Authors: Mar Rovira, Francesco Cuzzolin, Julio Calleja-González, Igor Jukic, Baris Kocaoglu, Sergej M. Ostojic, Jaime Sampaio
Players often carry a heavy burden on their shoulders. In the public eye, they are considered modern warriors and competitors who bravely push obstacles and adversity in pursuit of a game victory. But we shouldn’t forget they are people like us and that they are not immune to the stresses of life. Consequently, mental health is proof of that.
What is Mental Health?
There are a lot of definitions of mental health. According to the World Health Organization, it is a state of well-being in which an individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and can make contributions to his or her community.
It is important to recognize that mental health is on a continuum. At one end of the spectrum there is the Peak Performance Zone, where the athletes perform and feel well, followed by the Good Mental Health Zone, characterized by well-being and optimism. In the middle of the continuum there is the Life Balance Zone, where players may occasionally experience symptoms. At the other end of the spectrum, we can find the Mental Health Symptoms Zone, where athletes experience some distress and dysfunction followed by the Mental Health Disorder Zone, characterized by interference with life and performance (Lardon, 2012).
Tip #1: Monitor your mental health zone. Remember that mental health is a state which fluctuates.
Main mental health symptoms and disorders in professional sport
Determining the prevalence of mental health symptoms and disorders in elite sports remains challenging, due to the difficulty to get access to this population, the stigma surrounding mental health in sports and the scarcity of valid sport-specific instruments. However, previous studies have reported that mental health disorders occur in between 5 and 35% of elite athletes (Foskett and Longstaff, 2017).
But before we continue with data, we must clarify the difference between mental health symptoms and mental health disorders in order to have a clear picture of the phenomena.
As stated by the World Health Organization, mental health symptoms are self-reported negative patterns of thinking, emotions and behaviors that can/may cause distress and/or interfere with functioning, including sports performance. Besides, mental health disorders are clinically diagnosed conditions that produce significant and persistent changes in a person’s thinking, emotions and/or behaviors that are associated with significant distress and/or disability in social, occupational or other important activities, like learning, training or competition.
According to the IOC Mental Health Consensus Statement (2019) the most common presentations of mental health symptoms and disorders in elite athletes include:
- Anxiety and depression: a 2019 meta-analysis found that 6% of elite athletes and 26.4% of former athletes reported symptoms of anxiety/depression (Gouttebarge et al., 2019).
- Sleep-related problems: 49% of Olympic athletes would be classified as “poor sleepers” (a term that includes multiple sleep problems) such as insufficient sleep, difficulty falling or staying asleep, or misalignment of sleep-wake patterns. Poor sleep is strongly linked to poor mental health and can negatively impact athletic performance. Therefore, it is important to make sure that athletes have sufficient rest time and adequate rooms that encourage a good night’s rest. Based on this information and other research in the field, ELPA recently took action and arranged single rooms in hotels for EuroLeague players on all trips during the season.
- Alcohol misuse: studies have shown that even at the most elite level of sport, athletes may be prone to alcohol abuse, heavy drinking and/or binge drinking. A 2020 study reported that hazardous drinking was found in 25.8% of athletes (Åkesdotter et al., 2020).
- Eating disorders: The estimated prevalence of eating disorders and/ or disordered eating among athletes in general ranges from 0 to 19% in men and from 6 to 45% in women. These figures are higher than for non-athletes (Joy et al., 2016). A distinction should be made between disciplines and gender.
- Post-traumatic stress disorder and other trauma-related disorders: athletes may face traumatic experiences from inside or outside sports such as injuries or life events. Research in this field is limited.
- Attention-deficit/hyperactivity disorder: more research is required.
- Suicide: a 2020 study found that 1 in 6 international athletics athletes reported having experienced suicidal ideation (Timpka et al., 2020). However, the rate of suicide seems to be lower than in the same age group in the general US population. Research in this field is limited.
- Bipolar and psychotic disorders. More research is required.
- Other substance use and substance use disorders (e.g., drugs): the substances most commonly used and misused by elite athletes across countries, sports and genders are alcohol, caffeine, nicotine, cannabinoids, stimulants and anabolic-androgenic steroids.
- Gambling disorder and other behavioral addictions: a 2016 study investigating gambling among European professional athletes showed that 6% had participated in some form of gambling during the past year, and 8.2% had a gambling problem, either current or in the past (Grall-Bronnec et al., 2016).
Tip #2: Awareness is the first step of prevention. Mental health and well-being must be routinely considered when planning a sporting event, managing a competition calendar or making travel arrangements.
Stressors
There are many stressors and environmental factors that can influence athletes’ mental health. Key stressors can be split into three categories: competitive stress, organizational stress and personal stress (Fletcher et al., 2006).
- Organizational stress: the environmental demands associated with the organization within which the athlete is operating such as leadership and personal issues, interaction issues, cultural norms, travel/accommodation issues or perceived lack of support from the organization.
Organizational stress management has been defined as “any activity initiated by an organization, which focuses on reducing the presence of stressors or minimizing the negative outcomes associated with exposure to stressors” (Ivancevich et al., 1990). These management interventions will need to be tailored with a view to either modify organizational environment in which individuals function, or help sports performers and other stakeholders to respond and adapt more positively to the organizational environment (Rumbold et al., 2018).
Tip #3: We encourage sports organizations and clubs to adopt an empowering motivational climate where all individuals feel safe, valued and supported when doing their tasks.
- Competitive stress: the environmental demands associated with competitive performance such as preparation, self-expectations and expectations from others, rivalry, pressure to perform during a big game, injury, underperforming or unexpected success among others (Mellalieu et al., 2009).
Tip #4: We encourage sports organizations and clubs to enhance the role of the Sports Psychologist and Clinic Psychologist to help athletes perform better and safer.
- Personal stress: the environmental demands associated with personal “non‑sporting” life events such as work-lifestyle issues (sleep, alcohol intake), family issues, financial issues, death of a family member, academic or work commitments (McDuff and Garvin, 2016).
In stressful situations, athletes face two tasks: they need to solve problems and regulate their emotions (Lazarus, 2000). We have to help them use an approach-oriented coping style instead of an avoidance-oriented style and at the same time regulate their emotions by using strategies of emotion control, relaxation and calming down (Goal and Cook, 2004).
Once athletes are able to recognize the sources of stress listed above, we have to support and guide them in order to develop healthy coping strategies that will impact their mental health and their sporting success.
Tip #5: It is extremely important that athletes learn how to recognize key stressors which may impact their mental health in order to find the best solutions and coping strategies.
ELPA and its Performance Advisory Board (PAB) are committed to fight the idea of mental health not being perceived as important as physical health problems. This is why we took action by creating the ELPA Well-Being Program, led by Sports Psychologist and PAB member Mar Rovira. The program contains all elements required to promote, prevent, assess, evaluate, manage and (if needed) intervene and coordinate with players’ staff every possible issue related to ELPA members’ mental health and well-being.
Tip #6: Seek help. If you are an ELPA member, enroll in ELPA’s private and confidential Well-Being Program. We are here to fully support you and give you guidance. If you are professional athlete in any other competition, make the first step and contact your organization.
Conclusion
We recommend that professional athletes regularly monitor their mental health zone, become aware of the main stressors that are impacting their daily routine, apply adaptative coping strategies and ask for help at any time. We also encourage all clubs and sports organizations to create proper elite sports environment that includes the support of players’ mental health, which holds immense importance in the world of modern professional sports.
References:
- World Health Organization (2005). Promoting mental health: concepts, emerging evidence, practice: A report of the World Health Organization, Department of Mental Health and Substance Abuse.
- Lardon, M. and Fitzgerald, M. (2013). Performance Enhancement and the Sports Psychiatrist’, in Baron, D., Reardon, C., and Baron, H. (eds.) Clinical Sports Psychiatry: An International Perspective, John Wiley & Sons, Ltd., pp.132-146.
- Foskett, R. and Longstaff, F. (2017). The mental health of elite athletes in the United Kingdom. Journal of Science and Medicine in Sport.21(8), pp.765-770.
- Gouttebarge, V., Castaldelli-Maia J., Gorczynski, P., Hainline, B., Hitchcock, M., Kerkoffs, G., Rice, S., and Reardon, C. (2019). Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis.British Journal of Sports Medicine, 53, pp.700-706.
- Reardon C., Hainline, B., Aron C., Baron D., Baum A., Bindra A., and Currie A. (2019). Mental health in elite athletes: International Olympic Committee consensus statement.British Journal of Sports Medicine, 53(11), pp.667-699.
- Åkesdotter, C., Kenttä, G., Eloranta, S., and Franck, J. (2020). The prevalence of mental health problems in elite athletes.Journal of Science and Medicine in Sport, 23(4), pp.329- 335.
- Drew, M., Vlahovich, N., Hughes, D., Appaneal, R., Burke, L., Lundy, B., Rogers, M., Toomey, M., Watts, D., Lovell, G., Praet, S., Halson, S., Cplbey, C., Manzanero, S., Welvaert, M., West, N., Pyne, D., and Waddington, G. (2018). Prevalence of illness, poor mental health and sleep quality and low energy availability prior to the 2016 Summer Olympic Games.British Journal of Sports Medicine, 52(1), pp.47-53.
- Du Preez, E., Graham, K., Gan, T., Moses, B., Ball, C., and Kuah, D. (2017). Depression, Anxiety, and Alcohol Use in Elite Rugby League Players Over a Competitive Season. Clinical Journal of Sport Medicine, 27(6), pp.530-535.
- Joy, E., Kussman, A., and Nattiv, A. (2016). 2016 update on eating disorders in athletes: A comprehensive narrative review with a focus on clinical assessment and management.British Journal of Sports Medicine, 50, pp.154-162.
- Silverman, M., Meyer, P., Sloane, F., Raffel, M., and Pratt, D. (1997). The Big Ten Student Suicide Study: a 10-year study of suicides on midwestern university campuses. Suicide & Life Threatening Behavior, 27(3), pp.285-303.
- Grall-Bronnec, M., Caillon, J., Humeau, E., Perrot, B., Remaud, M., Guilleux, A., Rocher, B., Sauvaget, A., and Bouju, G. (2016). Gambling among European professional athletes. Prevalence and associated factors. Journal of Addictive Diseases, 35(4), pp.278- 290.
- Mellalieu, S.; Fletcher, D.; Neil, R. and Hanton, S. (2009) Competition stress in sport performers: stressors experienced in the competition environment. Journal of Sports Sciences, 2009
- McDuff DR, Garvin M. Working with sports organizations and teams. Int Rev Psychiatry. 2016 Dec;28(6):595-605. doi: 10.1080/09540261.2016.1212820. Epub 2016 Aug 9. PMID: 27686114.
- Lazarus, R. (2000). Toward better research on stress and coping.American Psychologist, 55(6), pp.665-673.
- Timpka, T., Spreco, A., Dahlstrom, O., Jacobsson, J., Kowalski, J., Bargoria, V., Mountjoy, M., and Svedin, C. (2020). 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.British Journal of Sports Medicine, [Published Online First] 26 February 2020.
