Dr Sarah Beable recently presented at the Sports Medicine New Zealand Conference on her work on Depression and Life Stress in Elite Sport, and the practical implications for those involved with these athletes.
Her study found that 1 in 5 New Zealand elite athletes fit the criteria for depression and that high-risk times were when contemplating retirement, those in an individual sport, and those in younger age groups. There was also a correlation between high life stress and depression.
Below is some content highlighting what she discussed in this presentation.
Depression is a significant public health issue, with approximately 18% of individuals suffering a major depressive episode in their lifetime with the rates continuing to rise.1 Depression is postulated to be second only to coronary artery disease as a cause of health decline and is a world-wide health issue. Previous research supports a positive correlation between regular exercise and positive mental wellbeing,2 and in the adolescent population sports participation has been reported to be protective for both depression and suicidal ideation.3 Furthermore exercise in various forms is also widely prescribed as a treatment for depression.4
In the past, it has been implied that only mentally and emotionally “strong” athletes would be competitive at the highest level and that those with significant mental illness would not be able to succeed.5 The observation that elite athletes are not immune to psychological disturbance has challenged this perspective, and it is time to tackle the stigma around mental illness in elite sport. There is a paucity of research in the elite athlete population, but emerging studies and reviews suggest that the prevalence of depressive symptoms in athletes is equal to or even greater than those in the general population.(6–10) Our colleagues across the Tasman in a recent study of 224 elite Australian athletes, found that 27.2% met criteria for depression.7 Similarly, US collegiate athletes demonstrated symptoms of depression in 19.2% of men and 25.6% of female athletes6 and a study of German elite athletes found that 15% were suffering a major depressive disorder.8 There is a great need for a shift in attitudes in the management of athletes who are suffering psychologically to enhance both awareness and support systems.
Many risk factors have been proposed to make the elite athlete more susceptible to depression. These include:
- Relocating for sport
- Eating disorders
- Individual sport (versus team sport)
- Female gender.
- Perceived failure around major events (Hammond et al).
Very few studies have examined the correlation between life stress and depressive symptoms.
It has been proposed that daily life niggles, or “hassles”, are more likely to cause a chronic level of stress than significant life events, and as such may be associated with depression in predisposed individuals.18,19 The 21st century exposes elite athletes to multiple sport specific stressors, including heightened social media usage for sponsors and sport followers, increased mainstream media obligations, financial concerns and extended travel commitments, all of which can add a high level of stress to the individual.
Taking all of this into account we embarked on a research project to assess the prevalence of depressive symptoms in elite athletes. The primary aim was to estimate the rates of depressive symptoms and life stressors and explore whether there was a correlation between life stress and depressive symptoms. Our secondary aim was to explore the influence of demographics and health history on mental health.
We found that 1 in 5 of the athletic population surveyed met the criteria for moderate depressive symptoms, and this was higher in those who were contemplating retirement, those in an individual sport, and those with higher life stress. The New Zealand general population is said to have similar rates of 1 in 4, or 1 in 5 suffering a major depressive illness in their lifetime, therefore, we feel that depression is likely as big a problem (and even could be unreported for a range of reasons) as it is in our society. This needs to be tackled as a public health and community issue, but sports specific support and attitude adjustments and education need to occur in the elite setting.
Our full paper is about to be published, so watch this space for more detail but below is the abstract of our research that will feature in The Journal of Science and Medicine in Sport.
SHARP - Sports mental Health Awareness Research Project: Prevalence and Risk Factors of Depressive Symptoms and Life Stress in Elite Athletes.
Our study aims to estimate the prevalence of symptoms of depression and daily life hassles in elite athletes.
A cross-sectional prospective epidemiological study design.
An online anonymous survey was administered during a 2-month period from May to July 2015. Athletes 18 years of age (or older) who were members of the High Performance Sport New Zealand programme were invited to participate. Of 370 potential participants, 187 completed responses were received (51%). Symptoms of depression were measured by the Centre for Epidemiological Studies Depression Scale - Revised (CESD-R). Life stress was measured by the Daily Hassles Questionnaire.
Overall 21% (n=39) of participants reported symptoms consistent with depression. Only 2 of the 39 athletes were currently taking an anti-depressant medication. Those contemplating retirement, partaking in individual sport, and who were less than 25 years old had significantly increased odds of experiencing depression. Reported life stressors were higher in females, in those who play an individual sport and those in a centralised programme. There was a significant correlation between higher levels of life stress and experiencing depressive symptoms.
This study highlights that depressive symptoms are prevalent in elite athletes with multiple potential risk factors identified including high life stress. These variables warrant further exploration to enable the early identification of athletes with depressive symptoms, screening and support for elite athletes.
- Mental Health Foundation New Zealand; Facts and Stats 2014 relating to New Zealand Health Survey. Ministry of Health 2014 Annual Update of Key Results 2013/14: New Zealand Health Survey Wellington: Ministry of Health 2014;
- Stanton R, Reaburn P. Exercise and the treatment of depression: a review of the exercise program variables. J Sci Med Sport2014;17(2):177–82.
- Babiss L a, Gangwisch JE. Sports participation as a protective factor against depression and suicidal ideation in adolescents as mediated by self-esteem and social support. J Dev Behav Pediatr. 2009;30(5):376–84.
- Brosse AL, Sheets ES, Lett HS, Blumenthal JA. Exercise and the treatment of clinical depression in adults: recent findings and future directions. Sports Med. 2002;32(12):741–60.
- Markser VZ. Sport psychiatry and psychotherapy. Mental strains and disorders in professional sports. Challenge and answer to societal changes. Vol. 261, European Archives of Psychiatry and Clinical Neuroscience. 2011.
- Yang J, Peek-Asa C, Corlette JD, Cheng G, Foster DT, Albright J. Prevalence of and risk factors associated with symptoms of depression in competitive collegiate student athletes. Clin J Sport Med. 2007;17(6):481–7.
- Gulliver A, Griffiths KM, Mackinnon A, Batterham PJ, Stanimirovic R. The mental health of Australian elite athletes. J Sci Med Sport. 2015;18(3):255–61.
- Nixdorf I, Frank R, Hautzinger M, Beckmann J. Prevalence of depressive symptoms and correlating variables among German elite athletes. J Clin Sport Psychol. 2013;7(4):313–26.
- Hammond T, Gialloreto C, Kubas H, Hap Davis H. The Prevalence of Failure-Based Depression Among Elite Athletes. Clin J Sport Med 2013;23(4):273–7.
- Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG. The Mental Health of Elite Athletes: A Narrative Systematic Review. Vol. 46, Sports Medicine. Springer International Publishing; 2016. p. 1333–53.
- Rao AL, Hong ES. In the mood for change: shifting the paradigm of mental health care in athletes—an AMSSM thematic issue. Br J Sports Med. 2016;50(3):133–4.
- Appaneal RN, Levine BR, Perna FM, Roh JL. Measuring Postinjury Depression Among Male and Female Competitive Athletes. J Sport Exerc Psychol. 2009;31:60–76.
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- Bruner MW, Munroe-Chandler KJ, Spink KS. Entry into Elite Sport: A Preliminary Investigation into the Transition Experiences of Rookie Athletes. J Appl Sport Psychol. 2008;20(October 2014):236–52.
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- Gouttebarge V, Frings-Dresen MHW, Sluiter JK. Mental and psychosocial health among current and former professional footballers. Occup Med (Chic Ill). 2015;65(3):190–6.
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- NZRPA Retired Player Survey. 2013.
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- Eaton WW, Muntaner C, Smith C, Tien A, Ybarra M. Center for Epidemiologic Studies Depression Scale: Review and Revision (CESD and CESDR). In: The use of psychological testing for treatment planning and outcomes assessment Vol 3: Instruments for adults. 2004. p. 363–78.
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- Lazarus RS, Folkman S. Hassles and Uplift Scales; Manual, Instrument and Scoring Guide [Internet]. Mind Garden, Inc; 1989. 0-52 p. Available from: www.mindgarden.com
- Trojian T. Depression is under-recognised in the sport setting: time for primary care sports medicine to be proactive and screen widely for depression symptoms. Br J Sports Med. 2015;137–40.
By Dr Sarah Beable on