A safer approach to
work, life and sport


A safer approach to work, life and sport


Athlete Mental Health

Amanda Muscatell 10 October 2018

The Positive Impact of Sports on Mental Health

As a whole, sports participation provides physical, emotional and social benefits for adolescents. Playing sports helps keep kids active and is a leading indicator of future health. Student athletes are more likely to remain physically active as adults and are subsequently less likely to experience obesity, cardiovascular disease, cancer and stroke. To reap these benefits, the Center for Disease Control and Prevention (CDC) recommends that youth participate in at least one hour of physical activity daily. However, by the time students are in the 6th grade only approximately 28% of girls and 41% of boys are meeting this recommendation.1 Sports participation, at the appropriate age and skill level, may also provide substantial mental health benefits. The CDC reports suicide as the third leading cause for death in adolescents and advocates for sports participation because of the psychological benefits. “Frequent vigorous activity reduces the risk of feelings of hopelessness and suicidal tendencies in both males and females. In addition to the physical benefits of exercise, the social support and acceptance that being part of a team can provide contribute to the success of sport in reducing the risk of suicide. Student athletes who report a strong social support system appear to be more resilient in terms of the negative processes that push teenagers toward suicide. The influence of friendship and peer interactions cannot be underestimated for the female athlete.” 2,3

Athlete Mental Health

Sports participation, however, does not make an athlete immune from mental health conditions. “Mental health isn’t apart from, but rather a part of athletic health,” explained Brian Hainline, NCAA Chief Medical Officer at the 2017 Collaborative Solutions for Safety in Sport. “Student athletes, they look fit so, basically, they must be healthy and they must be immune to things like depressive thoughts and suicidal thoughts,” Hainline said. “At times, student athletes are idolized and worshiped as heroes, so of course there can’t be something dark and dire inside of them.” MENTAL HEALTH FACTS
  • 1 in 3 adolescents (31.9 %) met the criteria for anxiety disorder,
  • 19.1% were affected by behavioral disorders,
  • 14.3% experienced mood disorders,
  •  11.4% had substance abuse disorders 5
  • The incidence of depression increases with age.6
Considering the sheer number of individuals who have a mental disorder, it is likely that nearly every secondary school team has at least one student athlete who experiences a mental health condition. While many youth are able to manage the demands of being a student athlete, some may struggle with the numerous demands. In situations where there is an unhealthy sports culture, an intense pressure to perform or an increased risk of injury, athletes may actually be more susceptible to mental health conditions like anxiety or depression. 4 Student athletes experience unique stressors that may cause or exacerbate mental health conditions include:
  • Over Training: being pushed too hard, physical practices as punishment, and playing above the appropriate age or skill level can lead to anxiety and attrition in sport.
  • Early Specialization: many student athletes specialize in one sport early in their career and engage in advanced level, year-round training which can lead to anxiety, stress, overuse injuries, fatigue and ultimately, athlete burnout.
  • Identity Crisis: part of a student’s identity may be tied to being an athlete. When things occur that challenge this identity, such as not making a team, an injury, performance issues or making mistakes during a game, the athlete may experience a negative psychological reaction.
  • Demands to Balance it All: student athletes experience a number of stressors that may affect their mental health including the physical demands of the game (training, injuries, environmental conditions), the mental stressors (game strategy, toughness, meeting expectations, peer pressure), and the academic rigor (maintaining necessary GPA to stay active, earning a scholarship).
  • Maintaining Weight: many athletes, especially those who compete in weight classes, feel pressure to maintain a certain weight and physique. This pressure can lead to the use of performing enhancing drugs (PEDs) or the development of an eating disorder and trigger comorbid mean.
  • Hazing: many view hazing as a rite of passage; approximately 48% of adolescents who belong groups experienced hazing. Hazing cannot only be physically dangerous, it can also have a negative impact on both the victim and perpetrator including feeling angry, confused, embarrassed or guilty and lead to mistrust, anxiety and depression. 6

Changing the Culture: Mental Health Matters

A team’s culture has the potential to affect the mental health of its athletes. If there is a “safety first” culture, athletes will feel more comfortable talking about mental health concerns and will feel less pressure to perform and less likely to engage in risky behavior that stems from that pressure, including playing through injuries, cheating or using performing enhancing drugs. Teams that prioritize safety are also more likely to have implemented appropriate policies and procedures and make an investment in overall athlete safety. On the other hand, if the culture of a team promotes winning at all costs, student athletes’ mental health may be negatively affected by the pressure to perform. Attending to an athlete’s mental health is an essential part of caring for the entire athlete. School administrators, coaches, parents, physicians, school nurses and athletic trainers all play an important role in supporting the mental health of their student athletes and influencing culture. Here are eight ways promote a positive sport experience and foster a culture of safety.
  1. Make sure it is fun. One of the primary reasons kids quit sports is because it isn’t fun anymore. Keep the game in perspective, show good sportsmanship and focus on opportunities instead of failures.
  2. Play at the appropriate age and skill level: forcing student athletes to play above their abilities may lead to stress and anxiety.
  3. Provide adequate time for rest during the week and between seasons: student athletes are susceptible to mental health conditions when their bodies are worn down. Ensure your student athlete is getting the appropriate amount of sleep. Make sure they are getting breaks between sport seasons as well.
  4. Mix it up – athletes are more prone to burnout if they specialize in one sport early. Encourage your student athlete to participate in a variety of activities and multiple sports.
  5. Ensure the athlete receives a psychosocial screening as part of his or her pre-participation examination. Ideally, this would be done by the athlete’s primary care provider.
  6. Know the signs and symptoms of mental health concerns. Knowing these will help support early recognition and necessary referrals for student athletes.
  7. Remove the stigma around seeking care. Promote a culture where student athletes feel comfortable talking with authority figures about their mental health status. Initiate a conversation about how an athlete is feeling and make this a regular dynamic.
  8. Ensure there is a policy established for the appropriate referral of student athletes with mental health concerns.

The Athletic Trainers Role in Mental Health

Athletic trainers (ATs) play an important role on a school’s athletic health care team. ATs are uniquely positioned to support both the physical and mental health of their student athletes. Because of their close relationships and day-to-day interactions with athletes, ATs may be the first to recognize the signs and symptoms of a mental health crisis. ATs provide an unbiased medical opinion and can support a culture of safety, especially with regard to mental health, for a team. ATs also play an important role in communication between student athletes, parents, coaches and school counselors. ATs work collaboratively with the athletic department and school administration, to develop a plan to recognize student athletes with psychological concerns and facilitate an effective referral system to mental health care professionals for evaluation and treatment.6

Mental Health Resources

REFERENCES 1. Based on numbers reported by 16 states in 2013. Centers for Disease Control and Prevention (CDC), 1995-2013 Middle School Youth Risk Behavior Survey Data, available at http://nccd.cdc.gov/youthonline 2. Merkel, D. (2013). Youth sport: Positive and negative impact on young athletes. Open Access Journal of Sports Medicine, 151. doi:10.2147/oajsm.s33556 3. Taliaferro LA, Rienzo B, Miller MD, et al. High school youth and suicide risk: exploring protection afforded through physical activity and sport participation. J Sch Health. 2008;78:545–553. 4. Jon Almquist, Tamara C. Valovich McLeod, Angela Cavanna, Dave Jenkinson, Andrew E. Lincoln, Keith Loud, Bart C. Peterson, Craig Portwood, John Reynolds, and Thomas S. Woods (2008) Summary Statement: Appropriate Medical Care for the Secondary School-Aged Athlete. Journal of Athletic Training: Jul/Aug 2008, Vol. 43, No. 4, pp. 416-427. 5. Merikangas KR, He JP, Burstein M, et al. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–989. 6. Timothy L. Neal, Alex B. Diamond, Scott Goldman, Karl D. Liedtka, Kembra Mathis, Eric D. Morse, Margot Putukian, Eric Quandt, Stacey J. Ritter, John P. Sullivan, and Victor Welzant (2015) Interassociation Recommendations for Developing a Plan to Recognize and Refer Student-Athletes With Psychological Concerns at the Secondary School Level: A Consensus Statement. Journal of Athletic Training: March 2015, Vol. 50, No. 3, pp. 231-249.