In these blog posts here at HeadCheck Health, we normally highlight issues/concerns or new findings and opportunities in research relating to concussion, specifically concussion in sport. For this post, we’re going to take a bit of a different approach and focus on a different issue that impacts athletes: mental health. Athletes can face significant mental health issues and it is our responsibility to bring this health issue to the forefront of the discussion so that athletes know they aren’t alone and to help create environments where mental health is discussed and action plans to manage mental health issues and risks are established.
Why does it matter?
The first question that may arise for you is why does mental health in athletes matter? Is it actually a prominent issue? Well, this is what the writers of the paper we are looking at today say on the matter:
“Although participation in athletics has many benefits, the very nature of competition can provoke, augment, or expose psychological issues in athletes. Certain personality traits can aid in athletic success, yet these same traits can also be associated with MH disorders. Importantly, the athletic culture may have an impact on performance and psychological health through its effect on existing personality traits and MH disorders”
So basically, the very nature of competition and the culture surrounding sport puts athletes at risk of developing, exposing, or exacerbating mental health issues. And ultimately, it is the responsibility of athletic care personnel to provide comprehensive medical care to athletes, including MH disorders.
Therefore, the American Medical Society for Sports Medicine put out a Position Statement on Mental Health Issues and Psychological Factors in Athletes. A position statement is basically an evidence-based, best practice document that is created by a panel of experts in order to assist members of the athletic care network with the “detection, treatment, and prevention of mental health (MH) issues in competitive athletes.” In this paper, competitive athletes range from Olympian and professional athletes to youth and collegiate athletes.
What do we know?
This paper basically highlighted key psychological, cultural, and environmental factors that influence MH in athletes. These factors include:
- personality issues (i.e. MH issues arising from high association of identity with being an athlete);
- sexuality and gender issues (i.e. MH issues arising from sexual orientation or gender identity)
- hazing (i.e. issues arising from hazing activities)
- bullying (i.e. MH issues arising from teammates, opponents, coaches, spectators, parents, etc. engage in bullying)
- sexual misconduct (i.e. MH issues arising when authority figures, peer athletes, or even coaches engage in sexual abuse or harassment)
- transitioning from sport (i.e. MH issues that arise when athletes retire by choice or unwillingly (such as due to career-ending injury))
- psychological response to injury and illness (i.e. psychological and sociocultural factors (such as stress) can be potential risk factors for injury as well as ability to rehabilitate from injury and return to sport)
- self-medication in response to injury/illness (i.e. an athlete may cope to injury/illness through self-medication which is an unhealthy, mental health-related method of coping)
- eating disorder/disordered eating (i.e. athletes demonstrate increased prevalence of disordered eating, which is a mental health issue)
- depression and suicide (i.e. depression and suicide are MH issues that may develop, be exacerbated, or be exposed in competitive sport environments)
- anxiety/stress (i.e. anxiety and stress are MH issues that may develop, be exacerbated, or be exposed in competitive sport environments)
- overtraining (i.e. excessively training with inadequate recovery can result in or be a sign of MH issues)
- sleep (i.e. sleep disorders commonly occur alongside mental disorders, suggesting sleep quality is important to MH)
- attention deficit hyperactivity disorder (ADHD)
What can we do?
Some recommendations on how to combat these issues include:
- create strong supportive environments that are welcoming to sexual minorities and include education of all stakeholders
- establish a zero-tolerance policy for any hazing activities and instead focus on activities that promote dignity and teamwork
- educate all stakeholders on bullying
- create a comprehensive preretirement plan to transition from competitive sport to retirement
- annual pre-participation screening for eating disorders should be routine
- using cognitive behavioural therapy to treat anxiety
- monitor training loads to prevent the development of over-training syndrome
- educate athletes about regulations and requirements regarding medication treatment of ADHD
At the end of the day
Basically what these results mean is that there are many factors that can influence an athlete’s MH and athletic care personnel need to be aware of these factors in order to identify MH issues in athletes. Furthermore, they also need to know how to address these specific factors – fortunately, there seem to be good strategies to manage many of these factors. Yet, as always, there is limited research in some of these areas and more research is needed to fully understand MH in athletes as well as identify and validate strategies for the detection, management, and prevention of MH disorders in competitive athletes.
The executive summary of this position statement is only 4 pages long and I highly recommend that if you’re interested in finding out a bit more about what the key findings are that you take a look! Alternatively, you can read the whole report here.
- Chang, Cindy J. MD*#; Putukian, Margot MD, FACSM, FAMSSM†,‡#; Aerni, Giselle MD§; Diamond, Alex B. DO, MPH¶; Hong, Eugene S. MD║; Ingram, Yvette M. PhD**; Reardon, Claudia L. MD††; Wolanin, Andrew T. PsyD‡‡ American Medical Society for Sports Medicine Position Statement: Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention—Executive Summary, Clinical Journal of Sport Medicine: March 2020 – Volume 30 – Issue 2 – p 91-95 doi: 10.1097/JSM.0000000000000799