Gymnastik- och idrottshögskolan, GIH

Objectives

The first aim was to examine mental health problems (MHP) in elite athletes addressing prevalence, sex-differences, onset, recurrent episodes, help-seeking, symptoms of specific disorders and previous psychiatric diagnoses. The second aim was to investigate if sport-specific instruments could indicate clinical levels of psychiatric symptoms.

Design

Cross-sectional survey.

Methods

Elite athletes (representing different Swedish national teams and applying for a university scholarship (n = 333) answered a web-based survey. Females represented 58.9%. Mean age was 24.6(±3.1) years and 77.2% were individual-and 22.8% team-sport athletes.

Results

Lifetime prevalence of MHP was 51.7% (females 58.2%, males 42.3%). Point prevalence was 11.7% (females 13.8%, males 8.8%). Onset of first MHP episode peaked at age 19 with 50% of onsets between ages 17–21. Recurrent episodes were common, and females sought help more than males (females 37.8%, males 16.8%). Overall 19.5% reached the clinical cut-offs for symptoms of anxiety and/or depression (females 26.0%, males 10.2%). Previous psychiatric diagnoses existed among 8.1% (females 10.7%, males 4.4%). A depressive disorder, an eating disorder or a trauma and stress related disorder (self-reported as burnout) were most common. Finally, most sport-specific instruments (80%) demonstrated a fair diagnostic accuracy compared to clinically validated instruments.

Conclusions

Lifetime prevalence of MHP was reported by more than half of the athletes. Symptoms manifested in young age and recurrent episodes were common. Sport-specific instruments indicating when symptoms reach clinical levels are potentially useful for data summary purposes on a group level, but without sufficiently high sensitivity and specificity to be recommend for applied work with athletes.

Objectives Few studies have evaluated the prevalence of psychiatric disorders among treatment-seeking elite athletes (EA) or high-performance coaches (HPC) in psychiatric outpatient settings. Methods Descriptive overview of EA and HPC with psychiatric disorders at two publicly funded psychiatric outpatient treatment clinics in Stockholm and Malmo, Sweden. Co-occurring psychiatric disorders were illustrated using Venn diagrams for EA and HPC, and male and female EA separately, among patients from the Stockholm clinic (SC) that used standardised diagnostic interviews. Results Overall, most patients were EA (n=221) compared with HPC (n=34). The mean age was 23.5 (+/- 5.9) years for EA and 42.8 (+/- 8.8) for HPC. Anxiety disorders were most common at the SC in EA and HPC (69% vs 91%, respectively). Stress-related disorders were found in 72% of HPC compared with 25% of EA. Affective disorders were found in 51% of EA and 52% of HPC. Eating disorders were common among EA (26%), especially females (37%). Substance use disorders were found in 17% of HPC. Comorbidity was generally common between affective and anxiety disorders. Conclusion Stress and adjustment disorders were found in nearly three of the four HPC compared with one in four EA. Eating disorders were prevalent in around one in four athletes and about one in six HPC had a substance use disorder.

This study explores the reasons given by five elite athletes for choosing to seek psychiatric support and treatment outside, rather than inside, their own sport environments. Life story interviews were conducted with these athletes, who were recruited from an open psychiatric clinic in Stockholm, Sweden. The interviews were then subjected to a structural and a thematic narrative analysis. The former revealed the power of the performance narrative to frame the lives of the athletes by producing a single-minded focus on performance outcomes that justifies, and even demands, the exclusion of any form of psychological weakness or vulnerability. The latter revealed the relationship between the performance narrative and the process of stigmatization associated with psychiatric disorders in elite sport and how this pressures athletes to adopt specific Goffmanesque impression management strategies to protect themselves within their own sport environments. These strategies were as follows: wearing a mask (to hide their psychological suffering), adhering to a vow of silence (making stories of psychological suffering untellable in elite sport), and finding an alibi (a way of portraying suffering in an “acceptable” form). Finally, we reflect on implications for practice, including the potential of narrative care, to help elite athletes explore alternative narratives that might be supportive rather than dangerous companions when suffering from psychiatric disorders.

Lay summary: Five elite athletes were interviewed about their experiences of living with psychiatric disorders, focusing on their choice to seek psychiatric treatment outside, rather than inside, their own sport environments. Stigma and adhering to a single-minded focus on performance forced the athletes to adopt different strategies to hide their psychological suffering.

IMPLICATIONS FOR PRACTICE

• The performance narrative, characterized by a single-minded focus on performance that demands the exclusion of any form of psychological weakness, stigmatizes elite athletes with psychiatric disorders, making their stories untellable within elite sport.
• To protect themselves from stigma, these athletes developed impression management strategies to hide their psychological suffering within elite sport.
• Knowledge of these impression management strategies among different mental health providers working to support athletes, and the use of narrative care to explore alternative narratives, may facilitate elite athletes in seeking support, help, and understanding for their psychiatric disorders.

Eating disorders are highly prevalent in elite athletes but the lived experience of these has not been investigated extensively. In this article, we draw on life story data generated from four hours of interviews with a young (20 years plus), Swedish, elite, female athlete in an individual sport, named Lisa (a pseudonym) to explore her experiences of living with, seeking treatment, and attempting to recover from a diagnosed eating disorder. This exploration is accomplished by the use of poetic representations. Having made the methodological case for their use we then present the poems for consideration by the reader. The three poems are entitled All the little pointers, The voice inside my head, and Turning it around. Following this, we offer some reflections on how each poem might act as a pedagogical resource to assist those involved with elite athletes to better understand the nature of eating disorders, how the sporting environment can play a role in initiating and sustaining them, and how athletes might be supported and guided on the road to recovery.