First IOC consensus statement on mental health issues in elite athletes

By Nicole MacKee
Stigma is a key barrier to elite athletes seeking treatment for mental health disorders say the authors of a systematic review published recently in the British Journal of Sports Medicine.

The review of 52 studies, covering more than 13,000 elite athletes from 71 sports, found that stigma was the most commonly reported barrier to seeking mental health treatments among elite athletes. Low mental-health literacy, negative past experiences when seeking mental health support, busy schedules and hypermasculinity also contributed to athletes’ reluctance to access treatment.

The review authors noted that mental health symptoms and disorders affected 5 to 35% of elite athletes annually.

The review was one of 20 systematic reviews that informed the International Olympic Committee’s (IOC) first consensus statement on the diagnosis and treatment of a range of mental health symptoms in elite athletes, published in the same issue.

Coauthor of the consensus statement Professor Rosemary Purcell said there had been an explosion of interest in the risks of mental health problems among elite athletes in the past five years.

‘There is a lot more understanding that athletes are dealing with these problems, but not a lot of evidence as to how to help them,’ said Professor Purcell, who leads the Elite Sports and Mental Health Unit at Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne.

She said this scarcity of evidence had prompted the IOC to convene a panel of experts to provide guidance to healthcare professionals managing mental healthcare issues among elite athletes. Also, she said, it was hoped that the statement would break down stigma among athletes and non-health professionals working in elite sport.

‘It’s potentially the whole elite sporting system that can have some stigma towards mental illness,’ Professor Purcell said.

Although the prevalence of mental health issues among retired athletes had been in the spotlight for some time, she said disorders among current athletes remained under-recognised.

‘With this [consensus statement], we are trying to be more proactive supporting athletes during their playing career,’ she said.

Professor Purcell said the consensus statement covered a lot of subspecialty areas – from depression and anxiety to attention deficit disorder and eating disorders.

She said elite athletes were at higher risk of mental health symptoms and disorders for a range of reasons.

A single-minded focus was needed to excel at elite-level sport, Professor Purcell said, but this may also put athletes at higher risk of mental health problems. Injury, poor performance and the pressures of public scrutiny also contributed to mental health issues among elite athletes.

‘There is a public perception that if you are not a gold medallist in these sports, you somehow have failed, which is a terrible state of affairs.’
Br J Sports Med 2019; doi: 10.1136/bjsports-2019-100710.
Br J Sports Med 2019; doi: 10.1136/bjsports-2019-100715.