Call It an "Evolution": Promoting Student-Athlete Well-Being During the Transition From Collegiate Sport

After highly publicized stories of student-athletes' struggles with mental health, the spotlight on mental health and well-being in this special issue coincides with a broader growing concern for the long-term impact of competitive sport participation on student-athlete health and wellness. The end of a competitive sport career represents a potentially vulnerable life transition. As demonstrated in the literature, the unique aspects of elite sport culture shape student-athletes' perceptions of their identity, health, and health behaviors, which have implications for how student-athletes navigate their health and well-being as they transition away from the embedded health care structure inherent to elite sport. Given evidence indicating that student-athletes may face mental and physical health concerns after retirement from sports, targeted transitional strategies are needed to provide patient-centered care in this population. In this article, we briefly summarize current understanding of sport transition and highlight some key findings from studies conducted by the contributing authors' research groups exploring the impact of sport career transitions on student-athlete well-being. We also reflect on limitations of the existing research and transition models and, in turn, propose potential directions for adopting a nuanced and multidimensional framework to explore interconnected transition domains. We conclude by offering recommendations for sports medicine professionals to consider in future research, programming, and policies to promote student-athletes' holistic well-being through this critical transition.

Prevalence and Formal Reporting of Sexual Violence among Undergraduate Student-Athletes: A Multi-State Study

Sexual violence (SV) is a serious problem on college campuses, and student-athletes are one group of college students at risk for experiencing SV. The administrative context and close-knit bonds of college teams introduce opportunities and structures for responding to SV and delivering uniquely tailored prevention programming, but there is limited research about formal reporting of SV among student-athletes. The current study examines the prevalence of SV and SV reporting history and perceptions among a multi-state sample of undergraduate student-athletes. Student-athletes at 10 National Collegiate Athletic Association (NCAA) Division I institutions across the US participated in an online survey about their experiences of SV victimization, formal reporting of SV, knowledge of resources, and perceptions of responses to SV at their institutions. Among 1004 student-athletes who completed the survey, 29% experienced some type of SV since enrolling at their university, with higher prevalence of SV among student-athletes on women's teams (36%) compared to men's teams (13%). About one fifth of student-athletes felt very or extremely knowledgeable about where to make a report of SV, and only about 10% felt very or extremely knowledgeable about what happens when a student reports SV. Only 9% of participants who experienced SV filed a formal report at their institution. Perceptions about whether campus officials would take the report seriously or would conduct a fair investigation were most positive for students who experienced and formally reported SV. Further research with student-athletes about their decision to formally report and barriers to reporting is needed to build a more comprehensive understanding of the unique experiences of SV among student-athletes. Our results highlight the importance of including and targeting student-athletes in campus SV prevention efforts to build knowledge and trust in hopes of ultimately decreasing the prevalence and adverse consequences of SV.

Pre-post Evaluation of the “Supporting Student-Athlete Mental Wellness” Module for College Coaches

This study sought to determine whether completion of the National Collegiate Athletic Association’s “Supporting Student-Athlete Mental Wellness” online module for coaches increased mental health literacy, reduced stigma, and increased intentions to: 1) communicate proactively with team members about the importance of mental health care seeking, and 2) respond appropriately to support an athlete believed to be struggling with a mental health issue. College head coaches completed pre-test surveys (n = 969) and immediate post-test surveys (n = 347, completion rate = 36%). Module completion was associated with increased mental health literacy, decreased stigma about help seeking and increased intentions to engage in culture setting communication. These findings suggest that the online module is a good start for coach education about mental health; however, additional modifications may be warranted to the extent coach referral to sports medicine staff or provision of emotional support to student-athletes struggling with mental health concerns are considered desired behaviors.

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

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

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

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

OBJECTIVE

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

DESIGN

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

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

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

RESULTS

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

CONCLUSION

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