Student-Athletes’ Mental Health

While this is an issue very near and dear to my heart as both a mental health therapist and former college athlete, it occurred to me that not everyone is aware of the unique stressors of this population and how prevalent mental illness is for these students. 

The mean age of onset for anxiety disorders is 21 years old (Lijster et al., 2017) and 18 years old for eating disorders such as anorexia and bulimia (Volpe et al., 2016). In another study of adults struggling with depression, the age group making up the largest percentage of adults with depression symptoms is 18-29 year olds. Women also seem to be more likely to experience symptoms of depression than men (Villarroel & Terlizzi, 2019).  A meta-analysis of over 100,000 college students worldwide found 33.6% of college students showed clinically significant symptoms of depression and anxiety with the highest levels of anxiety symptoms in North American college students and overall increased levels of both anxiety and depression post the COVID-19 outbreak (Li, Zhao, Chen, Peng, & Lu, 2022). 

So based on these statistics, college students are already at increased risk of developing mental illness due to their age and what we know about the onset of mental illness, but when faced with unique pressures to perform and high demands of their sport and school, athletes are even more likely to struggle. Not only are athletes exposed to unique stressors they have to find ways to cope with, there is often more stigma around seeking mental health support in addition to the logistical challenges of balancing their schedules/demands. They might be more likely to struggle in silence compared to their non-athlete peers whether that be due to fear of judgment, lack of perceived or actual ability to access resources, normalization among athletic peers, and more. 

While the prevalence rates vary based on the study it is clear eating disorders occur at an extremely high rate in college athletes. For female athletes the rate of eating disorders and disordered eating is 6-45% and 0-19% for male athletes (Power et al., 2020) (significantly higher than the rates in the general population) and these are just self-reported rates likely underestimating rates given many individuals who do not recognize their eating as disordered. 

I believe the increased rates of eating disorders (and other mental health challenges) in athletes compared to the general population be due to a combination of personality traits present in athletes like competitiveness, high achieving tendencies/pressure whether they put that on themselves or it is coming externally, habits that predispose them to using behaviors like compulsive exercise, restriction, and all of this on top of being a young adult in a world rampant with diet culture messages. 

Coaches, athletic trainers, strength and conditioning coaches and all of those in close contact with athletes have a chance to have a profound impact on athletes for better or for worse during this formative period. These adults are the frontline for athletes during this time of their life. They often see and interact with these students more than their own family members so they are a really important factor in early detection and intervention for athletes’ mental well-being. 

While there are no doubt benefits, life lessons learned, and emotional growth that can happen as a result of the student-athlete experience, there are also challenges that have the potential to do harm when individuals are not equipped with the right support and education. Athletes are human beings first and we need to value their overall well-being (not to mention improving their mental health will likely improve their performance).

Ways Colleges/Universities can help:

• Make resources/counseling accessible - 

• Normalize seeking support -

• Provide trainings and workshops to coaches and support staff - make them aware of verbal abuse looks like (where is the line of pushing their athletes and holding them accountable versus going too far)

• Educate coaches, trainers, support staff, and players on the prevalence of mental illness in college students and warning signs/symptoms to look out for (anxiety, depression, OCD, eating disorders etc)

References

Li, W., Zhao, Z., Chen, D., Peng, Y. and Lu, Z. (2022), Prevalence and associated factors of depression and anxiety symptoms among college students: a systematic review and meta-analysis. J Child Psychol Psychiatr, 63: 1222-1230. https://doi.org/10.1111/jcpp.13606

Lijster JM, Dierckx B, Utens EM, Verhulst FC, Zieldorff C, Dieleman GC, Legerstee JS. The Age of Onset of Anxiety Disorders. Can J Psychiatry. 2017 Apr; 62(4):237-246. doi: 10.1177/0706743716640757. Epub 2016 Jul 9. PMID: 27310233; PMCID: PMC5407545.

Power, Ksenia, et al. “Disordered Eating and Compulsive Exercise in Collegiate Athletes: Applications for Sport and Research.” The Sport Journal, 14 Feb. 2020, thesportjournal.org/article/disordered-eating-and-compulsive-exercise-in-collegiate-athletes-applications-for-sport-and-research/. 

Villarroel MA, Terlizzi EP. Symptoms of depression among adults: United States, 2019. NCHS Data Brief, no 379. Hyattsville, MD: National Center for Health Statistics. 2020.
Volpe, U., Tortorella, A., Manchia, M., Monteleone, A. M., Albert, U., & Monteleone, P. (2016). Eating disorders: What age at onset? Psychiatry Research, 238, 225–227. https://doi.org/10.1016/j.psychres.2016.02.048