“Health is Health:” Injury Prevention Symposium Takes a Deep Look at Mental Health Issues for Elite Athletes
Jun 8, 2023
Reardon: “Mental health is an integral dimension of an athlete’s well-being and performance and should not be separated from other aspects of physical health. Health is health.”
VAIL/COLORADO SPRINGS, COLO. – Injuries in the sports world most often attract attention because of their physical nature and how they limit or prohibit an athlete from competing. What sports fans hear less about—despite their prevalence—are the non-physical or mental illnesses and conditions that can impact an athlete’s performance.
This topic has become more public in recent years as athletes such as Olympic champions Simone Biles and Michael Phelps, tennis great Naomi Osaka, NBA star Kevin Love and others have spoken out on their mental health struggles and have sought help.
Claudia Reardon, M.D., a professor in the School of Medicine and Public Health at the University of Wisconsin, spoke on this topic in the keynote presentation of Day Two of the 7th Annual Injury Prevention Symposium, virtually presented by Steadman Philippon Research Institution (SPRI) and the United States Olympic & Paralympic Committee (USOPC) on June 8, 2023.
In 2018, Dr. Reardon and Dr. Brian Hartline, the chief medical officer of the NCAA, co-chaired a workgroup studying mental health issues. Over the last five years, her research has helped troubled athletes explore the disorders they were facing and has helped to reduce the stigma of mental health illness.
“Many of our high-level athletes have really courageously been coming forward to talk about their mental health struggles,” said Dr. Reardon. “And this was not the case five years ago, surely not 10 years ago, heaven forbid 20 years ago. I'll just say this has made a world of difference and I want to publicly thank these courageous athletes.”
“It's (mental health illness) kind of like the final frontier where stigma has really persisted,” continued Dr. Reardon. “This culture of toughness is robust, but we're starting to get through it and it's thanks to athletes who have come forward and allowed us to address their issues.”
Dr. Reardon detailed some of the most notorious culprits in the fight against mental health disorders:
The most common mental health symptom and disorder is sleep—or lack of it, to be more exact.
“Sleep problems are real and common in everyone, and they are prominent in athletes,” said Dr. Reardon.
In a recent study of Division I college athletics, football players were averaging only 5.8 hours of sleep per night, while women’s volleyball players were only getting 6.0 hours each night, numbers far below what young athletes need to remain healthy and strong.
The next common disorder is depression. Studies have shown that elite athletes—despite the success they have enjoyed in their field and the rewards that success brings—suffer from depression at nearly the same percentage as everyone else, from all ages and occupations. Female athletes, particularly college freshman athletes, tend to have the highest rates of depression.
“That's no surprise to me,” said Dr. Reardon. “Quite honestly, how any college freshman isn't depressed or anxious, I don't know, because that's a really difficult transition. And then you throw sports into the mix in addition to all the other transitions that accompany that. It's a really high risk.”
Anxiety hits top athletes in many ways. With their elite status, they are expected to win and set records on a regular basis. The pressure to succeed can be enormous.
“There is some evidence that individual sport athletes are more likely to suffer from anxiety than our team sport athletes,” noted Dr. Reardon. “Also highly affected are those in the aesthetic sports where there's a sense of physical appearance mattering, and those sports with judges assessing performance. Some fine motor sports, like golf, rifle, archery, are all seemingly associated with higher risk for anxiety.”
This subject may be the most pervasive among young athletes today and Dr. Reardon theorizes as to why.
“This is a really big deal,” explained Dr. Reardon. “Athletes spend their lives focused on their body, and it's really hard when you think about athletes who at baseline can be a fairly perfectionistic, kind of all-or-nothing person. It's hard for them to not go to an extreme, oftentimes with the best of intentions. You know, if eating healthy is good, then taking that to an absolute perfect extreme must be better, and then it gets out of hand quickly.”
ADHD (attention-deficit/hyperactivity disorder)
“This, by definition, is a childhood condition that starts before the age of 12 and may persist to the tune of 30% of kids diagnosed with ADHD in childhood. Many of those continue to meet ADHD criteria as adults. Within athletes, ADHD may be even more common than in the general population,” said Dr. Reardon.
Substance Use Disorders
Some of the substances and habits for young athletes that Dr. Reardon brings up for discussion are binge alcohol drinking (“Overall rates of alcohol use are less, but when they drink, they drink a lot.”), oral tobacco, non-prescription opioid drugs, and vaping (“The reality is vaping does impact lung capacity. Athletes are leaving practice for nicotine breaks. I had an athlete have to leave my hour-long appointment with them the other day to go vape, which can have even more nicotine than traditional cigarettes and therefore cause addiction quite quickly.”)
How does Dr. Reardon think we can help prevent these disorders that lead to mental health issues?
Each problem and each athlete is clearly a different case, so she acknowledges that there is no set cure or prescription to relieve mental health disorders.
One of the more common times when depression, anxiety and other disorders seem to develop is while an athlete is sidelined from activity and recovering from an injury.
“Time spent recovering from an injury is a very high-risk time for the development of depression and anxiety in athletes,” noted Dr. Reardon. “What athletes describe in terms of what leads them to feel depressed or anxious when injured, is they're terrified of being re-injured. The isolation is terrible, and they feel alienated from their teammates and coaches.”
Dr. Reardon proposes that injured athletes should continue their daily schedules and off-field routines with their teammates even though they are not preparing to play the next game or match.
“If they are kept from going to those kinds of meetings, practices, team social functions and especially the games, they're more likely to become depressed and anxious as they recover from concussions and other injuries. So, the setting of injury recovery really does matter and may speed up and strengthen the rehabilitation process.”
“Athletes are at risk for a variety of mental health symptoms and disorders,” summarized Dr. Reardon. “These symptoms and disorders may present in nuanced ways within athletes compared to the general population. Mental health is an integral dimension of an athlete’s wellbeing and performance and should not be separated from other aspects of physical health. Health is health. And finally, there are spaces and there are places where we can intervene to prevent mental health symptoms and disorders and to optimize mental wellness in all of our athletes.”
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