In the last post, we discussed how sports can be helpful, or sometimes hazardous to mental health. But how are athletes affected by having a mental health diagnosis, or just poor mental health in general?

Poor mental health doesn’t just affect an athlete’s happiness and performance, but also compromises safety. Anxiety and depression have been shown to alter how alert and focused an athlete is. They impair one’s ability to think quickly and make good decisions under pressure, affect balance and coordination, and increase muscle tension. All of these changes can compromise an athlete’s split-second reactions and decision-making, both immediately and over the long term. Mental health disorders thus increase the chances of getting injured and reduced performance after returning to sport. When they return but are performing poorly, this can contribute to more anxiety and depression, which can again increase the chances of injury. It can thus become a vicious cycle, which is why it’s important to address mental health symptoms early. 

A study even found that psychological factors and negative life events were a more accurate predictor of how soon an athlete is going to get injured than their orthopedic and musculoskeletal risk factors, which was a surprising finding. Then once an athlete is injured or sick, having to deal with a mental health condition on top of that also tends to mean a longer recovery and a lower chance of returning to their sport. 

Eating disorders and disordered eating (behaviors that don’t meet the full criteria for a clinical eating disorder), are linked to energy deficiency, loss of muscle and lean tissue, and imbalances in the body’s electrolytes, thus affecting training, recovery, and competition. Burnout, which was mentioned in the previous article as becoming more common, leads to athletes feeling less capable, performing worse on thinking tasks, and makes them more likely to drop out of their sport.

But the most feared outcome in mental health is suicide. Thankfully, elite athletes as a group generally have lower rates of suicidal thoughts, suicidal behavior, and completed suicide compared to non-athletes. It may be that something about being competitive sports protect them from this. However, it is possible that things are changing. One study of NCAA college athletes compared the percentage of athlete deaths from suicide in two time periods (2002 to 2012 versus 2013 to 2022) and found the rate had doubled, from 7.6% in the previous decade to 15.3% in the recent decade. This meant suicide became the second leading cause of death among college athletes, right behind accidents. Interestingly, another study found that suicide rates among former NFL players also more than doubled over the past two decades (caveat – the researchers noted that maybe it was growing public awareness of CTE or chronic traumatic encephalopathy, a brain disease linked to repeated head injuries in contact sports, that contributed to increased reporting of these deaths as suicides rather than from other causes). Still, the fact that suicide rates appear to be rising in these different athlete populations is very concerning, especially since this trend lines up with the increase in athlete burnout over the same time period discussed in the last post. This suggests a growing mental health crisis within modern competitive sports that deserves urgent attention.

Meanwhile, having ADHD (attention deficit hyperactivity disorder) seems to make it up to two times more likely that an athlete will sustain a concussion, and if they do, their recovery period seems to be longer. The ADHD brain is wired differently (thinner prefrontal cortex, cerebellar dysfunction, issues with neurotransmitter signaling) and can therefore suffer from variable attention, poor motor control and timing, and impulsivity. Science has also found that the white matter (the supporting/connective cells) in a brain with ADHD is less robust. The theory is when the skull receives a concussive blow, the white matter is less able to handle the forces, although, more research needs to confirm this. Also, evaluating a concussed athlete with ADHD is more difficult than evaluating one without — it’s not so easy to tell how much of the current symptoms are from the ADHD or from the concussion. This is also an area that needs more investigation.

The above are only some examples of what current research has shown in regards to how mental health can affect athletes. There are many other areas that science has not caught up to yet. The take home message is that athlete mental health is supremely important in overall athlete wellbeing and performance optimization, something that seems very commonsense but unfortunately not everyone is taking seriously. 

By educating more athletes and everyone else around them, hopefully we can make mental health something that is openly discussed. Physicians and anyone caring for athletes also need to regularly ask about mental health symptoms. This way, athletes can be better supported and get the right care at the right time.