New Study Sheds Light on Mental Health of Elite Athletes

The biggest buzz surrounding the Tokyo Olympics isn't gold, silver, or bronze. Instead, mental health took center stage as Simone Biles and Naomi Osaka opened up about their own mental health. Interestingly, this development coincides with a new study that highlights the prevalence of mental health issues like depression and anxiety among Olympic-level athletes.

But the importance of this information is not limited to just Olympians. It also applies to other athletes as well—even those weekend warriors setting personal records (PRs) at the local gym. Mental health should be a top priority for everyone.

“When it comes to athletes, they’re no different from anyone else," says Stephen Wakschal, PhD, a New York State-licensed psychologist who also serves as the Mental Health Director for NYPD CrossFit. "They just happen to be people whose job it is to be athletes. They still face the trials and tribulations we all do—family issues, anxiety, and bereavement—in addition to whatever the demands may be of their athletics.”

About The Study

The study, which was published in Psychology of Sport and Exercise, followed 186 Canadian athletes training for the 2020 Summer Olympics. Throughout the study, researchers evaluated the prevalence of mental health disorders like depression, anxiety, and eating disorders among the athletes. They also looked at the relationship between stress, social support, and self-esteem, and the athletes' symptoms.

What the researchers discovered was that nearly 42% of the athletes met the criteria for one or more mental disorders. More specifically, 31.7% of the study's athletes reported symptoms of depression, 18.8% reported symptoms of anxiety, and nearly 9% were at risk for eating disorders. The researchers also noted that an athlete's training load and stress levels were often predictors of depression and anxiety.

To mental health experts, these results are not surprising. An elite athlete's life stresses often deviate far from the norm. Not only are they often living far from home and away from loved ones, but they also are thrust into financial changes, and have an extrinsic motivation to perform, says Dr. Wakschal.

"Athletes, in general, have been raised on the premise of approval being performance-related," he says. "They learn that their core value is to perform. When placed in a position where their performance is not up to standard, it can affect their very existence."

Training the Mind

And while that extrinsic motivation to perform is par for the course for elite athletes—medals and championships are on the line, after all—normalizing improving mental health as a daily practice, as opposed to something dealt with only in crisis, can help tap into an athlete's intrinsic motivation.

For this reason, experts like Graham Betchart, MA, a mental performance coach who has worked with numerous NBA players, emphasize the importance of training the mind on a daily basis. Just as elite athletes condition their bodies and tend to their nutritional needs, they also need daily mental coaching as well.

Betchart advises thinking of mental health care as existing on a spectrum. On one end, you have a surgeon, and on the other, a strength and conditioning coach, he says.

"You're not going to seek out the surgeon every day to work on your body, and you're not going to your strength and conditioning coach if your leg is bleeding out," he says. "But each serves his or her purpose. We need to treat mental health the same way."

To accomplish this goal, Betchart focuses on pro-active mental skills training—the key tenets of which are being present in the moment and trusting physical skills. Breaking down the process into what he refers to as MVPs (meditation, visualization, and powerful self-talk), success is gauged by answering the question: "How present was I at the moment?"

"Athletes love routines," he says. "This is all about creating habits, not a quick fix. The greatest athletes trust the most. They're willing to be vulnerable and go into that space of finding grace, poise, and surrender. Victory goes to the vulnerable."

But perhaps most notable in Betchart's approach is the concept of dual coding, essentially combining music with his meditations. Just as preschoolers learn the ABCs and nursery rhymes through melodies, Betchart taps into the same concept.

"It's coaching with a hook," he says. "Music and athletes go hand in hand."

The Role of Diet

The role of diet in improving anxiety and depression is an emerging area of research and can be applied to the goals of an elite athlete as well. But sometimes athletes struggle with their diet and food choices. In fact, an athlete's mental state can impact food choices, which can in turn impact performance, says Kate Davis, RD, CSSD, LDN, a registered dietitian and board-certified specialist in sports nutrition (RDkate.com).

"Mental conditioning is just as important for the elite athlete as training and nutrition," says Davis. "It is yet another important tool to allow athletes to compete and perform at their best."

Overall, an athlete's mindset can impact what they choose to eat. It also can affect their ability to eat enough to support their training. So, the three areas of nutrition, training, and mental conditioning are inseparable, Davis says.

How This Applies to Everyday People

The candor of athletes such as Biles, Osaka—and even Michael Phelps in the past—may have shone a light on the importance of mental health among elite athletes. But experts agree that being mindful of and caring for your mental health is important for everyone, not just for the athletes at the top of their sports.

Even if you're not out seeking a place on a podium, there's something to be gleaned from the techniques used by some of the world's greatest athletes.

“I’m a little bit biased but mental health should be primary," says Dr. Wakschal. "Everything filters down from good mental health—including sleep hygiene and self-care. Where [mental health] is currently, is much lower on the totem pole and often neglected.”