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How to help athletes recognise the mental health risks of sport

Although athletes might benefit from a rush of endorphins that elevates their mood and suppresses feelings of pain when they exercise, this antidepressant effect will not stop them from normal feelings of anxiety, agitation, depression, self-doubt or experiencing sleep disturbance1 just like any other person in the community

Sadly, we can’t always see when someone is suffering from mental illness. Even for the athletes themselves, they may not recognize the signs and just attribute their feelings of tiredness and depression as being due to a tough work out and “par for the course”

Building mental health literacy is our first important step towards improving the mental health of athletes and ourselves.

Just like a fractured leg, mental health issues can have different degrees of severity and effects on performance.

Mental Health Disorders

These disorders are diagnosed on the basis of a list of symptoms and the frequency they occur in order to meet the criteria outlined in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)2. Such conditions include e.g. Bipolar and Psychotic; Attention-deficit/Hyperactivity (ADHD); Post-traumatic Stress (PTSD); Substance and abuse and Eating Disorders.2

Mental Health Symptoms

These symptoms of distress can be common to all of us and do not follow a DSM- 5 pattern E.g. Depression, anxiety, fatigue, loss of concentration, decreased pleasure or interest.

It is possible for an athlete to suffer from mental health symptoms and disorders without any association between their sports participation and mental health condition 3-5

Specific risk factors for athletes.

During the course of a sporting career, generic and sports specific factors can conspire to increase the mental health risks compared to other athletes. Precipitating factors might include:

  • Failing to surpass their personal best times/targets due to a loss of form
  • The pressure of discipline to keep training as well as the pressure to perform imposed by the media and expectations of fans, friends and family.
  • Overtraining, and transitioning too soon onto higher levels of difficulty can lead to injury and fatigue.
  • Loss of sleep, particularly in the lead up to competition, can increase stress levels and impede self-regulation capabilities such as planning, prioritizing, control of emotions and behavior.
  • Making weight in sports categorized by weight, while at the same time having sufficient energy intake to compete can prove challenging for some athletes.
  • Lifestyle issues– leaving family to tour, balancing studies and training, living in residential halls can prove very stressful.
  • The down times- recovery from injury, non-selection can lead to feelings of isolation
  • Serious injury – especially head injury/concussion, unplanned early retirement, can lead to feelings of sadness and loss of identity.6-8

Risk factors vary across career phases

During junior development athletes are more dependent on a stable family life and the support of parents and coaching staff. Any changes in this such as shifting town or changing schools or coach, or family breakdown can be very de-stabilizing emotionally.

At high performance and elite development level, athletes are dependent on environmental and training demands such as access to venues and equipment for training and weather conditions and billeting arrangements if touring to other cities etc.

Transitioning out of sport, whether planned or forced, can lead to body dissatisfaction and grief, eating disorders and compensatory behavior such as increased alcohol and drug use during this transitionary period 7-8

Barriers to help seeking

There can be lots of different circumstances that delay athletes with mental health concerns from seeking help.

  • Lack of mental health literacy: as mentioned earlier not all athletes are aware of the symptoms associated with mental health problems, they are unsure of what distress is compared to normal levels of stress, thinking its normal to feel tired etc.
  • Athletes unsure who to approach for help: athletes may be unsure when, where and who to go to. They may fear that talking to their coach may reduce their chances of re-selection or be seen as a sign of weakness.
  • Athletes fear breach of privacy: athletes may fear that their competitors or teammates might find out their vulnerabilities and that this could alter their place in the team.
  • A negative attitude: athlete could be just stubborn or believe that their problem will solve it’s-self. Any bad experience in the past talking to a health professional may make them wary of trying again.
  • Practical barriers to access help: athletes may have problems accessing transport or funding to attend appointments with health professional who can help.6

Concerns about Covid-19

Junior and High performance/elite athletes are reporting mental strain9 associated with having to grapple with feelings of:

  • Uncertainty and anxiety about when qualifiers will be held
  • Fear that they may lose their competitive edge or get sick
  • Isolation in various stages of lockdowns can feel disconnected from their teammates, family, friends and support services.
  • Being lost and beginning to over think their life’s direction and choice of sport.
  • Loss of control over issues such as retirement. Suddenly Covid-19 is calling the shots, effecting their play, life plans, training, location etc.
  • Emotional stress, particularly if someone they know or a family member becomes ill with Covid -19
  • Tiredness, fatigue can be due to a serious lack of sleep or appetite but is also a sign of depression. Some athletes recovering from Covid-19 are reporting chronic fatigue lasting for weeks

There is concern also that Covid-19 can trigger pre-existing illnesses such as anxiety, depression, Obsessive Compulsive (OCD); Post-traumatic(PTSD) and Eating disorders.9

What can be done to help?

  • Encourage athletes to talk about their feelings with people they trust.
  • Seek help from health professionals e.g. sports psychologist, sports dietitian, school counsellor if struggling to cope.
  • Encourage routines for sleep, exercise, healthy eating and involvement in some non-sporting activities.
  • Reduce reliance on social media and chat shows as these can increase anxiety.
  • If caught in lockdowns maintain fitness by encouraging athletes to talk to their coaches about training exercises, online video training to maintain their fitness.
  • Build mental health literacy and discuss any concerns with your GP who can then refer you on to get the appropriate help.
  • At a team level encourage management to develop a non-judgmental environment where athletes can talk openly and gain access to education and prevention of mental health illness.
  • As discussed earlier, insufficient sleep can affect our ability to self-regulate the things we do. E.g. thinking, emotions, responses, problem solving, strategic thought. A lack of sleep can also alter the hormones that regulate appetite, growth, gut and heart health and our weight.10 So encourage athletes to get a good sleep hygiene

The nutrition message

Exercise has many health benefits and most of all we want athletes to be injury free, to have fun and enjoy a wide range of physical activity throughout their life.

We have just looked at some of the mental health concerns facing athletes today however prevention is alway better than cure.

Paying attention to nutritional adequacy now can make all the difference to an athletes total health and sporting success in the long-term as well.

Eat well

There are a number of nutrients that protect and improve brain health and cognitive function and that also provide the energy and strength to think more clearly, to support mobility and build a healthier body. Are you getting enough?

Get a nutritional assessment

As this can help an athlete review their intake of these nutrients and to build a sports nutrition plan for their sport and future competition. Results can be back within a few days so it’s well worth the effort.

Prevent eating disorders

A lack of nutrients and energy can contribute to eating disorders and chronic health problems in anyone. However, this is particularly a problem for athletes competing in sports where leanness may contribute to their success e.g.

  • Weight categorized – rowing, equestrian, martial arts, wrestling
  • Aesthetic and anti-gravitational; gymnastics, figure skating, ballet, aerobics and swimming.
  • Leanness advantage– cross country, cycling, endurance, distance, runners, athletics.

It is possible to reach and maintain a healthy body weight for one’s sport but it does take knowledge, commitment and the support of family, coaches and team mates.

If you have concerns about a family member then seeking nutritional support sooner rather than later is the best advice.

Team building
Sports Dietitians can be a valued member of a sports team (working with individuals or as a group) to raise awareness of the nutritional demands of the sport and how to maximise energy levels to achieve team goals. They can also work alongside team doctors and sports psychologists to help any athletes struggling to cope.

If you would like to personally learn how to gear your energy intake to suit your mental and physical demand’s then contact me for an online appointment. I’d love to help you.

.

For further reading on similar topics:

Brain food : Part 2 Thinking food

Sleep for better self-regulation and diet

Retiring athletes may need to rethink their nutrition

Are you eating enough to build strength?

Orthorexia Nervosa: when healthy eating can make you sick

Alcohol and sport- is it a good match for you?

Don’t let disordered eating ruin your performance

 

References

1. Cooney GM, Dwan K, Greig CA, et al. Exercise for depression. Cochrane Database Syst Rev 2013;12:CD004366.
2.American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5. Washington, DC: American Psychiatric Publishing, 2013.
3.Smith B. Causes of mental illness WebMD June 30 2020 https://www.webmd.com/mental-health/mental-health-causes-mental-illness#1

4.Reardon CM.et al. Mental health in elite athletes: International Olympic Committee Consensus Statement (2019) Br.J Sport .Med. 2019; 53:667-699.
5.Reardon CL. Psychiatric comorbidities in sports. Neurol Clin 2017;35:537–46
6.Gulliver 1, Griffiths KM, Christensen H. Barriers and facilitators to mental health help seeking for young elite athletes: a qualitative study. BMC Psychiatry 12 Article number: 157 (2012).
7. Purcell R, Gwyther IC, Rice SM. Mental health and elite athletes: Increase awareness requires an early intervention framework to respond to athlete’s needs. Sports Med Open 5, (46) 28 Nove2019.
8. Buckley GL, Hall LE, Lassemillante AC M, Ackerman KE, Belski R. Retired athlete and the intersection of food-body: A systematic literature review exploring compensatory behaviour and body change. Nutrients 2019 June:11(6):1395.
9.Edwards, C; Thornton, J. Athlete mental health and mental illness in the era of COVID-19: shifting focus with a new reality. March 25,2020. Blog: Brit.J. Sports med. https://blogs.bmj.com/bjsm/2020/03/25/athlete-mental-health-and-mental-illness-in-the-era-of-covid-19-shifting-focus-a-new-reality/

10.O’Donnell S, Beaven M, Driller MW. From pillow to podium: a review on understanding sleep for elite athletes. Nat.Sci. Sleep. 2018; 10:243-253.

About the author View all

Lea Stening

Lea is one of New Zealand’s leading paediatric dietitians and also specialises in Sports Nutrition. She has specialised in Paediatric Nutrition for 31 years and in 1985 was the first paediatric dietitian to enter private practice in New Zealand. Lea helps families through her private consultations, public lectures, newspaper and magazine articles as well as television and radio interviews. Read more »

View all posts by Lea Stening »

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