THE ROLE OF MENTAL HEALTH IN COMPETITIVE SPORT: PREVALENCE, RISK FACTORS, AND MANAGEMENT STRATEGIES OF PSYCHIATRIC CONDITIONS AMONG ATHLETES
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6490Keywords:
Mental Health, Elite Athletes, Sports Psychiatry, Competitive Sports, Psychiatric ConditionsAbstract
Background. Historically, the sports culture has prioritized "mental toughness," often viewing psychological vulnerability as a contradiction to elite performance. However, growing evidence suggests that competitive athletes face a unique constellation of various stressors, which if not identified early and treated adequately, may result in mental health disorders.
Aim. To draw attention to the importance of psychological well-being of an athlete detailing prevalence, risk factors and specifics of various mental health conditions in competitive sports and to outline the role of integrated management strategies.
Material and methods. A narrative review of existing literature was conducted, incorporating cross-sectional surveys, prospective cohort studies and systematic reviews focused on elite and ultra-endurance athletes.
Results. Prevalence rates for mental health symptoms in athletes are comparable or even higher than among the general population, with depression and anxiety affecting up to 34% of elite cohorts. Specific risk factors include musculoskeletal injuries, career transitions, and the individual nature of certain sport disciplines.
Conclusions. Integrated management requires a core multidisciplinary team (CMT) to provide holistic care that balances clinical stability with athletic performance maintenance.
References
Claussen, M. C., Burger, J. W., Menon, R., Nishida, M., Koh Boon Yau, E., Nahman, C., et al. (2024). The underestimated role of the sports psychiatrist in athletic performance restoration, maintenance, and enhancement in sports. Scand J Med Sci Sports, 34(8), e14697. https://doi.org/10.1111/sms.14697
Åkesdotter, C., Kenttä, G., Eloranta, S., Håkansson, A., & Franck, J. (2022). Prevalence and comorbidity of psychiatric disorders among treatment-seeking elite athletes and high-performance coaches. BMJ Open Sport Exerc Med, 8(1), e001264. https://doi.org/10.1136/bmjsem-2021-001264
Scheer, V., Valero, D., Valero, E., Weiss, K., Rosemann, T., & Knechtle, B. (2026). Examining attention-deficit/hyperactivity disorder in endurance and ultra-endurance runners. Acta Psychol (Amst), 262, 106144. https://doi.org/10.1016/j.actpsy.2025.106144
Depression in Danish and Swedish elite football players and its relation to perfectionism and anxiety. (2018). Psychol Sport Exerc, 36, 147–155. https://doi.org/10.1016/j.psychsport.2018.02.008
Beable, S., Fulcher, M., Lee, A. C., & Hamilton, B. (2017). SHARPSports mental Health Awareness Research Project: Prevalence and risk factors of depressive symptoms and life stress in elite athletes. J Sci Med Sport, 20(12), 1047–1052. https://doi.org/10.1016/j.jsams.2017.04.018
The prevalence of mental health problems in elite athletes. (2020). J Sci Med Sport, 23(4), 329–335. https://doi.org/10.1016/j.jsams.2019.10.022
Golding, L., Gillingham, R. G., & Perera, N. K. P. (2020). The prevalence of depressive symptoms in high-performance athletes: A systematic review. Phys Sportsmed, 48(3), 247–258. https://doi.org/10.1080/00913847.2020.1713708
Rice, S. M., Gwyther, K., Santesteban-Echarri, O., Baron, D., Gorczynski, P., Gouttebarge, V., et al. (2019). Determinants of anxiety in elite athletes: A systematic review and meta-analysis. Br J Sports Med, 53(11), 722–730. https://doi.org/10.1136/bjsports-2019-100620
Reardon, C. L., & Hitchcock, M. (2024). Mental health in individual versus team sports. Int Rev Psychiatry, 36(3), 284–295. https://doi.org/10.1080/09540261.2024.2349079
Update on integrative treatment of psychiatric symptoms and disorders in athletes. (n.d.). https://doi.org/10.1080/00913847.2020.1757370
Hu, S., Wang, L., Chen, Y., Li, N., Lou, S., Shao, Y., et al. (2025). Sleep disturbances, mental health symptoms, and chronotype in Chinese elite athletes: Insights from the Beijing 2022 winter olympics preparatory period. BMC Psychiatry, 25(1), 400. https://doi.org/10.1186/s12888-025-06839-8
Wells, K. R., Jeacocke, N. A., Appaneal, R., Smith, H. D., Vlahovich, N., Burke, L. M., et al. (2020). The Australian Institute of Sport (AIS) and National Eating Disorders Collaboration (NEDC) position statement on disordered eating in high performance sport. Br J Sports Med, 54(21), 1247–1258. https://doi.org/10.1136/bjsports-2019-101813
Bradley, S. L., & Reardon, C. L. (2022). Bipolar disorder and eating disorders in sport: A case of comorbidity and review of treatment principles in an elite athlete. Phys Sportsmed, 50(1), 84–92. https://doi.org/10.1080/00913847.2021.1881841
Li, Q., Li, H., Zhang, G., Cao, Y., & Li, Y. (2024). Athlete body image and eating disorders: A systematic review of their association and influencing factors. Nutrients, 16(16), 2686. https://doi.org/10.3390/nu16162686
Rousselet, M., Guérineau, B., Paruit, M. C., Guinot, M., Lise, S., Destrube, B., et al. (2017). Disordered eating in French high-level athletes: Association with type of sport, doping behavior, and psychological features. Eat Weight Disord - Stud Anorex Bulim Obes, 22(1), 61–68. https://doi.org/10.1007/s40519-016-0342-0
Kristjánsdóttir, H., Sigurðardóttir, P., Jónsdóttir, S., Þorsteinsdóttir, G., & Saavedra, J. (2019). Body image concern and eating disorder symptoms among elite Icelandic athletes. Int J Environ Res Public Health, 16(15), 2728. https://doi.org/10.3390/ijerph16152728
Li, J. Z., Lim, H. B. T., Lou, S. S., Tun, M. H., & Lai, S. (2025). Prevalence of mental health symptoms in Singapore elite athletes. Singapore Med J. https://doi.org/10.4103/singaporemedj.SMJ-2024-253
Colangelo, J., Smith, A., Buadze, A., Keay, N., & Liebrenz, M. (2023). Mental health disorders in ultra endurance athletes per ICD-11 classifications: A review of an overlooked community in sports psychiatry. Sports, 11(3), 52. https://doi.org/10.3390/sports11030052
Han, D. H., McDuff, D., Thompson, D., Hitchcock, M. E., Reardon, C. L., & Hainline, B. (2019). Attention-deficit/hyperactivity disorder in elite athletes: A narrative review. Br J Sports Med, 53(12), 741–745. https://doi.org/10.1136/bjsports-2019-100713
Vakhitova, Z., Mezzetti, C., Alston-Knox, C., Jowett, S., Rhind, D., Lin, C. Y., et al. (2026). Performance-enhancing drug use in sports: A Bayesian variable selection and profile regression approach to identifying risk factors and estimating prevalence. Subst Abuse Treat Prev Policy, 21(1), 25. https://doi.org/10.1186/s13011-025-00699-x
Currie, A., Gorczynski, P., Rice, S. M., Purcell, R., McAllister-Williams, R. H., Hitchcock, M. E., et al. (2019). Bipolar and psychotic disorders in elite athletes: A narrative review. Br J Sports Med, 53(12), 746–753. https://doi.org/10.1136/bjsports-2019-100685
Vorster, A. P. A., Erlacher, D., Birrer, D., & Röthlin, P. (2024). Sleep difficulties in Swiss elite athletes. Life, 14(6), 779. https://doi.org/10.3390/life14060779
Choi, Y., Kim, S., Park, S. H., Kim, K., Kim, R. K., Kwak, H. B., et al. (2025). Relationship between poor sleep and depressive symptoms in Korean elite youth athletes. J Clin Med, 14(2), 479. https://doi.org/10.3390/jcm14020479
Li, C., Fan, R., Sun, J., & Li, G. (2021). Risk and protective factors of generalized anxiety disorder of elite collegiate athletes: A cross-sectional study. Front Public Health, 9, 607800. https://doi.org/10.3389/fpubh.2021.607800
Gülü, M., & Yapıcı, H. (n.d.). Elite level athletes’ perspective on prohibited substances for performance enhancement: A cross-sectional study.
Tahtinen, R. E., Kristjánsdóttir, H., Þorgeirsson, S., Oddson, H. R., Saavedra, J. M., & Morris, R. (2021). Depressive symptoms in Icelandic elite athletes: A prospective examination through the lens of the response styles theory. Psychol Sport Exerc, 56, 101964. https://doi.org/10.1016/j.psychsport.2021.101964
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Copyright (c) 2026 Laura Kobaka, Maurycy Jabłoński, Klaudia Jurga, Jakub Chołast, Jakub Kacer, Julia Kacer, Wiktoria Łuniewska, Jakub Niepokój, Marta Modrzyk

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