Mental Health and Student Athletes: Statistics, Challenges, and Support
Athletes are often admired for their physical prowess and dedication. However, beneath the surface of peak performance lies a realm of mental health challenges that can significantly impact their well-being. Like other individuals, athletes are susceptible to mental health conditions, and in some cases, they may face an increased risk due to the unique stressors associated with their demanding lifestyles. This article explores the prevalence of mental health issues among student-athletes, the factors that contribute to these challenges, and strategies for providing support and fostering a culture of well-being.
The Rate of Mental Health Issues in Athletes
Many people experience a mental health condition at some point in their lives. Athletes, like other individuals, are susceptible to mental health challenges throughout their lifetimes. In fact, athletes may have an increased risk of developing mental health conditions. A 2019 study found that about 35% of elite athletes have mental health concerns. The top issues reported by athletes included feelings of burnout, depression, and anxiety.
Athletes operate under intense pressure. They often face unrealistic expectations from coaches, fans, teammates, and even themselves. The relentless pursuit of perfection can take a toll on their well-being. Athletes often face the challenges of balancing personal responsibilities and meeting their sports commitments. For instance, student athletes must ensure their grades remain in good standing while being part of a school team.
Mental health issues can affect anyone at any stage of their life. However, athletes often face unique stressors, which can leave them vulnerable to mental health conditions. Recent research has dispelled the concept of athletes being immune to depression. The notion that athletes aren’t prone to depressive episodes came from the idea that exercise “makes you happy” and releases mood-boosting endorphins.
Recognizing the Signs of Mental Health Issues in Athletes
Looking for the signs of mental health issues is the responsibility of coaches, athletic trainers, and family members. Although each individual experiences symptoms differently, there are common indicators to look out for. Athletes can face a variety of mental health challenges throughout their sports careers.
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Eating Disorders
Athletes, especially those in specific sports, tend to follow extreme diets or exercise regimens. They do this to control their weight. Anorexia, bulimia, and binge eating are three types of eating disorders that can affect athletes. Eating disorders are more common in females who play sports, particularly in women who feel dissatisfied with their physical appearance. There are also stereotypes in sports that can lead to disordered eating. For example, there’s the false perception that runners and swimmers must be thin to perform well. Coaches often perpetuate eating disorders within specific sports teams. Dieting, weight loss, and extreme training may lead the coach to characterize the individual as a “good athlete” dedicated to their team.
Substance Misuse
One driving factor of substance misuse in athletics is that players want to gain an advantage on the field. Players rely on steroids and other types of drugs to enhance speed and strength. Anti-doping agencies have tried to reduce illegal drug use. However, some substances have evaded detection. Another concern among athletes is painkiller misuse. Due to frequent injuries, athletes may take narcotics to manage pain symptoms. Once the injury heals, the individual may still rely on the opioid and find it difficult to quit. Retired athletes will also misuse painkillers following their professional careers.
Sleep Disturbances
Research has found that sleep issues occur in about 25% of athletes. Poor sleep affects a person’s sports performance and their ability to focus. Sports factors that can contribute to difficulties sleeping include high training loads, early morning training, late night training and competition anxiety. Sleep disturbances can also occur as a result of concussions.
Anxiety, OCD, and ADHD
According to the NCAA, 85% of athletic trainers believe anxiety among student athletes is a cause for concern. Players can struggle with performance anxiety or generalized anxiety disorder. Anxiety can cause symptoms that affect the mind and body. In a recent study, the American Journal of Psychiatry published that OCD is more common among college athletes than previously believed. The expected rate of OCD among the population was 2.3%. However, researchers found that the percentage was 5.2%-nearly double the anticipated rate. Athletes and others with OCD develop obsessive thoughts that lead to compulsive acts. Attention-deficit/hyperactivity disorder (ADHD) is very common among athletes and non-athletes alike. However, there are special considerations for athletes with this disorder. Medications used to treat ADHD may raise core temperatures, leading to a higher risk of training-related illness or injury. In addition, athletes with ADHD may struggle when presented with high expectations from sports teams, especially when combined with strict academic requirements. Athletes with ADHD may or may not have a formal diagnosis.
Factors Influencing Mental Health in Athletes
A combination of personality, cultural, and environmental factors influence the rate of mental health disorders in athletes.
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Personality
Athletes often possess specific personality traits that help them succeed. Certain characteristics often allow them to thrive in competition. However, these traits can predispose athletes to mental health disorders. Research shows that athletes tend to be hardworking, persistent, committed, intelligent, able to have a high level of self-control and achievement-oriented good decision-makers. Persistence and diligence are often viewed as positive traits. However, these same characteristics can lead athletes to place a lot of pressure on themselves. The intense pressure to perform consistently and endure grueling training regimens can contribute to high anxiety levels. Perfectionism can have negative consequences, and sports teams often want flawless game play. However, when someone overthinks their performance, such stress can undermine their ability. When athletes underperform, they question their self-worth, heightening their fear of failure.
Gender and Sexual Misconduct
An NCAA Student-Athlete Well-Being study released in 2022 found that female athletes experienced more incidences of mental exhaustion, sadness, and anxiety than their male counterparts. Suicide rates among female athletes have increased in recent years. For example, in 2022, five female athletes in the NCAA took their own lives. In many of the cases where female athletes died by suicide, injuries and mounting pressures have been contributing factors. Sexual misconduct and harassment have also factored into the mental health spectrum in athletics. All genders face a risk of harassment from coaches and teammates. Studies show that peers on sports teams are more likely to commit acts of sexual misconduct than coaches. Abuse can range in severity, but higher levels of competition have been linked to an increased likelihood of sexual misconduct.
Hazing and Bullying
Hazing is the practice of subjecting new players to abusive rituals. The practice can have severe short- and long-term effects on an athlete’s mental health. Hazing often involves taking health risks, such as drinking an excessive amount of alcohol in a short period. Not only does hazing pose mental health challenges, but the acts put a person’s physical well-being in jeopardy. Hazing rituals put an individual at risk for a career-ending injury and an increased chance of negatively affecting athletic performance on the field. Bullying in athletics can involve coaches or peers as perpetrators. Bullying can take on different forms and have long-term consequences. Bullied athletes can experience feelings of exclusion, isolation, and low self-esteem. Some individuals who are bullied during sports can develop depression, anxiety, or acute stress disorder.
Injury and Illness
Sustaining an injury or falling ill can prove stressful for anyone. However, injured athletes often feel intense pressure to rehabilitate quickly and return to the field. If an injury is severe and an athlete can’t return to their sport, they can experience a loss of identity. An injury can sometimes unmask mental health issues such as anxiety and depression. Injuries can increase the risk of substance misuse as players attempt to self-medicate to recover quickly. Additionally, injured athletes are at risk of disordered eating-they may significantly limit their calorie intake because they are hurt and feel they “don’t deserve to eat.”
Concussions
Concussions pose a serious risk to athletes. For women, basketball and soccer pose a higher concussion risk. Common symptoms of a concussion include dizziness, headache, nausea, confusion, memory impairment, balance issues, and cognitive impairment. Concussions have been linked to mental health issues including anxiety, depression, and sleeping difficulties. Most people recover from a concussion over time. However, repeated concussions can lead to chronic post-concussion syndrome and chronic neurodegeneration. In recent years, more attention has been given to chronic traumatic encephalopathy (CTE), a progressive brain disease found in people who have sustained repeated impacts to the head. Contact sports like American football are a primary cause of CTE. While many symptoms overlap with those of concussions, CTE symptoms typically manifest years or even decades after experiencing brain trauma or after an individual stops actively participating in contact sports.
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Overtraining Syndrome
With the intense competition of sports, athletes may think that more training is better. However, even strong, athletic bodies can only endure a certain amount of stress. Overtraining syndrome (OTS) occurs when athletes train beyond their bodies’ ability to recover and do not allow adequate rest. The exact process of OTS is still unknown, but it is believed a lack of rest and repair places the body into survival mode. When this happens, multiple systems within the body adapt to the inhospitable environment created by stress and insufficient rest. These adaptations, which are designed to keep the body alive at a basic level, lead to immunological, neurological, muscular, metabolic, and psychological changes. In overtraining syndrome, athletes reach a plateau followed by a decline in performance.
Strategies for Supporting Athlete Mental Health
To effectively support the mental health of athletes, it’s essential for everyone involved in their lives to adopt a comprehensive approach.
Team Dynamics
Team dynamics play a prominent role in athletes’ mental well-being. Coaches and other staff must prioritize creating an inclusive team environment where everyone feels supported. Maintaining connections with everyone on the team is important, even if a player is out due to injury. Involve the injured athlete as much as possible in team-bonding experiences to help them feel included. Team-building activities help foster positive relationships between staff and team members. Retreats, scavenger hunts, team trivia, or community service projects are a few examples of ways that teammates can come together off the field.
Work-Life Balance
Maintaining a healthy work-life balance is crucial for an athlete’s mental health. Players need to set boundaries between their sports commitments and personal lives. It’s important for athletes to rest or take breaks between training schedules in order to recover mentally and physically. If coaches notice a player is struggling, they can ask what the athlete may need to feel better. For instance, athletes may need time away from the sport or a different training schedule.
Addressing Stigma
One of the top barriers to addressing mental health concerns in athletes is the stigma surrounding mental health conditions. Athletes may feel that speaking up about mental health issues will put their careers in jeopardy. To combat stigma, it’s important to share resources like educational articles and webinars to increase the understanding of mental health issues. Athletic trainers are typically the first point of contact in managing mental health concerns for student athletes. Trainers are expected to provide the necessary resources for team members to get the help they need. In some situations, trainers or team physicians can make referrals to mental health professionals.
Open Communication
Creating a culture of open communication makes a significant difference in supporting the mental health of athletes. Everyone on a team should feel comfortable expressing emotions. Team members should feel safe when reporting issues that could affect athlete mental health, such as team hazing or bullying. Coaches and staff can strive to have an open-door policy and should receive training to effectively handle such concerns. Regular team meetings should be part of a sports schedule. Coaches can allow athletes to share their experiences and receive support in a safe space. Before a new player joins a team, coaches can share a pre-screening questionnaire to assess the person’s mental health.
Mental Health Awareness Programs
Athletes should be exposed to mental health awareness programs from a young age. Coaches, support staff, and players should know how to recognize signs of mental distress and should be aware of available resources. Mental health programs spark discussions that allow athletes to seek support without judgment. While coaches and trainers can offer resources, they aren’t expected to treat mental health disorders.
Self-Care Plans
One strategy for maintaining mental health involves creating a self-care plan. An athlete can brainstorm strategies that focus on well-being. Athletes are not immune to struggles and should feel supported to acknowledge their vulnerabilities. High-profile athletes who share their mental health challenges can have a lasting impact-they encourage others to speak up and seek help. Anti-stigma projects, like the Deconstructing Stigma public awareness campaign, often highlight personal stories of everyday people brave enough to share their mental health journey.
Age Considerations of Athletes
It’s important to consider age in the context of mental health. The risks of mental health issues are different for athletes at the youth, college, professional, and retirement levels.
Youth
According to the American Academy of Pediatrics, youth sports offer positive mental health benefits, including better sleep, improved communication skills, better concentration, and a boost to self-confidence. However, since young athletes often fear failure, they are at risk of experiencing stress and anxiety. As the level of competition increases, the risks of anxiety, eating disorders, and depression grow. Today, college and professional teams start the recruitment process early, and many high school students may not be prepared for the intensity of the experience. In high school, about 57% of all students participate in at least one sport. High school sports have a higher level of competition than recreational youth leagues. High school sports also frequently require more practice and training time. The physical and mental commitment can take a toll on teens. More than 60% of those who participate in sports report feeling moderate to severe levels of stress. The stress of sports affects all areas of students’ lives-including athletic performance.
College
The data indicated rates of mental exhaustion, anxiety and depression have seen little change since fall 2020 and remain 1.5 to two times higher than identified before the COVID-19 pandemic. The Association-wide survey, which was open from Nov. 17-Dec. 13, had responses from over 9,800 student-athletes. "A lot of what influences the direction on this topic is what sort of conversations are happening on a campus surrounding mental health," said Scott Hamilton, a mental health clinical counselor at DePauw. Hamilton is also the coordinator of student-athlete mental health at DePauw. "Within a week or two, you start to see some familiar faces show up at the counseling center," said Hamilton, who has worked at DePauw for 12 years. The survey included a question about teammates taking mental health concerns of one another seriously. Sixty-five percent of women's sports participants and 58% of men's sports participants agreed or strongly agreed that they did. Sixteen percent of the women's sports participants said they felt very lonely constantly or most every day, a drop of 5 percentage points from the fall 2020 survey. Half of the student-athletes were pleased about their ability to find balance between academics and extracurricular activities, including athletics. Eighty-four percent of women's sports respondents and 78% of men's sport respondents said they occasionally or frequently performed volunteer work. Regarding racial justice engagement over the prior six months, 81% of women's sports participants and 73% of men's sports participants took an active role in learning more about race or racial justice on their own. In gender equity engagement, 72% of women's sports participants and 56% of men's sports participants reported actively trying to learn more about gender equity on their own. College athletes are balancing school, social life, and this time-consuming and physically draining job of playing a sport. College athletes are going through all of this while dealing with many other personal issues at such a young age. This overload of activities at the same time can cause a person to “crash,” and collegiate sports don’t take this into account. In addition, athletes are less likely than other college students to seek help. One study shows that around 33% of all college students will experience serious mental health struggles, such as depression, anxiety, or eating disorders. Among this group, around 30% seek help through college resources. However, of college athletes experiencing mental health struggles, only around 10% seek help. College athletes are ordered to be mentally tough so often that they never seek help when they face a true issue because they don’t want to show weakness or vulnerability. One factor of college athletes' mental health struggles is the lack of sleep they receive. A study stated that poor sleep has been linked to a greater risk of depression & anxiety.
NCAA Initiatives
Recognizing that success in sports is inseparable from good mental health, the NCAA is helping colleges and universities create healthier, more supportive environments where student-athletes can thrive both on and off the field. The NCAA is adopting a holistic approach that recognizes the relationship between mental, emotional, and psychological wellness. The NCAA has also strengthened academic and counseling support services. Educational resources are being developed to help coaches, athletic trainers, and student-athletes recognize signs of mental distress and seek appropriate help. However, just as important in the program is the inclusion of a benefit that offers up to $25,000 for mental health services related to an injury.
On Feb. 14 students and staff gathered to listen to “Surviving or Just Thriving? Student Athlete Health and Wellness Post Pandemic,” presented by the Director of Research and Policy at the National Collegiate Athletics Association (NCAA), Lydia Bell. During the presentation, Bell spoke about the data from an NCAA substance use and mental health survey. Bell explained that the NCAA sent out a nationwide survey to each school’s Faculty Athletic Representative (FAR), who then administered the survey to a few teams preselected by the NCAA. The survey was a paper and pencil survey that was anonymous and voluntary. Across the NCAA divisions there were 23,000 participants, with about 6,000 from division II. The data Bell presented was specific to division II schools during the 2022-2023 academic year. Bell first covered substance use. “There is a continued decline in alcohol use in student athletes,” Bell said. “This is the lowest number we have seen in alcohol use.” One substance that has increased is vaping and e-cigarette use. This increase could be due to the age of the students taking the survey. When these athletes were in high school vaping was very accessible, Bell explained. Bell is curious to see if the trend will start to decline, with more regulations put in place. Bell then moved into mental health. The survey asked questions about feeling mentally exhausted, overwhelmed, and whether the student athletes experienced sleep difficulties. “They reported feeling these mental health concerns either constantly or almost every day,” Bell said. The numbers were higher for women as well as those who are part of the LGBTQIA+ community. “Part of the work we are trying to do in research is think about all the various strands of identity of our athletes whether it’s racial identity, socioeconomic status, gender identity, sexual orientation, and really think about how all the different components of the athlete themselves impacts their mental wellness,” Bell explained. When asked what is driving their negative mental health, most of the answers were not athletics related. The biggest cause of anxiety was academic worries followed by financial worries and the future. A majority of student athletes said they feel their coaches care about their mental health, but only 54% of men and a third of women feel comfortable talking to their coaches about mental health. This could be due to stigma, but it could also be that there are more resources on campus so students may not want to talk to coaches about mental health, Bell explained. The survey also addressed whether the student athletes felt adequately rested. Sleep is something that a lot of college students struggle with, not just athletes. The NCAA survey found that about 50% of athletes say that they wake up well rested less than three days a week. Only 14% of women felt well rested most days of the week. Bell emphasized the importance of sleep, in general, in addition to their athletic performance. “Sleep is an amazing, free and legal, performance-enhancing drug,” Bell said. The NCAA found that athletes who specialized in sports by age 12 were more likely to experience physical and mental burnout than those who did not. In addition, athletes who sustained one or more major injury, either requiring surgery, hospitalization, or at least one month away from the sport before college were more likely to face a major injury in college. Another major focus of the study was on weight and body image. The survey data indicated that most participants felt like they were the right weight for their sport. For those who did not feel like they were the right weight, however, men were more likely to say that they are underweight, and women were more likely to say they are overweight. Although two-thirds said they felt they were the “right weight for their sport,” more than 40% of men said they were trying to gain weight and more than 40% of women said they were trying to lose weight. “Clearly it is not their sport that is driving their perceptions of their body.
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