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Understanding mental health within sport psychology

This is an excerpt from Foundations of Sport and Exercise Psychology 8th Edition With HKPropel Access by Robert S. Weinberg & Daniel S. Gould.

Mental Health

A fairly wide variation exists in studies investigating the prevalence of mental health issues in athletes, sometimes comparing across sports and sometimes comparing against nonathletes. One of the issues in trying to document prevalence rates of mental illness is the conceptualization and definition of mental health and mental illness, especially as they relate to athletes competing in sport. Historically, the term mental health was used dichotomously as a way of distinguishing between optimal and suboptimal personal functioning (Henriksen, et al., 2020). Contemporary psychological science typically maintains that mental health is on a continuum, with one end representing the status of high-functioning individuals whose psychological states do not interfere with daily activities, and the other representing low-functioning individuals whose psychological states consist of a variety of problematic cognitive, emotional, or behavioral characteristics, often referred to as mental illness (Schinke et al., 2018). This continuum might range from active mental illness, to subclinical illness, to normal health (occasional symptoms), to good mental health, and to peak performance. For example, a soccer player might get depressed after missing a penalty kick that results in the loss of a championship game, and this might be seen as normal (or possibly subclinical if it persists for a period of time) but would not be considered mental illness.

Research on the prevalence of some degree of mental illness in sport continues to be conducted. Wolanin and Marks (2019) found that approximately 24% of college athletes surveyed exhibited mild depressive symptoms, with 6% showing moderate to severe symptoms. In this study, female athletes were almost twice as likely to display depressive symptoms; this is consistent with several other studies. In addition, 35% of track and field athletes reported at least mild depressive symptoms, with 8% displaying moderate to severe symptoms. The group at the lowest risk for depressive symptoms were lacrosse athletes, with 11% showing mild symptoms. However, the range of depressive symptoms in athletes in different studies have ranged from a low of 4% to a high of 68%, which is similar to the general population (Van Slingerland, 2021). Prevalence rates for eating disorders have ranges from 0% to 19% in male athletes and 5% to 45% in female athletes, which far outpace rates in the general population (Gorczynski et al., 2017). In another study, university athletes showed a similar prevalence rate of anxiety and depressive symptoms to college students, but they presented a higher subclinical and clinical risk (Donohue et al., 2018). Further research (Schaal, 2011) found that both athletes and nonathletes had prevalence rates on panic attacks (anxiety disorder) in the 2% to 4% range.

So, what do all these prevalence numbers mean? Basically, the prevalence of mental health issues within athletic populations and across samples varies widely; however, these are comparable or in some cases slightly higher than nonathletic peers, with females displaying more symptoms of mental health issues than males. This requires that individual differences be considered when making mental health judgments within an athletic population. Furthermore, many situational constraints might make athletes vulnerable to mental health issues, as are discussed in Mental Health of Athletes. Since the interest in mental health of athletes is fairly recent, the number of empirical studies, programs, or interventions to guide best practices is limited. However, we will present prevalence data, proposed causes of mental health issues, and interventions that appear promising.

Interventions to Help Athletes Cope With Mental Health Issues
With a variety of personal and situational factors impacting the mental health of athletes, several interventions have been developed to help athletes more effectively cope with these factors. Several of these interventions are discussed here.

Fogaca (2021) developed an intervention that was based on the transactional model of stress and coping (Lazarus, 2000). The aim was to implement a program that would combine teaching mental skills for sport performance and mental well-being in one intervention to enhance athlete buy-in and reduce the persistent stigma toward mental health interventions. The 8-week intervention included five sessions on mental skills training for performance and coping with life stressors, two sessions with coaches for social support, and four sessions with captains for social support. Results revealed that the intervention group had significantly higher scores on coping skills and lower anxiety than the control group. In addition, the intervention group appeared to have lower depression scores and higher quality of life scores than the control group, although these were only trends and were not statistically significant. Fogaca (2021) notes that combining mental skills for performance in sport and life and mental skills for improving mental health really helped athletes’ engagement with the program.

Liddle and colleagues (2021) developed an intervention to enhance the mental health literacy of adolescents who are typically at increased risk of mental illness and prefer to seek help from informal supports. The goal of the intervention was to assess the effects of a brief sports-based mental health literacy program to increase competencies and intentions to provide and seek help for mental health problems, including how to access appropriate resources, among adolescent male sport participants. The intervention was a brief 45-minute workshop (Help Out a Mate) that was delivered in a usual football team practice session. A short intervention was employed because adolescents often are not engaged or responsible enough to attend a multiday intervention program. The topics covered included the following:

• What is mental health and mental illness
• Myths about mental illness
• What is depression, including risk factors and causes
• Anxiety, including risk factors and causes, and how to provide help
  
  

Compared to a control condition, athletes who attended the workshop reported significant increases in knowledge of signs and symptoms of mental illness, intentions to provide help to a friend who may be experiencing a mental health problem, and attitudes that promote problem recognition and seeking out help.

Although not technically an intervention, improvement in mental health literacy by athletes could minimize their own mental health issues and help others who are struggling with mental health issues. Mental health literacy includes concepts related to

• knowledge of effective self-management strategies,
• challenging mental disorder stigma,
• awareness and use of mental health first aid to assist others (an education program designed to help individuals improve their knowledge of mental well-being and mental health symptoms, and respond to those who may be experiencing acute or chronic symptoms of a mental disorder), and
• facilitation of help-seeking behaviors among athletes (especially elite athletes) that is delivered in a manner that is context specific and culturally competent.
  
  

As discussed in detail in chapter 8, cultural competence involves recognizing culturally based differences as well as interacting and working effectively with people from cultures different than your own. Key components of cultural competence are cultural awareness, cultural knowledge, and cultural skills.

Pankow and associates (2021) investigated how coaches attempted to maintain their positive mental health, which they called flourishing. Interviews with coaches revealed three consistent themes for how they maintained their positive mental health:

1. Balance (managing sport and nonsport demands, making time for nonsport activities)
2. Personal growth (learning and reflection)
3. Making a difference (promoting the development of student-athletes’ personal competencies)

Finally, a treatment that has been gaining traction in helping athletes dealing with mental health issues is psychedelic-assisted psychotherapy (Walton & Liknaitzky, 2022). Despite much negative press in the past, classical psychedelics (e.g., LSD) are experiencing a revival in scientific and clinical research. The authors outline the potential for psychedelic therapies to treat mental health problems seen in athletes. However, high-quality clinical trials need to be conducted to assess the safety and efficacy of this treatment approach as well as ethical issues that this type of research would entail. The field of sport psychology should take note of these promising developments, as researchers and practitioners work through the challenges and possibilities of this type of treatment for mental health issues in athletes.

Sport psychology consultants could help coaches establish these and other principles to enhance their continued mental health.

These interventions are in their infancy, so more data will become available as researchers and practitioners continue to explore the mental health area for athletic populations. Furthermore, while most previous mental health studies in sport have focused on athletes and sport psychology consultants, Lebrun and colleagues (2020) have focused on coaches, highlighting the need to provide coaches with more knowledge and tools in dealing with athletes who have mental health issues. This is not to say coaches should be responsible for treating these athletes; rather, it is to help coaches provide support and understand how these mental health issues might affect athletes’ behavior and performance.

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