Mental Health/Wellness

Mental illness in student-athletes may relate directly to the athlete’s sport, or it may have nothing to do with the sport.  There are 3 possible relationships between the student-athlete’s sport and their mental illness:

1. The illness is caused or worsened by the sport (for example, a student-athlete who develops an eating disorder directly related to wanting to be thin for their sport)
2. The student-athlete chooses the sport as a way to cope with the mental illness (for example, the student-athlete with anxiety who finds that running helps them to feel less anxious)
3. The sport and the mental illness are completely coincidental and have nothing to do with each other

While student-athletes are probably at similar risk for most mental illnesses compared to the general population, there are several unique factors that may especially put athletes at risk for these conditions.  These include:

1. Injuries (including musculoskeletal injuries and concussion)
2. Lack of balance in life (no free time, including time with friends)
3. Pressure of competition
4. Overtraining (training too hard for too long without enough time for recovery)
5. Failure in sport
6. Harassment and discrimination related to personal characteristics such as race/ethnicity or sexual orientation
7. Coaching styles that do not match up with how the student-athlete performs best    

Like most other mental illnesses, depression probably occurs in athletes at the same rate as in the general population.  Symptoms of depression include (and note a person does not need ALL of these symptoms in order to have depression):

1. Feeling sad, down, hopeless, or tearful on most days
2. Feeling irritable on most days (this can be especially common in adolescent depression)
3. Not looking forward to or enjoying things that used to make the person happy
4. Feeling worthless
5. Lower energy than usual
6. Worse concentration than usual
7. Appetite changes (either much lower or much higher than usual)
8. Sleep changes (either trouble falling or staying asleep or sleeping more than usual)
9. Thoughts of death or dying, including suicidal thoughts

On rare occasion, someone who has times of feeling depressed may have a condition called bipolar disorder.  This is a disorder in which they not only may have times of depression, but they also have times of abnormally elevated mood (called mania or hypomania). In mania or hypomania, they have multiple days or weeks on end of feeling euphoric, not needing very much sleep and still feeling rested and very energetic (this is different than simple insomnia in which they wish they could sleep but can’t), feelings of being better than everyone around them, talking much more quickly than usual, engaging in uncharacteristically risky behaviors without thinking through the consequences, engaging in much more activity than usual, seeming more sexual than usual, and reckless spending of relatively large amounts of money (note a person does not need ALL of these symptoms in order to have mania or hypomania).  Importantly, this is not just feeling better than they feel compared to when they are depressed. It is a dramatic state of elevated mood in which people around them notice they are not their usual selves, and the behaviors and symptoms create problems in their lives.

Student-athletes with depression, bipolar disorder, or any number of other psychiatric disorders may be at risk for suicide.  High school student-athletes do no appear to be at any greater risk of suicide than their non-athlete peers. 

Anxiety may also occur in student-athletes at the same rates as in the general population.  Some symptoms of anxiety are similar to those of depression.  It is possible that athletes can have both depression and anxiety.  Symptoms of anxiety may include (and note a person does not need ALL of these symptoms in order to have anxiety):

1. Worry about many things (for example, sports, school, friends, family, day to day obligations) in a way that feels difficult to control and happening on most days
2. Trouble sleeping (especially falling asleep)
3. Lower energy than usual
4. Worse concentration than usual
5. Muscle tension
6. Feeling fidgety or restless
7. Feeling irritable much of the time
8. There are also specific types of anxiety that can occur, including:

Social anxiety disorder:  This is a condition in which someone has significant fear and anxiety about being negatively judged and evaluated by others.  People with this condition may be viewed as extremely shy or unfriendly, but in actuality, these people would like to be able to make friends.  They dislike being the center of attention and being observed while doing something, and this can make it hard for some people to participate in certain sports, especially individual sports.

Panic disorder:  This is a condition in which someone has sudden, severe attacks of intense anxiety and fear lasting several minutes. They usually involve physical symptoms such as feeling short of breath, feeling one’s heart beat hard in the chest, or feeling dizzy.  Sometimes the symptoms can feel similar to how people feel when they exercise intensely, and that can make an athlete with panic disorder start to avoid their sport out of fear that exercise will bring on an actual panic attack.

Obsessive-compulsive disorder (OCD):  This is a condition in which someone has repeated, unwanted thoughts that come into their mind that they have difficulty controlling (obsessions) and/or physical or mental behaviors that they feel must be performed over and over (compulsions).  Examples include intense fear of germs and associated washing of hands over and over, or ordering things “just so” or symmetrically to an extreme degree.  OCD is different than superstitious rituals, which are usually harmless.  Rituals are common among athletes, and examples include wearing the same pair of socks for every game or eating the same meal before each race. Full-blown OCD may be more common in athletes than in non-athletes.

Post-traumatic stress disorder:  This is a condition in which someone has suffered any sort of trauma (for example, physical, verbal, or sexual abuse, assault, major accidents or illnesses).  Associated with that trauma, they have symptoms that may include:  nightmares or flashbacks about it, avoidance of anything that reminds them of the trauma, increased startle response, and any of a number of symptoms of depression and anxiety.  Traumas unique to athletes may include “out of the ordinary” sport-specific adverse events, such as severe injuries (especially if they involve threats to physical integrity), witnessing of lethal accidents, loss of a crucial game where the athlete feels they are to blame, public cheating scandal, or teammate suicide. The more a student identifies themselves as "athlete" to the exclusion of other sources of identity, the more traumatic a major injury may feel to them.

1. Student-athletes with mental health concerns may reach out to any of a number of people, including coaches, athletic trainers, team physicians, parents, school nurses, school counselors, or others.  In emergency situations such as when someone is suicidal, any of these contacts should ensure the athlete gets emergency treatment, such as in the emergency department.  Additionally, student-athletes (and anyone else) in the U.S. may call or text 988 to access the Suicide and Crisis Lifeline, through which they will be able to talk to/message with a trained counselor.

2. For non-emergency issues, student-athletes should be referred to health care providers who are familiar with mental illness if it is suspected that they might be suffering from such a condition.  These providers include pediatricians, family medicine physicians, internal medicine physicians, sports medicine physicians, psychiatrists, psychologists, or other counselors/therapists.  Early signs that an athlete might be suffering from mental illness include changes in personality, demeanor, interactions with peers, and general behavior. 

3. Treatment may include talk therapy (psychotherapy), medications, or changes in the environment.  The athlete will usually be allowed to continue to participate in the sport.  However, if the sport itself is significantly contributing to the symptoms, then a break from sport may be necessary.

4. The National Federation of State High School Associations (NFHS) has developed a course for student-athletes and anyone responsible for their care and well-being titled “Student Mental Health and Suicide Prevention” that is available here: https://nfhslearn.com/courses/student-mental-health-and-suicide-prevention 

Mental Health Action Plan - Overview, Background and Information

Mental Health Action Plan Template and Flow Chart

COVID and Sports

COVID Mental Health Tips