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

Authors:
Claudia L Reardon,  Brian Hainline,  Cindy Miller Aron, David Baron, Antonia L Baum, Abhinav Bindra, Richard Budgett, Niccolo Campriani, João Mauricio Castaldelli-Maia, Alan Currie, Jeffrey Lee Derevensky, Ira D Glick, Paul Gorczynski, Vincent Gouttebarge, Michael A Grandner, Doug Hyun Han, David McDuff, Margo Mountjoy, Aslihan Polat, Rosemary Purcell, Margot Putukian, Simon Rice, Allen Sills,Todd Stull, Leslie Swartz, Li Jing Zhu, Lars Engebretsen
Reference: Claudia L Reardon et al. Br J Sports Med 2019;53:667-699

Abstract

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.

This is a very thorough and in depth study of Mental Health, a few things that stand out for me

The reported prevalence of mental health symptoms and disorders among male elite athletes from team sports (cricket, football, handball, ice hockey and rugby) varies from 5% for burnout and adverse alcohol use to nearly 45% for anxiety and depression.

Men’s:

The reported prevalence of mental health symptoms and disorders among male elite athletes from team sports (cricket, football, handball, ice hockey and rugby) varies from 5% for burnout and adverse alcohol use to nearly 45% for anxiety and depression.

Prospective studies have reported that mental health disorders occur in 5% to 35% of elite athletes over a follow-up period of up to 12 months.

The sports with the highest general substance use/misuse rates across all substances for men’s elite sports are lacrosse, ice hockey, football, rugby, baseball, soccer, wrestling, weightlifting, skiing, biathlon, bobsleigh and swimming, and lowest for track, tennis and basketball.

Women’s

For women’s elite sports, the highest rates occur in ice hockey, gymnastics, lacrosse, softball, swimming, and rowing, and lowest in track, tennis, basketball and golf.

As women continue to engage in elite sport opportunities, their participation has led to varying degrees of cultural acceptance.

Women competing in sports traditionally considered ‘male’ may face being marginalised and stereotyped and may experience unequal training opportunities and resources.

Sexualisation, traditional gender roles, religion and ethnic beliefs all influence opportunities for women.

Tension may also exist between what is functionally optimal for women elite athletes to be wearing and what is culturally deemed acceptable. Gender stereotyping in the media may influence how women athletes view themselves.

Women athletes may be stereotyped as ‘lesbian’ to keep them from playing certain sports, or from playing for certain coaches or with certain teams. Some professional women athletes must train outside their native countries and may struggle to find a support network and cultural understanding from teammates in their new location

Summary on Male and Female

In general, those who participate in team sports are more likely to use or misuse substances than athletes in individual sports.

Common risk factors for use include: sport context and culture (eg, normative beliefs about heavy peer drinking or illicit drug use); situational temptation (eg, drinking games); permissive on attitudes among athletes, coaches and parents; male sex; use of performance enhancing substances or tobacco; identification as lesbian, gay, bisexual, transgender or queer; party lifestyle or drinking game participation; sensation seeking; overestimating peer use; achievement orientation; lower use of protective measures (eg, avoiding serious intoxication, using a designated driver); leadership position; fraternity/sorority membership; problem gambling; and injury.

Summary

The IOC has committed to improve the mental health of elite athletes, recognising that doing so will reduce suffering and improve quality of life in elite athletes and serve as a model for society at large. The IOC hopes that all involved in sport will increasingly recognise that mental health symptoms and disorders should be viewed in a similar light as other medical illnesses and musculoskeletal injuries; all can be severe and disabling, and nearly all can be managed properly by well informed medical providers, coaches and other stakeholders. Mental health is an integral dimension of elite athlete wellbeing and performance and cannot be separated from physical health.

Mental health assessment and management in elite athletes should be as commonplace and accessible as their other medical care; ideally elite athletes should have access to the best interdisciplinary care. To advance a more unified, evidence informed approach to mental health assessment and management in elite athletes, the IOC Consensus Group has critically evaluated the current state of the science and practice of mental health in elite athletes.

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Methods