Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment

Abstract

ObjectiveTo summarise the literature on the barriers to athletes seeking mental health treatment and cultural influencers of mental health in elite athletes.DesignSystematic reviewData sourcesPubMed, Cochrane, Scopus, SportDiscus (Ebsco), and PsycINFO (ProQuest) up to November 2018.Eligibility criteria for selecting studiesQualitative and quantitative original studies of elite athletes (those who competed at the professional, Olympic, or collegiate/university levels), published in any language.ResultsStigma, low mental health literacy, negative past experiences with mental health treatment-seeking, busy schedules, and hypermasculinity are barriers to elite athletes seeking mental health treatment. Cultural influencers of mental health in elite athletes include: (1) the lack of acceptance of women as athletes; (2) lower acceptability of mental health symptoms and disorders among non-white athletes; (3) non-disclosure of religious beliefs; and (4) higher dependence on economic benefits. Coaches have an important role in supporting elite athletes in obtaining treatment for mental illness. Brief anti-stigma interventions in elite athletes decrease stigma and improve literary about mental health.ConclusionThere is a need for various actors to provide more effective strategies to overcome the stigma that surrounds mental illness, increase mental health literacy in the athlete/coach community, and address athlete-specific barriers to seeking treatment for mental illness. In this systematic review, we identified strategies that, if implemented, can overcome the cultural factors that may otherwise limit athletes seeking treatment. Coaches are critical for promoting a culture within elite athletes’ environments that encourages athletes to seek treatment.

Help-Seeking for Mental Health Issues in Professional Rugby League Players

“…This is in line with previous research which found that lack of time was a chief barrier to help-seeking in college athletes (López and Levy, 2013). Together this highlights the importance of making appropriate services and sources of help available and accessible to athletes taking into account their demanding schedules, time constraints and needs (López and Levy, 2013;Castaldelli-Maia et al, 2019).…”

“…This suggests that changing the culture to allow elite athletes to be more open may facilitate help-seeking. Coaching staff have an important role to play in ensuring a supportive culture in which help-seeking is encouraged (Castaldelli-Maia et al, 2019).…”

“…Elite athletes may fear that opening up about mental health symptoms or difficulties would negatively impact their chances of a successful athletic career (e.g., being excluded from the team, not signing a new contract or an advertising campaign). Athletes may also fear negative reactions from their teammates and coaches if they open up about mental health symptoms or difficulties (Castaldelli-Maia et al, 2019). Confidentiality, privacy and trust must be promoted with elite athletes and particularly with coaching and support staff, because they may expect to be kept informed about their athletes.…”

“…For elite athletes a number of individual barriers to accessing help for mental health issues have been identified. This include lack of knowledge and awareness of mental health difficulties (i.e., low mental health literacy), perceived stigma, negative past experiences of help-seeking (Gulliver et al, 2012a;Castaldelli-Maia et al, 2019), and more negative attitudes toward help-seeking (Purcell et al, 2019). Further, cultural factors (such as attitudes of coaches, normalization of help-seeking) also play a role, particularly where a sport emphasizes mental and physical toughness (Baum, 2005).…”

Determining the role of sport coaches in promoting athlete mental health: a narrative review and Delphi approach

“…Despite efforts to bring awareness to the issue of mental health, normative and socially reinforced reluctance to seek help has persisted 34. Coaches have the potential to help shape team cultures that normalise, destigmatise and are supportive of mental health help-seeking,6 35 which may function as a form of primary prevention by shifting the willingness of team members to seek care should their own mental health challenges arise.…”