Setting the bar: athletes and vulnerability to mental illness

Hair cortisol is a physiological indicator of training stress for female footballers

PURPOSE

Chronic physical stress in female athletes can reduce mental health and athletic performance. Therefore, a chronic physical stress assessment method is required.

METHODS

This study examined whether hair cortisol concentration (HCC) predicted chronic physical stress changes in female university football players. We took measurements in August and December, just before the Japan college national tournament.

RESULTS

Self-reported training load was significantly positively correlated with HCC. Self-reported training load had no significant relationship with fatigue as measured by the Profile of Mood States 2nd Edition or with the stressors from the Stressor Scale for College Students. HCC was negatively correlated with reaction time in the spatial Stroop task, although the repeated correlation analysis showed no significant relationship.

CONCLUSION

These results suggest that the chronic physical stress experienced by female footballers cannot be predicted by psychological indicators; however, they can be predicted by HCC, which could be used to prevent overtraining in these athletes.

Prevalence, severity, and predictors of self-reported depression in ultra-distance runners: An online survey based on 265 athletes

BACKGROUND

Literature suggests a high prevalence of mental health disorders among athletes practicing elite and extreme sports. One of the most commonly encountered disorders in this group of individuals is depression.

OBJECTIVE

The aim of this study was to examine the prevalence, severity, and risk factors of symptoms of self-reported depression among ultra-distance runners.

METHODS

Data was collected using an online survey (February to April 2023) and included 265 (age 48.35 ± 10.52 years) adult ultra-runners. The Beck Depression Inventory-II (BDI-II) was used to measure self-reported depression. Additional variables comprised basic sociodemographic information and information regarding training, ultramarathon experience, and previous injury. Descriptive and interferential statistics were performed using JASP Version 0.16.4.

RESULTS

We found that 21.9 % (n = 58) of ultra-runners suffered from self-reported depression (i.e., BDI-II score ≥ 14) with an average BDI-II score of 22.7 ± 7.1 (moderately severe symptoms). Female ultra-runners had a higher prevalence (30.8 %) of self-reported depression than males (16.2 %, p = .001). Logistic regression revealed that ultra-runners without previous sports injury (p = .01) and those of increasing age (p = .003) had a significantly lower risk of self-reported depression. Similarly, linear regression showed the absence of injury (p < .001) and increasing age (p = .02) resulted in significantly lower BDI-II scores. Training volume in distance and hours per week as well as ultra-running experience did not show any significant association.

CONCLUSIONS

Affecting more than one-fifth of our collective, depressive symptoms appear to be highly prevalent among ultra-runners. Our findings underline the importance of screening for clinical depression, especially among injured athletes. However, the previously assumed peculiarities of the sport in the area of high training volume do not appear to be a significant factor.

Mental health symptoms among Dutch elite athletes and their coaches: a cross-sectional study

A bstract

Objective

To establish the prevalence of mental health symptoms (MHSs ) among Dutch elite athletes and their coaches, to examine the association between potential contributing factors and MHS among Dutch elite athletes and their coaches and to explore the view and needs of Dutch elite athletes and their coaches regarding mental health resources and support.

Methods

A cross-sectional study was conducted by distributing an electronic questionnaire based on validated screening questionnaires for the assessment of MHS.

Results

In total, 156 athletes (55 % female) and 95 coaches (79 % male) across various sports participated in this study. The most prevalent MHS among athletes and coaches were distress (73 % and 41 %) and alcohol misuse (52 % and 53 %). Adverse life events showed an association with anxiety, depression, sleep disturbance, alcohol misuse and disordered eating while severe injuries showed an association with distress and sleep disturbance in elite athletes. Among coaches, no significant associations were found between potential contributing factors and MHS. 60 % of the athletes and 60 % of the coaches (totally) agreed that they could openly address their mental health issues within their sport while 53 % of the athletes and 41 % of the coaches (totally) agreed a need for increased attention regarding mental health/guidance in their sport.

Conclusions

MHSs are prevalent among Dutch elite athletes and coaches. Recent adverse life events and severe injuries have a potential intersection with MHS in elite athletes. There is a need for increased attention regarding mental health/guidance among Dutch elite athletes and coaches within their sport so that subsequent treatment/support can be provided.

Wellbeing in high-performance swimming: A grounded theory study

The demands of elite sport have the potential to negatively impact on athletes' wellbeing (e.g., Arnold & Fletcher, 2012; Rice et al., 2016). Despite this, not all elite athletes experience detrimental effects, rather some individuals thrive in an elite sports environment. The reasons why some athletes experience positive wellbeing while others struggle remains unclear although, in part, due to methodological limitations of previous research. To overcome these limitations, the purpose of the current study was to examine how change in high-performance swimmers' wellbeing occurs. Grounded theory methodology was used to enable examination of processes of change. Semi-structured interviews with 22 current and five retired swimmers, eight coaches, and seven support staff were used to generate data alongside observations and field notes. The resultant theory illustrated how a dominant performance narrative influenced the development and maintenance of an exclusive swimmer identity that was tied to performance. Specifically, transitions were highlighted as critical points where wellbeing was likely to be affected, due to the increased potential for change and uncertainty to impact on performance and subsequently identity. However, the use of proactive coping strategies, such as anticipating and planning, as well as accessing and utilising appropriate support were shown to help minimise the impact on wellbeing.

Media's Effect on Athletes' Mental Health

This article explores the athlete's relationship with both traditional and social (digital) media and describes athletes' media obligations and the pressures of media attention. It explains the difference in the representation of diverse groups, and the potential positive and negative outcomes of the media on an athlete's mental health. The article will review the emergence of social media, its limitless reach, and ways in which it diverges from traditional media coverage of athletic performance. Finally, the article concludes with a discussion of ways that athletes' multidsciplinary medical teams may become advocates for healthy and supportive interactions between athletes and media.

The Design and Implementation of a Novel Mental Health Literacy Educational Intervention Program in Gaelic Footballers

CONTEXT

Lack of education, stigma, and negative self-attitudes are key barriers to help-seeking in Gaelic footballers. With the prevalence of mental health issues in Gaelic footballers and the increased risk of experiencing mental health challenges after injury, mental health literacy (MHL) interventions are necessary.

OBJECTIVES

To design and implement a novel MHL educational intervention program in Gaelic footballers.

DESIGN

Controlled laboratory study.

SETTING

Online.

PATIENTS OR OTHER PARTICIPANTS

Elite and subelite Gaelic footballers divided into intervention (n = 70; age = 25.1 ± 4.5 years) and control (n = 75; age = 24.4 ± 6.0 years) groups. In the intervention group, 85 participants were recruited, but 15 dropped out after completing baseline measures.

INTERVENTIONS

A novel educational intervention program, "GAA [Gaelic Athletic Association] and Mental Health-Injury and a Healthy Mind," was designed to address the key components of MHL and was underpinned by the Theory of Planned Behavior and the Help-Seeking Model. The intervention was implemented online via a brief 25-minute presentation.

MAIN OUTCOME MEASURES

Measures of stigma, help-seeking attitudes, and MHL were completed by the intervention group at baseline, immediately after viewing the MHL program, and at 1 week and 1 month after the intervention. The control group completed the measures at similar time points.

RESULTS

Stigma decreased, and attitudes toward help-seeking and MHL increased in the intervention group from baseline to after the intervention (P < .05), with significant differences sustained at 1-week and 1-month follow-ups. Our results showed differences in stigma, attitudes, and MHL between groups across time points. Intervention participants provided positive feedback, and the program was appraised as informative.

CONCLUSIONS

Remote online delivery of a novel MHL educational program can effectively decrease mental health stigma, improve attitudes toward help-seeking, and increase the recognition and knowledge of mental health issues. Gaelic footballers with improved MHL may be better equipped to manage their mental health and cope with stressors, leading to improved mental health outcomes and overall mental well-being.

Increased anxiety and depression among collegiate athletes with comorbid ADHD and history of concussion

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is prevalent among student-athletes when compared to the general population. Mental health disruptions (i.e., depression or anxiety) are common among student-athletes, and risk of experiencing depressive and anxious symptoms may be even greater among student-athletes that have incurred concussion.

OBJECTIVE

To examine the influence of pre-existing ADHD and history of concussion on mental health in collegiate student-athletes.

DESIGN

Retrospective cross-sectional study.

SETTING

National Collegiate Athletic Association Division-I (NCAA) athletics.

PATIENTS

Between 2010 and 2017, student-athletes at a Southeastern NCAA Division-I institution were surveyed as part of a Performance, Health, and Wellness Program. Analyses were conducted using a sample of 324 student athletes (212 female) with either a prior diagnosis of ADHD, a prior history of a sport-related concussion, both prior diagnosis of ADHD and a history of sport-related concussion, or neither (controls).

MAIN OUTCOME MEASURE(S)

Symptomatology associated with ADHD was characterized using the Behavior Assessment System for Children Self-Report of Personality College Version. The State-Trait Anxiety Inventory and the Center of Epidemiological Studies-Depression Scale examined anxious and depressive symptomatology.

RESULTS

Student-athletes with ADHD and a history of concussion had 16.4 times greater odds of exhibiting clinically significant symptoms of state anxiety and 7.9 times greater odds of exhibiting clinically significant symptoms of depression, relative to control student-athletes. Every participant with both a diagnosis of ADHD and a history of concussion exhibited clinically significant attentional problems.

CONCLUSIONS

Having both ADHD and a history of concussion may have a synergistic effect on mental health beyond that of ADHD and/or concussion alone. Additional longitudinal research is necessary to verify current findings. However, athletic trainers and other health care professionals are encouraged to be mindful of student-athletes with ADHD, as they may be more vulnerable to experiencing symptoms of depression and state anxiety with elevated inattentive behaviors following a concussion.

The psychological effects of sports disruptions in NCAA Division I and II athletes during the COVID-19 pandemic: a mixed methods analysis

BACKGROUND

Improving mental health outcomes in college athletics requires better understanding of how student-athletes respond to stress-inducing events.

METHODS

Using a cross-sectional design, this study aimed to assess student-athletes' mental health status during the COVID-19 pandemic. Eligible participants (N.=489) included Division I and II student-athletes at least 18 years of age with plans to compete in the 2020-2021 sport season. Participants completed an online battery of psychological health surveys.

RESULTS

Survey results suggested high psychological strain (APSQ: 20.58±8.08), mild symptoms of anxiety (GAD-7: 7.66±5.51) and depression (PHQ-9: 7.51±5.65), and burnout (ABQ: 2.37±0.96).

CONCLUSIONS

A subset of student-athletes reported symptoms of psychological strain, depression, and anxiety warranting follow-up clinical evaluation and/or treatment according to scoring guidelines. Findings encourage psychological screening, particularly during sport-disrupting events, to better support athletes' mental health during high-stress conditions.

The Potential of Heart Rate Variability Monitoring for Mental Health Assessment in Top Wheel Gymnastics Athletes: A Single Case Design

The assessment of heart rate variability (HRV) upon waking has been proposed as a method to evaluate mental health; however, owing to large individual differences among athletes, it is unclear whether HRV is adequate to predict mental health decline. In this study, we sought to establish this by evaluating HRV upon awakening in one athlete over 20 months. We assessed mental health once a month by calculating the depression index. In addition, self-reported training load and psychological fatigue index were assessed as psychological indices for athletes. Heart rate and HRV were each measured three days per week in both resting (supine) and standing (upright) positions. The results showed that orthostatic HRV upon waking had moderate linear relationships with the scores on the depression index and psychological fatigue index. By contrast, self-reported training load, a measure of physical stressor, was not associated with HRV. The findings suggest that the repeated assessment of HRV upon waking and mental health indicators may be useful in preventing mental health decline in athletes.

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.

Irrational Beliefs Among Competitive High School Student Athletes: Are they General or Context-Driven?

While student-athletes strive for high performance both athletically and academically, understanding the role of beliefs as it relates to objective measures of performance has not been readily studied (Turner and Barker in J Appl Sport Psychol 25:131-147, 2013) and even less so among youth. This research examined if irrational beliefs that are context specific to performance settings (academic vs. athletic) are more predictive of academic and athletic performance than those more general irrational beliefs among 30 high-school student athlete basketball players. While both general and context-specific irrational beliefs were predictive of athletic performance as measured by performance analysis from game video footage and academic performance as measured by Grade Point Average, there were no differences in terms of their predictive ability. Implications for researchers and practitioners are provided to guide the scholarly research and applied implications regarding the role of specific beliefs as it relates to performance with this population.

Controlling Behavior, Sex Bias and Coaching Success in Japanese Track and Field

Coaching athletes is a complex and lengthy process. Recently, attention has been given to coaches over-controlling behavior toward the athletes' personal lives and possible sex bias, but the impact of these behaviors on coaching success is unclear. An anonymous survey was answered by 412 track and field coaches (male: 369; female: 43), comprising questions regarding controlling behaviors, sex bias, and personal background. A Chi-square test and logistic regression were performed to determine the factors related to the coach's characteristics and their success in coaching athletes (to national vs. non-national level). The results showed that controlling behaviors and sex-bias-related beliefs were present. The coaches who coached national-level athletes were more likely to be older, more experienced, and were national level athletes themselves. More national-level coaches reported controlling behaviors but fewer held sex bias beliefs than the non-national level coaches. However, the strength of these beliefs (scores for controlling behavior and sex bias) was not related to the coaching success.

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.

Holding open spaces to explore beyond: Toward a different conceptualization of specialization in high-performance sport

This conceptual analysis aims to challenge the state of high-performance sport by questioning the concept of specialization. To start, we offer a brief, but critical overview of what specialization currently entails. Then, shifting the paradigm, we suggest an expansion rather than a reduction of developmental possibilities once an athlete reaches the "top". Specifically, rather than athletes conforming to national standards imposed by governing bodies about what it means to be "elite", we suggest sport systems consider a person-environment fit approach to support ongoing development. Drawing on an ecological dynamics rationale and various socio-cultural theories, we explore how concepts such as affordances and perspectives can be harnessed to create a better "fit" between athletes' action capabilities and the opportunities within their broader environment. Our conception of specialization requires moving away from a definition of success based on the accumulation of medals, toward one that accounts for the exploration and achievement of the possible. We argue that a person-environment fit welcomes diversity, so long as it sustains the person's health, wellbeing, and performance. This, it is suggested, is about collectively holding open spaces for each other to explore beyond the constraints of high-performance sport, encouraging all to carry on their lives in directions meaningfully impactful for them. We conclude this conceptual analysis with a brief case example demonstrating what our theorizing could look like in practice.

The psychological responses of British amateur point-to-point jockeys to personal injury

Previous research has reported significant psychological consequences of injury on rehabilitation success, performance, and wellbeing in athletes, although little is known within horse-based sports. There is a high prevalence of injury reported in point-to-point (P2P) jockeys, but despite this, comparatively little research exists examining the psychological implications resulting from physical trauma within horseracing. The aim of this study was to investigate the psychological responses to personal injury in British amateur P2P jockeys. Five amateur P2P jockeys (two male, three female, x- age 25 years old) were interviewed about their experiences post an injury sustained during racing in the preceding 12 months. Interview questions explored their pre-injury career, the rehabilitation phase, pre-return to racing phase issues and coping strategies used by jockeys. Thematic analysis revealed three higher order themes: emotional responses, coping strategies, and factors affecting recovery. Subjects universally cited negative emotional responses following injury, including grief, a sense of loss, and frustration, and all experienced denial at the onset of injury. Typical coping strategies included strong support networks of family, friends and racing staff, and goal setting. Fear of reinjury was identified by all athletes, particularly on return to the saddle, and the attitudes towards injury management, such as denial, seen in this study may provide opportunities to develop targeted education campaigns for P2P jockeys on injury services. Targeted marketing for P2P jockeys on available injury support is recommended, such as seen for professional jockeys, as well as the creation of career development resources to offer alternative routes for P2P jockeys following injury.

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.

Barriers and Facilitators to Mental Health Help-Seeking in Elite Gaelic Footballers Post-Injury: A Qualitative Study

Purpose: Injury can exacerbate mental health issues in athletes. However, the prevalence of mental health issues is not equivalent to the rate of professional help-seeking, with reluctance to seek-help acknowledged as one of the greatest obstacles in efficient management of mental health issues. The current study aimed to examine perceived barriers and facilitators to professional mental health help-seeking in elite male and female Gaelic footballers post-injury. Methods: Male (n = 14) and female (n = 12) elite Gaelic footballers, with a history of moderate or severe injury, were recruited to participate in a focus group. Group discussions began with a written task where participants noted perceived barriers to help-seeking followed by a group discussion of these barriers. Following discussion, participants ranked identified barriers in order of those perceived as most important in stopping a player from seeking help when experiencing mental health issues post-injury. All three tasks were repeated for help-seeking facilitators. Focus groups were audiotaped, transcribed and thematically analyzed. Results: Lack of education, stigma, negative attitudes to help-seeking and accessibility issues were identified as key barriers to help-seeking among elite Gaelic footballers. Education, the attitudes and actions of others and accessibility were perceived as factors facilitating help-seeking. Conclusions: Given the negative psychological responses that can accompany injury, there is a need for facilitation and encouragement of help-seeking among players experiencing mental health issues post-injury. Interventions for reducing the barriers to help-seeking identified in the current study are necessary.

The Athlete's Paradox: Adaptable Depression

We proposed that an athlete's depressive symptoms may be different from the general population in etiology if considered from the context of a depressive disorder. By shifting focus from a limited notion of symptoms onto a comprehensive model of depression, the full scope of the phenomenon becomes clearer. This paper investigated the relationship between neurotransmitters and allostatic load to explain the incidence of depression among elite athletes. This literature review extensively analyzed exercise-induced neurohormonal imbalance resulting in depressive states among athletes. The research revealed that 5-HTTLPR polymorphism, brain-derived neurotrophic factor (BDNF), extensive psychological demands, social stigma, and overtraining syndrome (OTS) may all contribute to a unique version of depression. The research revealed that the biological standards of athletes differ from those of non-athletes, to the point that the new model may be useful, thereby introducing the new term "Adaptable Depression (AD)" to the literature. This framework suggests a new direction for future research to precisely measure the neurotransmitter-related brain changes that result in "Adaptable Depression" in athletes and to establish a better understanding of the depressive tipping point.

At the Coalface: Practitioner Perspectives on Applying Rational Emotive Behaviour Therapy (REBT) in High Performance Sport

The reported usage of rational emotive behaviour therapy (REBT) in high performance sport is becoming more common in research literature. This research indicates that REBT is a useful and effective approach to performance psychology. However, applied professional practice reflections and insights remain sparse. The current paper brings together REBT practitioners who work predominantly in performance settings (i.e., sport) to answer three questions pertaining to their application of REBT. Practitioners were asked to respond to the following questions: (1) What do you consider to be among the main irrational beliefs that interfere with performance? (2) In your experience, which irrational beliefs impair one’s ability to recover from a significant injury or major setback? (3) Can you describe the role of cognitive restructuring/change/reappraisal/disputation in applied work as it relates to performance? In the present paper, the practitioners’ responses are collected and presented, following which common themes are drawn from the responses to form guidance for practitioners wishing to apply REBT in performance settings. It is hoped that the experiences of the included practitioners will be useful for those wishing to take an REBT approach to their performance psychology consultancy.

Non-shoulder Injuries in Swimming: A Systematic Review

OBJECTIVE

The shoulder is the most common injury in swimming, followed by the knee and spine. The repetitive nature of swimming training may predispose a swimmer to injury. Several risk factors have been previously identified, but the level of evidence and level of certainty that these risk factors predispose a swimmer to injury risk has yet to be evaluated critically in a systematic review.

DESIGN

Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

Data were obtained through PubMed, Cochrane, and Google Scholar. The database search was limited to articles that were published between January 1980 and December 2019.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Level I, II, and III studies were included in this review. All studies must have been conducted in swimmers or swimming, a description of the specific pathology and provide at least one identified risk factor with an association (P < 0.05).

RESULTS

A total of 19 critically appraised articles identified 28 potential risk factors for musculoskeletal injuries in swimmers. The risk factors were grouped by the anatomical region: neck and back, pelvis and hip, and the knee. Only 2 risk factors were appraised at a moderate level of certainty, both occurring in the knee. The remaining 26 identified risk factors were appraised at a low level of certainty. There is a clear lack of research surrounding nonshoulder injuries in swimmers.

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.

What Is Behind Disordered Eating Behaviors? An Exploratory Study With Female Adolescents From Individual Esthetic and Nonesthetic Sports

This study explored the differences in shame, perception of performance, the need to present a perfect body image, and disordered eating among 223 female athletes from esthetic (n = 114; Mage = 14.30; SDage = 1.65; Myearsofpractice = 6.62) and nonesthetic (n = 109; Mage = 14.75; SDage = 1.87; Myearsofpractice = 4.56) individual sports. Descriptive, t test, and correlational analyses were performed. Moreover, path analyses were conducted to examine the link between the variables. The two groups did not present significant differences in variables, except in perception of performance. The path model analyses explained 47% of disordered eating. Results suggested that individual characteristic of sports practice seems relevant in shame. This study suggests that female athletes from individual sports who experience inferiority tend to adopt perfectionist defensive strategies and engage in disordered eating behaviors. This study highlights the relevance of intervention and educational programs that promote more adaptative emotional regulation strategies in female athletes from individual sports.

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.

Psychometric Assessment of the Mental Health Continuum-Short Form in Athletes: A Bifactor Modeling Approach

Aim: A recent mental health in sport consensus statement advocates Keyes’ two continua model with an associated Mental Health Continuum (MHC) instrument to assess mental health in athletes. However, there remains statistically inconsistent usage of the MHC in athletes, so further exploration of the MHC’s psychometric factors is required. Methods: Athletes (N = 1,097) aged 32.63 (SD = 11.16) comprising 603 females (55.7%) and 478 males (44.3%), completed the 14-item MHC-Short Form, alongside validated measures of anxiety and depression. Five confirmatory factor analytic and bifactor models were developed based on extant research and theory. Results: Overall, a bifactor structure with a “general” positive mental health factor, and three specific factors (“hedonic well-being,” “social well-being,” and “psychological well-being”) fitted the data well and was deemed the superior model. Conclusion: A bifactor model of the MHC-Short Form is recommended comprising a composite score alongside specific factors of hedonic, social, and psychological well-being.

Profiles of Mental Well- and Ill-Being Among Elite Athletes: Associations With Sport-Related Demands and Resources

The aim of the present study was to identify profiles of elite athlete mental well- and ill-being and study how the profiles (i.e., subgroups of athletes) differed in sport-related demands and resources. A total of 259 Finnish elite athletes (n = 170 active and n = 89 retired) completed quantitative self-report inventories. Through cluster analysis, four profiles of mental well- and ill-being were identified. Profile 1 was overrepresented by retired, older, and male athletes, and characterized by good mental well-being. Profile 2 consisted mainly of active athletes who reported mild risk for alcohol abuse. Profile 3 consisted mainly of women who displayed possible presence of an eating disorder. Profile 4 was typical of young athletes with mental ill-being. The balance between sport-related demands and resources appeared to be the healthiest in Profile 1 and worst in Profile 4. The present findings are beneficial for those who work with and/or provide psychological support to athletes.

The Incompatibility of Motherhood and Professional Women's Football in England

There has been an advancement of professionalisation of women's football globally. Professional women's football in England has grown exponentially since the inception of the Football Association (FA) Women's Super League in 2011. This article offers an examination of the gender-specific needs of women as professional footballers, focusing specifically on the distinctive aspect of maternity policy. Sportswomen often feel compelled to make the difficult decision between motherhood and an athletic career. Contracts have become an essential component of the work-life of professional women footballers. However, these contracts pose questions regarding organisational intentions and motivations. This study draws on 30 semi-structured interviews with professional women footballers in England. Our key considerations include contracts, employment, motherhood, and athletes' bodies. This examination will develop our understanding of the complexities associated with professional football as a career choice for women.

Role of club doctors in the mental health management of Australian rules football players: a Delphi study

Professional team athletes experience a range of mental health problems, both sports and non-sports related. However, there is limited information available for those charged with responsibility for managing these mental health conditions, particularly within the context of professional sporting clubs. This paper reports on consensus findings from a study of club doctors, who are primary care providers for professional team athletes within a specific code, the Australian Football League (AFL). Drawing on findings from a systematic literature search, a two-round Delphi procedure was used to develop a consensus on best practice for managing mental health conditions for club doctors as primary care providers for professional team athletes. Participants in this study were current and former club doctors employed in professional AFL clubs across Australia, with 28 doctors participating across two survey rounds. Overall, 77 statements were presented, with 50 endorsed as essential or important by ≥ 80% of the participants across the two rounds. Primary themes across nine domains include: (1) Prevention and Mental Health Promotion Activities; (2) Screening; (3) Engaging External Specialists; (4) Duty of Care; (5) Treatment: Assessment, Treatment and Case Coordination; (6) Communication; (7) Confidentiality; (8) Sleep Management and (9) Substance Use Management. This study is the first to offer club doctors working in professional team settings consensus guidelines for the management of mental health conditions, and the opportunity for greater clarification and consistency in role delivery.

Depressive Symptoms and Burnout in Football Players: A Systematic Review

The purpose of this article was to systematically review and organise the available literature devoted to the topic of depressive symptoms and burnout in football players. A systematic search was conducted in Web of Science, Scopus, SPORTdiscus, PubMed, and Psychinfo for articles published up to June 2020. The searches yielded 1589 articles, and after the screening process, a total of 18 studies met the eligibility criteria and were included for review. Playing position and conflicts with coach/management seems to have a direct influence on the prevalence of depressive symptoms in current players as do the injuries and life events of former players. During the pre-competition phase, most of the athletes displayed reduced rates, indicating burnout. An exploration of the mental health of football players will help to create models of care and guide professionals so that they may help players achieve better performance while also having better wellbeing. Understanding how to prevent and cope with the emotional wellbeing of football players will be possible to guide players and coaches.

Achievement Goals, Fear of Failure and Self-Handicapping in Young Elite Athletes with and without Chronic Pain

Background: Pain is a common problem in elite athletes. This exploratory study compares goal orientations towards sport, fear of failure, self-handicapping and pain catastrophizing between active young elite athletes with and without chronic pain (CP) complaints (longer than three months). It examines the associations between chronic pain, fear of failure, goal orientations, self-handicapping and pain catastrophizing in young elite athletes. We explore how far goal orientation can be explained by these factors. Methods: Young elite athletes completed an online questionnaire. Data analysis: Independent samples t-test, correlational analyses and multivariate regression analyses. Results: Participants were 132 young elite athletes (mean 16 years); data for 126 were analyzed. A total of 47% reported current pain, of which 60% had CP. Adolescents with CP showed significantly more pain intensity, fear of failure, self-handicapping and mastery–avoidance goals than those without. Pain intensity was significantly related to fear of failure, self-handicapping, pain catastrophizing and mastery–avoidance. Self-handicapping and fear of failure contributed significantly to mastery–avoidance variance. Performance–avoidance and –approach goals were explained by fear of failure. Conclusion: CP was common, with sufferers showing more fear of failure and self-handicapping strategies, and being motivated to avoid performing worse (mastery–avoidance). Self-handicapping and fear of failure influenced mastery–avoidance orientation, and fear of failure explained part of performance–avoidance and –approach orientations. Longitudinal studies should explore the role of these factors in the trajectory of CP in these athletes.

A narrative review of the risk factors and psychological consequences of injury in horseracing stable staff

Horseracing stable staff have a multifaceted role, acting as care givers, skilled athletes and equine experts, resulting in inherent high emotional, physical and mental demands. Despite these demands, and reports of significant injury risk to those working in racing at ground level, there has been no research investigating the psychological risk factors for injury in UK racing stable staff and how psychological responses to injury may affect long term mental health and wellbeing. With mental health at the forefront of industry consideration, this narrative review aimed to reflect on the current literature to propose occupational, life and social stressors that may be increasing the risk of injury in racing staff. In addition, this review aims to apply current injury theory to propose whether stable staff are at heightened risk of injury mismanagement. A literature search was undertaken to investigate the psychological aspects of injury, using five search engines and the following key words: injury, psychological responses, occupational, sport and/or athlete, equestrian, horseracing, jockey, risk of injury, rehabilitation, and injury minimisalisation. Articles were selected based on relevance to review aims, and research findings were synthesised under two primary areas: predictors of injury (working hours, job security, job control, life stressors, mental health and drug misuse) and responses to injury (positive and negative responses to injury, the role of social support, rehabilitation adherence, and injury minimalisation). Whilst there are limitations to narrative reviews, this study provides a novel interpretation of injury risk and responses specific to staff working in horseracing, where injury-related challenges are currently a key focus for sector employees, managerial staff and racing organisations. Recommendations for further research have been made to direct the advancement of knowledge in the field.

Physiological and Psychological Effects of Treadmill Overtraining Implementation

Simple Summary

Overtraining occurs when an imbalance between training stress and recovery exists, and it is prevalent in athletes, soldiers, physical education, and health education undergraduates as well as a number of female and male adolescents. Despite a broad body of evidence concerning physiological and psychological correlates of this syndrome, the pathomechanisms of overtraining are still poorly understood. This illustrates the need to establish animal models of this disorder. This article outlines and discusses physiological and psychological effects of the current established overtraining model, based on an eight-week exhaustive treadmill exercise that reveals the involvement of imbalanced energy expenditure, exacerbated inflammatory response, increased intestinal permeability, and anxiety status in the development and onset of overtraining. This study highlights the maladaptation of overtraining and provides an animal model to determine the effectiveness of possible strategies, including nutrition and monitoring, for treatment and prevention of overtraining syndromes in future studies.

Abstract

Overtraining in athletes usually causes profound and lasting deleterious effects on the maintenance of health and exercise capacity. Here, we established an overtraining animal model to investigate the physiological modulation for future strategic applications in vivo. We subjected C57BL/6 mice to exhaustive treadmill exercises daily for 8 weeks (the exhaustive exercise group). Next, the physiological and psychological outcomes were compared with the regular exercise and sedentary groups. Outcome measures included growth, glucose tolerance, exercise metabolism profiles, cytokine levels, intestinal tight junction gene expression, and psychological behavioral changes. Our results revealed that overtraining negatively affected the physiological and psychological changes in the current model. The exhaustive exercise group exhibited significantly lower endurance performance and imbalanced energy expenditure, causing a decrease in body fat mass and slowing down the growth curve. In addition, the inflammatory cytokines (tumor necrosis factor-alpha, interleukin-6, and interleukin-1β) and immune cells (neutrophils and monocytes) were significantly elevated after successive exhaustive exercise interventions. Furthermore, overtraining-induced stress resulted in increased anxiety status and decreased food intake. Our findings reinforce the idea that an imbalance between exercise and recovery can impair health and performance maintenance after overtraining. This study highlights the maladaptation of overtraining and provides an animal model to determine the effectiveness of possible strategies, including nutrition and monitoring, for treatment and prevention of overtraining syndromes in future studies.

Effects of Physical Activity and Training Routine on Mental Health During the COVID-19 Pandemic and Curfew

This research aimed to explore the effects of physical activity and training routine on mental health during the COVID-19 pandemic and the proclaimed emergency state and curfew. To measure the mental health components of psychological distress and subjective well-being, two studies were conducted on different samples: Study 1 during the beginning of curfew in Serbia (N = 678) and Study 2 during the ending phase (N = 398). The results of Study 1 showed that elite athletes as well as those with high level of physical activity experienced the lowest distress. Furthermore, effects of the changes in the training routine on distress among physically active individuals depended on the level of sports participation with elite athletes who reduced trainings showing lower anxiety compared to recreational athletes who reduced trainings as well or kept the same training routine. Thus, we could conclude that in the early stage of the pandemic, elite athletes showed better mental health and adaptability to the crisis situation. Results of Study 2 showed that although all the participants had decreased well-being during the curfew, compared to the period before the pandemic and the curfew, there were no differences in well-being between elite and recreational athletes, who had higher well-being compared to non-athletes. However, this effect held both before and during the curfew showing that physically active individuals did not additionally benefit from this decrease compared to the non-active. Furthermore, athletes who became physically inactive showed lower well-being compared to those who kept the same training routine. Thus, in the later stage of the pandemic, prolonged physical inactivity had negative effects on mental health.

The psychological effects of event cancellation in Olympic-level swimmers: preliminary findings and mental health screening recommendations

BACKGROUND

Mental health screening of elite athletes is not routinely practiced following the cancellation of an athletic event. Though sporting event cancellation has negative career and training impacts on elite athletes, little is known about its psychological impact. To determine the extent to which sporting event cancellation might warrant psychological screening practices in elite athletics, this study evaluated elite-level swimmers' response to the cancellation of the 2020 Olympic Games through psychological assessment and qualitative interviewing.

METHODS

A cross-sectional study design was implemented. Online psychological assessment included self-report scales to measure anxiety, burnout, psychological strain, and optimism/pessimism. Follow-up semi-structured telehealth interviews were conducted to assess appraisals of and coping responses to the cancellation.

RESULTS

Of the 14 participants assessed for mental health symptoms, 12 were available for interview procedures. Results (mean ± SD) indicated 'very high' psychological strain (22.71 ± 4.83) and 'mild' anxiety (6.29 ± 4.87). All swimmers exhibited levels of psychological strain that warranted clinical evaluation per established cut-off scores. Thematic content analysis of interviews generated four themes: pre-cancellation evaluations, primary appraisals, coping responses, and coping outcomes. Most swimmers exhibited maladaptive coping (75%); however, adaptative coping was as prevalent (92%), particularly through use of support networks. Most swimmers achieved positive coping outcomes (75%) and maintained strong 2021 Olympicqualifying confidence (93%). In contrast, swimmers with poor coping outcomes (25%) employed more frequent maladaptive coping strategies and exhibited higher psychological distress.

CONCLUSIONS

Findings urge sports medicine clinicians to implement psychological screening protocols in elite athletes following the cancellation of a major sporting event to attend to symptoms of psychological distress and to direct appropriate psychological intervention.

National Collegiate Athletic Association Athletic Departments’ Mental Health Screening Practices: Who, What, When, and How

College student athletes face unique, sport-related stressors that may lead to, or exacerbate, mental health (MH) concerns and symptoms. Although the National Collegiate Athletic Association has identified MH screening as a best practice, minimal data exist regarding contemporary screening practices. We explored National Collegiate Athletic Association Division I (DI), Division II (DII), and Division III (DIII) athletic departments’ current MH screening practices (N = 264). Compared with DII/DIII (53%), a greater percentage of Division I (89%) conducted formal MH screening. At DII/DIII institutions, athletic trainers were more likely to both administer and review screeners than any other sports medicine professional; sport psychologists primarily oversaw these tasks at DI schools. DI, compared with DII/DIII, institutions were more likely to have had a student athlete attempt suicide (62% vs. 40%) and participate in inpatient treatment (69% vs. 43%). There is a clear need for the National Collegiate Athletic Association to continue to promote policies that support MH screening and to create mechanisms in which it can monitor institutional involvement.

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.

Development and Validation of a Well-Being Measure on Young Basketball Players: The NFAPW Scale

Basketball is a sport in which, beyond the physical and technical skills, the psychological aspects are a decisive factor and could negatively affect the well-being of the player. The present study analyzes how 11 items belonging to two stakeholders (coach and player) could negatively affect the well-being of the athlete. A sample of elite young basketball players (n = 121) consisting of 55 males and 66 females, ranging in age from 16 to 23 (M = 20.12 ± 1.71), completed the Negative Factors Affecting Players’ Well-being (NFAPW) Questionnaire. This questionnaire was designed ad hoc and demonstrated good psychometric properties that confirmed that it is a valid and reliable instrument to measure how those factors negatively affect their well-being. The results showed that females have a greater perception of the factors that negatively affect their well-being, especially those related to the actions of the coach. However, no differences were found regarding the experience. Although this research provides an initial tool for measuring the well-being of the player during competition, future studies are encouraged to provide guidance to the coaches and players in dealing with the psychological variables in a better way.

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.

Addressing mental health in elite athletes as a vehicle for early detection and intervention in the general community

Recent scientific literature in addition to increased media attention has highlighted the important role of mental health in elite athletes. Often defined by terms such as "mental toughness", athletes are now becoming more open to discussing the role of anxiety, depression and other psychologically distressing processes that are intertwined with their time both during and after elite sport. In line with this, recent international position statements regarding the mental health of athletes have been released. The current New Hypothesis article follows on from these statements and proposes that further work must be performed to better understand this aspect of elite sport in addition to developing sport-specific interventions for athletes, their families, and support staff. Furthermore, we propose that by better understanding and treating the mental health of elite athletes a follow-on effect may occur, whereby help-seeking in the general community will increase. In particular, young adults who were previously hesitant to seek help may take strength from this shift, maximizing the success of early intervention occurring.

Burnout syndrome in athletes and their association with body image dissatisfaction at a private university

BACKGROUND

Burnout syndrome, from the sporting point of view, is the integration of both physical and emotional signs, caused by the high demands in competition. According to several studies, the prevalence of burnout syndrome is influenced by several factors that would lead to athlete's body image dissatisfaction.

METHODS

The study design is cross-sectional analysis. The study sample was 352 athletes selected from the Universidad Peruana de Ciencias Aplicadas (UPC). The main variables of this study are the burnout syndrome; which was measured by Athlete Burnout Questionnaire (ABQ) and body image dissatisfaction, through thirteen Scale drawings contour figure Gardner. To find the association between body image dissatisfaction and burnout syndrome Poisson regression was used.

RESULTS

Athletes with burnout syndrome have 1.08 times more likely having body image dissatisfaction with a value P=0.011 (95% CI: 1.02-1.15). It was also found that a sport collectively practiced is a protective factor for Burnout Syndrome with P=0.015 (95% CI: 0.4-0.9).

CONCLUSIONS

Relation between burnout syndrome and body image dissatisfaction in athletes was found. In addition, a relationship between practicing an individual sport and burnout syndrome was also found. More studies are necessary to confirm these relationships.