. Four hundred and eighty athletes (52.3%, male) from North America, South America, Europe, Africa, Asia, and Oceania took part in the electronic anonymous survey. Outside Athletics setting, no gender difference was found for the prevalence of verbal, physical, and sexual abuses. However, 45 males (18% of the male population) and 34 females (15% of the female population) athletes reported sexual abuse. Asian athletes reported a slightly higher rate of sexual abuse; three quarters of them being non-touching abuses. Inside Athletics setting, no gender difference was found for the prevalence of verbal, physical, and non-touching sexual abuses. However, 58 males (23%) and 47 females (21%) reported verbal abuses. Thirty-one males (12%) and 20 females (9%) reported physical abuses, whereas 30 males (12%) and 17 females (7%) reported sexual abuses. Physical abuses were slightly more frequent in Asia and in Africa and less frequent in South America. Sexual abuses inside Athletics also differed over regions, and were unexpectedly twice more frequent than expected in Asia and slightly less frequent than expected in Europe. Friends and partners were identified as the more frequent (>50%) abusers outside or inside the Athletics settings, whereas outside Athletics and inside Athletics, coaches were identified as sexual abuse perpetrators in 8 and 25% of cases, respectively. The prevalence of verbal, physical, or sexual abuses is high but consistent with what has been reported in United Kingdom, Norway, Canada, and Sweden at national level in recreational or elite athletes. Sexual abuse, including touching or penetrative abuses, occurred significantly more often in male athletes when compared to female athletes. This finding invites healthcare and social workers, and policymakers to also consider the risk of sexual abuse of young male athletes in Athletics. These results also call for longitudinal studies on young elite athletes.

Confirmatory Factor Analysis and Validity of the Sexual Harassment Scale in Football Refereeing

Inequalities between men and women in the workplace are reflected in professional sports, specifically football refereeing. This phenomenon sometimes becomes sexual harassment since it is a stereotypically considered male profession in which women are a minority. To measure that behavior, it is necessary to count on valid and reliable tools. Therefore, the goal of this study was to determine the factorial structure and the discriminant and convergent validity of the ‘sexual experiences questionnaire’, version of the Department of Defence (SEQ-DoD). Eighty-nine male football referees and ninety-four female football referees, with a mean age of 23.30 ± 4.85 years, participated in this studio conducted questionnaire in Andalusia, Spain. A confirmatory factor analysis was performed using the robust maximum-likelihood estimation method. The goodness of fit was assessed, and the factorial invariance was calculated to determine the stability of the model. Subsequently, the validity was confirmed. The results corroborated the validity and reliability of the questionnaire adapted to the population studied. Therefore, it can be used as a research instrument.

Suicidal thoughts (ideation) among elite athletics (track and field) athletes: associations with sports participation, psychological resourcefulness and having been a victim of sexual and/or physical abuse

OBJECTIVE

To examine associations between suicidal ideation and sexual and physical abuse among active and recently retired elite athletics (track and field) athletes.

METHODS

The study population consisted of all athletes (n=402) selected for a Swedish Athletics team between 2011 and 2017. Data on suicidal ideation, suicidal events (estimated through the 1 year non-sports injury prevalence), lifetime abuse experiences, sociodemographics, sense of coherence and coping strategies were collected using a cross-sectional survey. The data were analysed using binary logistic regression with suicidal ideation and non-sports injury as outcomes.

RESULTS

192 athletes (47.8%) returned data. The prevalence of suicidal ideation was 15.6% (men 17.4%; women 14.2%) and the non-sports injury prevalence was 8.0% (men 11.6%; women 5.7%). Among women, suicidal ideation was associated with having been sexually abused (OR 5.94, 95% CI 1.42 to 24.90; p=0.015) and lower sense of coherence (OR 0.90, 95% CI 0.85 to 0.96; p=0.001) (Nagelkerke R²=0.33). Among men, suicidal ideation was only associated with use of behavioural disengagement for coping (OR 1.51, 95% CI 1.18 to 1.95; p=0.001) (R² =0.25). Among women, non-sports injury prevalence was associated with having been sexually abused (OR 8.61, 95% CI 1.34 to 55.1; p=0.023) and participating in an endurance event (OR 7.37, 95% CI 1.11 to 48.9; p=0.039 (R² =0.23), while among men, having immigrant parents (OR 5.67, 95% CI 1.31 to 24.5; p=0.020) (R² =0.11) was associated with injury outside sports.

CONCLUSIONS

About one out of six international athletics athletes reported having experienced suicidal ideation. World Athletics and National Olympic Committees need to include suicide prevention in their athlete protection programmes.

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.