Prioritize routine screening and regular monitoring of elite athletes’ mental health, says sports body

Sports bodies should prioritize routine screening and regular monitoring of elite athletes’ mental health to tackle the high prevalence of mental health issues among this group, concludes an International Olympic Committee (IOC) consensus statement, published online in the British Journal of Sports Medicine.

These activities should be done at predefined time points and after significant events, and should address the full range of contributing factors in training and competition, says the statement, which updates a previous statement on the topic, published in 2019.

And they should be part of an organizational culture that fosters good mental health and well-being among elite athletes across the board, it says.

The new statement draws on a synthesis of current scientific evidence reviewed by an international panel of 31 people with lived, clinical and scientific expertise. It aims to advance a more standardized, evidence-based approach to the management of mental health in elite athletes.

Mental ill health among elite athletes is common; may be triggered by, and manifest during, sport; and can affect performance, says the statement, adding that it exists on a continuum and is changeable.

“While recognition of overt mental health disorders in elite athletes remains essential, situating athlete well-being within a dynamic continuum offers an additional framework for understanding the spectrum of psychological functioning in this population,” suggests the statement.

“For example, elite athletes may experience transient stress reactions related to competitions, various temporary setbacks that are a normal and common part of elite athletes’ lives, or intense training periods. Thus, there are important mental health considerations even if an athlete does not have a diagnosable disorder,” it points out.

The statement covers a broad spectrum of topics, including detection and general management of mental ill health; types of treatment; specific mental health issues; influential stressors and environmental factors; cultural considerations; barriers to help-seeking; fostering mental well-being and resilience; social media; the intersection of injury, performance and mental health; and mental health emergencies.

Key recommendations:

• Mental health support for elite athletes should extend beyond individual management to making sure training environments, leadership behaviors, safeguarding systems and organizational culture support elite athlete mental health and well-being.
• Clinicians and sports bodies should proactively address stigma, confidentiality concerns, fear of deselection and low mental health literacy as part of routine elite athlete care.
• Sports bodies should implement routine screening and monitoring of elite athlete mental health at predefined time points and after significant events.
• All elite sport settings should establish, rehearse and regularly review mental health emergency action plans with defined roles and escalation pathways.
• Management of mental health symptoms and disorders should be tailored, evidence-based and culturally responsive, integrating psychotherapy, drug treatment and other contextually appropriate therapies, as indicated.
• Psychological responses to injury should be routinely assessed, and return-to-sport for elite athletes with mental ill health should incorporate athlete safety, stability and function as guiding principles.
• Athletes should receive targeted mental health screening and support before, during and after major transitions in sport.
• Mental health assessment and care for elite Para athletes must account for disability-specific stressors, accessibility barriers, classification systems and heightened transition risks.
• Mental health screening and support for elite adolescent athletes should reflect developmental stage, educational demands, family dynamics and the early onset of many common mental health disorders.
• Coaches, support staff and health professionals for elite athletes should receive role-appropriate mental health education to support early recognition, safe referral and psychologically informed practice.

“The responsibility for prevention, recognition and management of mental health symptoms and disorders and for promoting well-being extends across the entire elite sport ecosystem,” highlights the statement.

“Multiple interacting biopsychosocial and ecological factors influence athlete well-being, necessitating system-level attention and coordinated strategies. Elite athletes experience mental health symptoms and disorders at rates similar to, or higher than, the general population, and their presentations and care needs may differ from those of non-athletes.

“Ensuring that clinicians, coaches and sport organizations are prepared to recognize, respond to and proactively support mental health is essential to safe, ethical and sustainable elite sport participation,” it concludes.

In a linked editorial, Dr. Brian Hainline of New York University and international colleagues point out, “Emerging evidence also highlights a substantial mental health burden among members of the athlete entourage, including coaches and medical professionals.

“These findings reinforce the view that mental health in elite sport is an ecosystem issue rather than one borne solely by athletes.

“In parallel, all athletes ultimately transition out of sport, and difficult transitions are strongly associated with the development of mental health symptoms and disorders.”

The time has come for action, insist the authors, “For international federations and national governing bodies, this second IOC consensus statement demands decisive action. Mental health must be embedded as a core element of governance, safeguarding and high-performance systems, and not treated as an adjunct to medical care or athlete resilience.”

And they conclude, “This consensus provides a roadmap; our hope is that leadership, accountability and sustained investment will follow.”

Who’s behind this story?

Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries.

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Alexander Pol

PhD nano-engineering from Delft University. Published researcher and journal reviewer. Brings scientific insight to content standards.

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