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Are mental health conditions more common in sports performers? — December 3, 2013

Are mental health conditions more common in sports performers?

By Caroline Heaney

As cricketer Jonathan Trott went home early from the Ashes last week citing a stress related condition as his reason for doing so, mental health in sport has once again hit the headlines. There have been several high profile cases over the years of top level athletes revealing their battles with mental health conditions such as depression (e.g. Kelly Holmes, Marcus Trescothick and Ricky Hatton), but are sportspeople any more vulnerable to mental health conditions than the general population?

It’s certainly true that top level athletes compete in highly pressured environments and have to deal challenging situations such as long periods away from home, but what does the evidence say? In terms of research there simply isn’t enough evidence to answer the question of whether or not sportspeople are more prone to mental health conditions than the rest of the population.  The study of negative mental health amongst sports performers is a relatively new and emerging field of research. Traditionally research has examined sport and physical activity as a means of combating negative mental health, rather than as a potential cause. The potential for physical activity to have a positive impact on mental health is now well established (e.g. Blumenthal et al., 2007) and it is not uncommon for physical activity to be prescribed as a treatment for mild to moderate depression (e.g. Mental Health Foundation, 2008).

Most accounts of mental health issues amongst sports performers are anecdotal and more research is needed to establish the facts. There is however some research out there. Schaal et al. (2011), for example, undertook a study of 2067 French elite athletes. They found that 17% of the athletes had recently experienced at least one psychological disorder, with females (20.2%) demonstrating a higher incidence than males (15.1%). In relation to the prevalence of depression, 3.6% of the athletes (2.6% males and 4.9% females) had experienced at least one depressive episode in the last six months, and 11.3% of the athletes (8.7% males and 16.3% females) had experienced at least one depressive episode in their lifetime. Schaal et al. (2011) suggest that the rates of depression found are lower than in the general population, indicating that elite athletes are generally able to cope with the pressures placed upon them. Similarly, research undertaken by Proctor and Boan-Lenzo (2010) and Armstrong and Oomen-Early (2009) found that amongst a North American college population, athletes reported lower levels of depression than non-athletes, indicating that sports participation may have an anti-depressive effect. However, this could perhaps be due to a social unacceptability for the athletes to report psychological weakness, which could have biased the results. Reardon and Factor (2010) in their review of the research concluded that, given the inconsistency in findings, depression may be no more or no less likely in athletes compared to non-athletes.

Reasons suggested for why athletes might suffer with mental health issues are plentiful and include:

  • the social structure of some sports can disempower athletes
  • physical and psychological demands of sport can lead to burnout
  • heavy involvement in sport can develop a strong uni-dimensional athletic identity which can be damaging
  • some sports generate a culture where seeking help for a mental health concern would lead to stigmatisation and so issues escalate
  • many athletes participate in sport at an age where suicide  rates are at their highest
  • concussion is relatively common is certain sports and may cause biochemical disturbances in the brain that might lead to depression
  • diet e.g. biochemical changes associated with weight loss can be linked to depression
  • feelings of personal loss e.g. loss caused by a sports injury or retirement can lead to depression (Mummery, 2005; Hughes & Leavey, 2012; Fisher & Wrisberg, 2006; Henderson, 2007)

In conclusion it is not clear whether sports performers are more vulnerable or less vulnerable to developing mental health issues than the rest of the population, but what is clear is that mental health issues are relatively common amongst the population as a whole (1 in 6 adults according to Cooper & Bebbington, 2006) and that there is still a stigma attached to mental health; so a high profile sports person speaking publically about their difficulties with mental health can only be a positive thing.

Note: An adapted version of this article can be found at http://theconversation.com/trott-tweet-shows-why-its-hard-to-be-open-about-mental-health-in-sport-21103

References:

Armstrong, S. and Oomen-Early, J. (2009) ‘Social Connectedness, self-esteem, and depression symptomatology among collegiate athletes versus nonathletes’, Journal of American College Health, vol. 57, no. 5, pp. 521-526.

Blumenthal, J.A., Babyak, M.A., Doraiswamy, P.M., Watkins, L., Hoffman, B.M., Barbour, K.A., Herman, S., Craighead, W.E., Brosse, A.L., Waugh, R., Hinderliter, A. and Sherwood, A. (2007) ‘Exercise and pharmacotherapy in the treatment of major depressive disorder’, Psychosomatic medicine, vol. 69, no. 7, pp. 587-596.

Cooper, C., & Bebbington, P. (2006). Mental health. In M. Bajekal, V. Osborne, M. Yar & H. Meltzer (Eds.), Focus on health. Basingstoke: Palgrave Macmillan.

Fisher, L.A. and Wrisberg, C.A. (2006) ‘How sad is too sad?’, Athletic Therapy Today, vol. 11, no. 1, pp. 40-41.

Henderson, J.C. (2007) ‘Suicide in sport: athletes at risk’, in Pargman, D. (ed) Psychological Bases of Sport Injuries, 3rd edn. Morgantown, WV, Fitness Information Technology.

Hughes, L. and Leavey, G. (2012) ‘Setting the bar: athletes and vulnerability to mental illness’, The British Journal Of Psychiatry: The Journal Of Mental Science, vol. 200, no. 2, pp. 95-96.

Mummery, K. (2005) ‘Essay: depression in sport’, Lancet, vol. 366, pp. 36-S37.

Mental Health Foundation. (2008). New research shows rise in GPs prescribing exercise for depression. Retrieved 23rd March, 2009, from http://www.mentalhealth.org.uk/media/news-releases/news-releases-2008/8-february-2008/

Proctor, S.L. and Boan-Lenzo, C. (2010) ‘Prevalence of depressive symptoms in male intercollegiate student-athletes and nonathletes’, Journal of Clinical Sport Psychology, vol. 4, pp. 204-220.

Reardon, C.L. and Factor, R.M. (2010) ‘Sport psychiatry a systematic review of diagnosis and medical treatment of mental illness in athletes’, Sports Medicine, vol. 40, no. 11, pp. 961-980.

Schaal, K., Tafflet, M., Nassif, H., Thibault, V., Pichard, C., Alcotte, M., Guillet, T., Helou, N.E., Berthelot, G., Simon, S. and Toussaint, J. (2011) ‘Psychological Balance in High Level Athletes: Gender-Based Differences and Sport-Specific Patterns’, PLoS ONE, vol. 6, no. 5, pp. 1-9.

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