Minds matter: How COVID-19 has highlighted the growing need to protect and promote the mental health of athletes

The sports and exercise medicine community and other sports stakeholders are becoming increasingly aware of mental health symptoms (such as depression, anxiety, and substance abuse) reported by athletes. In 2019, this led to the publication of the first International Olympic Committee (IOC) consensus statement on mental health in this group and the creation of the IOC Mental Health Working Group.1 Over the past two years, the COVID-19 pandemic and related public health measures have posed additional challenges to the well-being of the entire population, including athletes. This editorial reflects how the COVID-19 pandemic has highlighted the growing need to protect and promote the mental health of athletes.

Mental health of athletes during the COVID-19 pandemic

Mental health symptoms are common among professional, Olympic/Paralympic and collegiate athletes, with prevalence rates (15%-35%) equal to or greater than that of non-athletes.1 Mental health symptoms are also common among young and adolescent athletes, with a prevalence of up to a third in some samples.2 Recent epidemiological evidence collected during the COVID-19 pandemic indicates increased rates of mental health symptoms among athletes during lockdown.3 In professional football (football), the prevalence of anxiety and depression during the COVID-19 emergency period doubled compared to immediately prior in both females (N = 600; 18% vs 8% for anxiety) and males (N = 1309; 13% vs 6% for depression) ).4 A significant difference was also found in professional athletes in the United States (N = 114; 27% vs. 5% for feeling anxious; 22% vs. 4% for feeling depressed),5 And also in the top leagues of Swedish football, ice hockey and handball (n = 327), all linked to the distress of the COVID-19 pandemic.3 In Norway, symptoms of insomnia (38.3%) and depression (22.3%) were common among female and male elite athletes during COVID-19 (n=378).3 Among high school athletes in the United States, the prevalence of moderate to severe depression more than tripled during the COVID-19 emergency period compared to previous years in both female (N = 1877; 37% vs. 11%) and male athletes (N = 1366; 27% versus 6%).6 The increase in mental health symptoms among the athletes in the above studies may be associated with a combination of factors associated with the pandemic.7 Alarmingly, while athletes who were able to return to sports participation after the emergency period ended showed some improvement in mental health, in many cases their mental health did not fully recover to a pre-pandemic state.7

Specific contributing factors to COVID-19

Combined with general (eg, adverse life events) and sport-specific (eg, injury) factors, it is likely that COVID-19 has specifically challenged the mental health of athletes (shape 1).1 Experiences of COVID-19 and related home confinement directives have been associated with increased mental health symptoms among athletes, although these effects have been mitigated somewhat by home conditioning programs and quarantine training camps.3 In particular, social isolation (eg, with team and championship ‘bubbles’), concerns about well-being and financial problems, fear of body changes with changing training and diets, as well as uncertainty about their identity, career and future, were cited as factors. Contributes to the mental health of COVID-19.3-5 8 Loss of an athlete’s motivation, meaning, and identity may also lead to persistent depressive symptoms in athletes, especially those who are prone to competition postponement.9

shape 1

Mental health symptoms in athletes before and after the COVID-19 pandemic.

Physicians’ approach to the mental health of athletes during the COVID-19 pandemic

With alarming rates of mental health symptoms among athletes during the COVID-19 pandemic, it has never been clear that athletes’ mental health is such a major concern.10 This highlights that while sport confers important mental health benefits, athletes are nevertheless exposed to the stresses of life and major events. The disruptions in sport brought about by the pandemic can be likened to the mental health effects that occur at the time of injury and (forced) retirement. Injuries, retirement, and the COVID-19 pandemic alike are making important changes in athletes’ lives through impacts on daily structure, support systems, livelihoods, career paths, and identity. Doctors have learned the importance of connecting with athletes at any time of transition – whether it is related to the pandemic or not.10 Mental health should be openly discussed and examination conducted systematically.11 All stakeholders in the sport and members of the athletes’ entourage (including coaches) should receive training and resources to be able to identify mental health “red flags” so that appropriate referrals can be made.11 Physicians must routinely “check in” with all athletes and take immediate steps to intervene when necessary.10 The IOC Sports Mental Health Assessment Tool 1 (SMHAT-1) provides a single framework for screening athletes for mental health symptoms.11

An ongoing need to protect and promote the mental health of athletes

The mental health of athletes was a growing concern before the pandemic, and the effects associated with the pandemic are likely to continue to affect in the future. Besides the work of the individual physician, stakeholders such as governing bodies, sports leagues and event management teams must take steps to improve the mental health of athletes and change the culture of sport for the better. This is even more important as the pandemic continues, allowing athletes to improve their mental resilience when faced with increased stressors. Team physicians and management should prioritize steps to protect and monitor the mental health of athletes. Notable sporting events should highlight the importance of mental health as the US Tennis Association did during the 2021 US Open.12 Ultimately, mental health assessments, resources, and treatment must be destigmatized and made more widely available. Athletes should feel that addressing mental health is a priority, not a sign of weakness. Now more than ever, brains matter! As athletes and as human beings, they deserve to be in great shape in all respects.

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Thanks and appreciation

This article is part of a series commissioned by BJSM for the World Innovation Summit for Health (WISH) 2022. BJSM peers reviewed, edited and made the publication decision. The main author(s) received a small honor for this work. The series, including open access fees and charges, is funded by WISH, an initiative of the Qatar Foundation.