Literature Review: Athlete Ecosystem Mental Health — We All Need Support

Let’s redefine mental toughness together.

Timeout

Published in

The Huddle

7 min readMay 16, 2022

**Image Description:** Light blue background with indigo words that read, “Reimagining science.”

By: Mikaela Brewer| Head of Content & Research

The athlete ecosystem is one of the most vibrant, inspiring, and soulful communities. It is also submerged in an expectation that these things can only be maintained by a standard of mental toughness that deeply embeds mental health stigma. At Timeout, we’re deconstructing this barrier by painting the full picture — bringing you the humans beneath athletes, coaches, care providers, and anyone else immersed in this world. We’re exploring mental health research in a fresh and approachable way — by welcoming our entire community into the conversation and asking questions that will prompt change. Let’s redefine mental toughness together.

In this literature review series called “Reimagining Science,” we are exploring research in a fresh way, by unpacking some of the literature around specific topics. Our goal is for these literature reviews to be accessible to the entire athletic community — coaches, athletes, care providers, etc. We’re beginning with grief, loss, and heaviness, as we navigate the uncertainty of our world.

Our entire athletic ecosystem is connected.

We often place student-athletes at the center of research, policy, programs, and conferences — a needed first step. However, sometimes this prevents us from seeing that when one limb of the ecosystem suffers (such as the student-athletes), then other limbs are likely suffering too.

When it comes to mental health data and statistics, there is a good amount of research about the student-athlete experience. There is less about the mental health of coaches, staff, administrators, strength & conditioning coaches, athletic directors, athletic trainers, and mental health care providers (to name a few). These people are high-performance humans too, and they are carrying similar pressures, weight, and expectations of toughness. There is perhaps an added responsibility of, “Who is there for the athlete when I can’t be?” Think about the last time you saw your coach take a day off? A real day off?

Mental health challenges and harmful demands in the athletic ecosystem are systemic and need both a structural and cultural shift — for everyone.

Here, we’re surveying a broader range of research beyond athletes, emphasizing the dire need to help the helpers. One crucial group is future clinical psychologists — those who will help athletes next. Mental health does not discriminate.

How to engage with research

First, you’ll see the title of the research paper, followed by its citation (if you’d like to read the full article, head to scholar.google.com and copy-paste this citation)! Beneath the citation are the critical points from the research, framed in an easy-to-understand way. There may be further citations beneath each “main citation” which can be used as further reading if you’re interested. Enjoy!

Athlete Burnout Symptoms Are Increasing: A Cross-Temporal Meta-Analysis of Average Levels From 1997 to 2019

Madigan, D. J., Olsson, L. F., Hill, A. P., & Curran, T. (2022). Athlete Burnout Symptoms Are Increasing: A Cross-Temporal Meta-Analysis of Average Levels From 1997 to 2019. Journal of Sport and Exercise Psychology, 1 (aop), 1–16.

This paper looked at athlete burnout through the past 2 decades (1997–2019).
Researchers looked at 91 studies, and through detailed analysis found that burnout symptoms have increased.
More specifically, they saw decreases in the average level of a few things: a sense of athletic accomplishment and sport devaluation.
Athletes who experience burnout symptoms are likely more vulnerable to burnout’s harmful side effects.
Burnout is difficult to reverse, so there is a need for prevention and intervention.

NCAA Student-Athlete Mental Health and Wellness: A Biopsychosocial Examination

Brown, B. J., Aller, T. B., Lyons, L. K., Jensen, J. F., & Hodgson, J. L. (2021). NCAA Student-Athlete Mental Health and Wellness: A Biopsychosocial Examination. Journal of Student Affairs Research and Practice, 1–16.

This study looked at the mental health and wellness experiences of student-athletes compared to their non-athlete student peers, specifically related to biopsychosocial factors (factors related to our biology, psychology, and social connections).
Key results: females, BIPOC, and D1 student-athletes reported higher levels of anxiety, depression, and stress. They also reported a worse quality of life.
Compared with their non-athlete student peers, these results may indicate greater mental health struggles among student-athletes.

Trends in college student-athlete mental health in the National College Health Assessment (NCHA), 2011–2019

Edwards, B., Froehle, A. W., & Fagan, S. E. (2021). Trends in College Student-Athlete Mental Health in the National College Health Assessment (NCHA), 2011–2019. Journal of athletic training.

This study’s goal was to look at changes in student-athlete mental health compared to non-athlete students, over the past decade.
Consistently, student-athletes reported significantly lower symptom and diagnosis rates compared with their non-athlete peers. The key exceptions here are attempted suicide, eating disorders, and substance abuse.
Over time, for both groups, diagnosis and openness to treatment increased. Both remained lower in student-athletes, even though they reported receiving more education and information about substance abuse, stress reduction, handling distress & violence, and eating disorders.
Over time, the impacts of mental health struggles on academics grew over time in both groups. Injury impacted student-athletes’ academics more.

Mental Health in Elite-Level Coaches: Prevalence Rates and Associated Impact of Coach Stressors and Psychological Resilience

Kegelaers, J., Wylleman, P., van Bree, I. B. N., Wessels, F., & Oudejans, R. R. (2021). Mental health in elite-level coaches: Prevalence rates and associated impact of coach stressors and psychological resilience. International Sport Coaching Journal, 8 (3), 338–347.

This study looked at elite-level coaches, and the impact of coach-specific stress (self-perceived) on mental health (psychological and social well-being).
Researchers also looked at symptoms of mental health disorders and resilience as a protective shield against mental health troubles.
Research results indicated that coach-specific stress was common, but it impacted self-perceived mental health moderately.
Mental disorder symptoms were very prevalent — 39% for depression & anxiety to 19% for distress and adverse alcohol use.
Coach-specific stress predicted depression & anxiety symptoms.
Resilience was found to be a protective factor.

Factors perceived to affect the wellbeing and mental health of coaches and practitioners working within elite sport

Hill, D. M., Brown, G., Lambert, T. L., Mackintosh, K., Knight, C., & Gorczynski, P. (2021). Factors perceived to affect the wellbeing and mental health of coaches and practitioners working within elite sport. Sport, Exercise, and Performance Psychology.

This study explored the mental health of coaches and sport science practitioners within a national sport organization. Researchers specifically looked at factors that may impact the well-being of these individuals through interviews and discussions.
The main risk factors were: excessive workload, post-competitive loss, and a feeling of isolation.
Protective factors were: effective organizational culture, transformational leadership, and access to quality social support.

Mental health concerns and barriers to care among future clinical psychologists

Hobaica, S., Szkody, E., Owens, S. A., Boland, J. K., Washburn, J. J., & Bell, D. J. (2021). Mental health concerns and barriers to care among future clinical psychologists. Journal of Clinical Psychology, 77 (11), 2473–2490.

This study looked at mental health, mental healthcare utilization, and barriers to care during graduate school for clinical psychology doctoral students.
During graduate school…
~25% of clinical psychology doctoral students reported moderate to severe anxiety symptoms
~20% of clinical psychology doctoral students reported moderate to severe depression symptoms or suicidal intent
~10% of clinical psychology doctoral students reported a high risk of alcohol abuse or moderate to severe drug use
LGBTQ+ & BIPOC clinical psychology doctoral students reported higher levels of depression symptoms and suicidal intent.
LGBTQ+ students reported more drug use and self-injury (non-suicidal).
Financial difficulty, inadequate time, and low availability were all commonly experienced as significant barriers to receiving mental health care.

Mental health problems among clinical psychologists: Stigma and its impact on disclosure and help-seeking

Tay, S., Alcock, K., & Scior, K. (2018). Mental health problems among clinical psychologists: Stigma and its impact on disclosure and help‐seeking. Journal of Clinical Psychology, 74 (9), 1545–1555.

This study assessed the mental health experiences of clinical psychologists, and how different types of stigma impact opening up and seeking help.
Mental health concerns among clinical psychologists is fairly common, and are compounded by stigma, shame, and fear about negative consequences (for self & career) of sharing struggles. These prevented some clinical psychologists in this study from seeking help.
67% of clinical psychologists in this study experienced mental health challenges.
There were greater levels of perceived stigma (the fear of being discriminated against) compared to other types of stigma.
Clinical psychologists in this study were more likely to share their mental health concerns with their friends and family, rather than with their coworkers.

Thank you for reading. More to come!

Other resources to check out (because we’re human first):