Introduction: Although research suggests that exercise benefits mental health, psychiatric disorders have been acknowledged in the ultra-endurance-athlete population. At present, the mental-health consequences of high-volume training associated with ultra-endurance sports are not well understood. Methods: We conducted a narrative review summarizing primary observations about mental disorders per ICD-11 criteria in ultra-endurance athletes using a keyword search in Scopus and PubMed. Results: We identified 25 papers discussing ICD-11-classified psychiatric disorders such as depression, anxiety, eating disorders, attention-deficit/hyperactivity disorder, and schizophrenia in ultra-endurance athletes. Discussion: Although evidence is limited, available papers indicate that there is a sizable incidence of mental-health issues and composite psychopathological vulnerabilities in this community. We contend that ultra-endurance athletes may represent a different, though similar, demographic than elite and/or professional athletes, as they often engage in high-volume training with similarly high motivation. This can have regulatory implications, which we also highlight. Conclusion: Mental illness in ultra-endurance athletes is an underrepresented topic in sports medicine, though psychiatric disorders may be especially prevalent in this population. Further inquiry is necessary to inform athletes and healthcare practitioners about the possible mental-health implications associated with participation in ultra-endurance sports.

IntroductionInterest in ultra endurance sport (UES) is increasing, with relevant events growing in popularity. However, these activities may encompass more complex characteristics and demands that do not correspond to scientifically validated correlations between physical activity and improved health. It is unknown whether high volume training for UES can have adverse implications, although certain sociocultural aspects of western society, such as an emphasis on autonomy and self-directed success, may encourage participation as a representation of personal achievement. As media depictions of UES can be highly influential, we aimed to explore prominent messages to better comprehend the values and aspirations of established and aspiring ultra endurance athletes (UEA).MethodsUsing qualitative, conventional content analysis techniques, we evaluated n = 15 popular YouTube videos on various UES to synthesize the most common themes. A YouTube search was conducted, and videos were selected based on sport and relevance. Subsequently, videos were analyzed and coded to discern the most frequently repeated themes.ResultsFive recurring themes were identified: discussion of the mental aspects of UES participation; the adoption of folk-tale storytelling; dietary habits of UEA; a focus on pain and suffering; the use of words associated with mental illness as a colloquial descriptor of UES/UEA.DiscussionYouTube depictions of UES participation appear to accentuate suffering and co-occurring phenomena as attractive qualities. These resonate with sociocultural ideologies in western contexts, which emphasize fitness and personal success, but appear inconsistent with evidence around potentially adverse health-related implications of UES.ConclusionDiscrepancies between popular portrayals of UES and scientific evidence suggest a need for greater community education and information sharing about sport-specific risk factors for physical and mental health conditions and appropriate training protocols. Further research is also required to better define the relationship between motivations for UES participation and overall health using interdisciplinary approaches.

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