# Exercise as it relates to Disease/Mental health in Australian elite athletes
## What is the background to this research?

Mental health is defined as psychiatric disorders and symptoms of psychological distress which has a significant impact on quality of life, resulting in functional impairment in work, social activities, and other important aspects of life. Athletes, in particular elite athletes face a variety of day to day challenges such as overtraining, burnout, body weight focus, injury, deselection and pressure to perform/expectation to name a few which can have a significant impact on an individuals mental health.
The prevalence of mental disorders is greatest among younger people with one-quater of 16-34 year olds meeting the clinical criteria for one or more mental health disorder. These disorders include depression, generalised anxiety, social anxiety, panic disorder and eating disorder. Due to the very little knowledge regarding prevalence of Mental health disorders in athletes, this study was aimed at investigating Australian Elite Athletes symptoms of general psychological distress and common mental disorders.

## Where is the research from?

Gulliver, Griffiths, Mackinnon, Batterham, and Stanimirovic conducted their research by administrating a self-report internet-based survey comprising measures of demographic status and mental health symptoms. Dr Gulliver is an early career research fellow at the Centre for Mental Health Research, National Centre for Epidemiology and Population Health, ANU College of Health & Medicine. Gullivan completed a Bachelor of Psychology (honours) as well as a PHD in research where she focuses on finding practical solutions to improve mental health in key at-risk population groups.

## What kind of research was this?

This research classifies as an observational study due to all subjects participating in the same methods, in the same order. It contains quasi-experimental elements as there were no random assessments or tasks undertaken outside of the experiment given. The main research undertaken was a cross-sectional survey design which was employed to assess self-reported symptom prevalence of mental health in elite athletes in Australia.

## What did the research involve?

224 elite athletes (118 Female, 106 male) from the Australian Institute of Sport (AIS) and Australian sporting organisations were administered a self-report internet-based survey comprising measures of demographic status and mental health symptoms. The survey took approximately 20-30 mins to complete and all online data was conducted using Lime Survey (www.limsurvey.com). Inclusion criteria were being aged 18 years or older and being an elite athlete, as defined by participants’ level of competition (Olympic or Paralympic, professional, or state, national, or international-level athletes). Ethics approval for the study was granted by both the Australian Institute of Sport (AIS) and The Australian National University Human Research Ethics Committee
There are a few limitations within this study. First being the response rate among AIS Athletes was low and the findings may not represent all Australian Elite Athletes. Second, athletes with past experience of mental health problems or injury may have been more likely to participate in the survey which could lead to a biased sample. Finally, the symptoms recorded where self reported which could represent indications of likely or probable mental disorder.

## What were the basic results?

Out of 224 elite athletes, just under half of respondents met criteria for at least one mental health problem, and over half had sought help from a mental health professional for personal or emotional problems.
General psychological distress (K-10) scores for the present study were significantly higher than other measures with a mean score of (males = 14.63, females= 16.67) (table 2) with 20.3% of females reaching the caseness cut-off score (table 3). Linear regression models demonstrated that injured athletes had significantly higher symptoms of depression (t = 3.23, p = .001) and generalised anxiety (t = 2.26, p = .025) than non-injured athletes. However Injury and relocation were not significantly associated with meeting criteria for any other disorder.
Specifically, 46.4% of athletes (males = 38.7%, females = 53.4%) were likely cases for at least one of the mental health problems measured (general psychological distress, depression, generalised anxiety, social anxiety, panic disorder, or eating disorder). One-quarter (males = 23.6%, female = 30.5%) of the athletes scored above the caseness cutoff score (table 3) for depression and 7.1% (males = 3.8%, females = 10.2%) was recorded for generalised anxiety disorder.
Table 1: Respondents Demographic Data
| Characteristics, n(%) | Male (n/%) | Female (n/%) | Female (n/%) |
| AGE in years, mean (SD) | 26.08 (6.76) | 23.86 (5.02) | 23.86 (5.02) |
| Level of competition | | | |
| Olympic | 8 (7.5) | 8 (7.5) | 18 (5.3) |
| Paralympic | 3 (2.8) | 3 (2.8) | 5 (4.2) |
| International | 35 (33.0) | 35 (33.0) | 70 (59.3) |
| National State | 25 (23.6) | 25 (23.6) | 12 (10.2) |
| Age group International | 14 (13.2) | 14 (13.2) | 6 (5.1) |
| Age group State | 6 (5.7) | 6 (5.7) | 6 (5.1) |
| Professional | 15 (14.2) | 15 (14.2) | 1 (0.08 |
| Injury occurred in the last 4 weeks (n = 54) | 6 (27.3) | 6 (27.3) | 10 (31.3) |
| Current injury or modified training program due to injury | 22 (20.8) | 22 (20.8) | 32 (27.1) |
Table 2: Symptoms of mental health disorders and reported help-seeking behaviour.
| Construct | Symptom measure (potential range) | Male (n=106) | Female (n=118) | Total (n=224) |
| General physiological distress | K-10 (10–50), M (SD)* | 14.63 (6.11) | 16.67 (5.70) | 15.71 (5.97) |
| Depressive symptoms | CES-D (0–60), M (SD) | 10.33 (9.47) | 12.64 (9.06) | 11.55 (9.31) |
| Anxiety symptoms | GAD-7 (0–21), M (SD)* | 3.32 (3.86) | 4.78 (3.84) | 4.09 (3.91) |
| Social anxiety symptoms | SPIN (0–68), M (SD) | 9.46 (8.40) | 9.97 (8.61) | 9.72 (8.49) |
| Panic disorder symptoms | PDSS-SR (0–28), M (SD) | 0.67 (2.92) | 1.02 (2.60) | 0.86 (2.75) |
| Eating disorder symptoms | SCOFF (0–5), M (SD)** | 0.43 (0.88) | 1.07 (1.25) | 0.77 (1.14) |
Table 3: Percentages meeting cut-off score
| Construct | CASENESS CUT-OFF (PERCENTAGE MEETING CUT-OFF SCORE) | Male (n=106) | Female (n=118) | Total (n=224) |
| General physiological distress | K-10 SCORE ≥ 22 (%) | 13 (12.3) | 24 (20.3) | 37 (16.5) |
| Depressive symptoms | CES-D SCORE ≥ 16 (%) | 25 (23.6) | 36 (30.5) | 61 (27.2) |
| Anxiety symptoms | GAD-7 SCORE ≥ 11 (%) | 4 (3.8) | 12 (10.2) | 16 (7.1) |
| Social anxiety symptoms | SPIN SCORE ≥ 19 (%) | 15 (14.2) | 18 (15.3) | 33 (14.7) |
| Panic disorder symptoms | PDSS-SR SCORE ≥ 19 (%) | 3 (2.8) | 7 (5.9) | 10 (4.5) |
| Eating disorder symptoms | SCOFF SCORE ≥ 2 (%)** | 13 (12.3) | 38 (32.2) | 51 (22.8) |
| MET CASENESS FOR ANY MENTAL HEALTH PROBLEM, N (%)* | MET CASENESS FOR ANY MENTAL HEALTH PROBLEM, N (%)* | 41 (38.7) | 63 (53.4) | 104 (46.4) |

## What conclusions can we take from this research?

This study is useful as it identifies the specific mental health disorders in elite athletes. In the study undertaken, it was demonstrated that more than half of the athletes surveyed met caseness for at least one mental health problem. It was reported that at least One-quarter (males = 23.6%, female = 30.5%) of the athletes scored above the caseness cutoff score for depression and 7.1% (males = 3.8%, females = 10.2%) was recorded for generalised anxiety disorder (Table 3). Within the study it was evident that one-quater of the athletes experienced an injury (table 1). Injury is considered to have a significant impact on depression in athletes and predicted depression symptoms. In this study sample injured athletes had higher depression scores than non-injured athletes. This indicates that anxiety and in particularly depression seem to be the most common mental health disorder found among elite athletes. Despite current data, the responses to depression and anxiety were ultimately self diagnosed and the questionnaire does not provide a mental health evaluation.

## Practical advice

Mental Health is something that can often be forgotten about. There should be a significant amount of importance placed on mental health, in particularly to elite athletes ensuring they are well supported and have access to mental health professionals. As seen in the results, injured athletes have a significantly high score for mental health problems and therefore should be a priority. Although there was an encouraging amount of help seeking behaviours for psychological problems, help seeking from professional sources should be facilitated. It is fundamental that Elite Athletes have access to qualified psychologists as this will allow for the athletes to better understand the way in which their brain ticks both away from training and during performance. Not only will this benefit an individual off field however it will allow athletes to be able to cope with added stresses when performing which can have a positive effect on overall performance.

## Further information/resources

Research Supports the need of continued focus on Mental Health
Focus on Mental health for Elite Athletes a must
IOC Mental Health In Elite Athletes Toolkit

## References

* ↑ Åkesdotter, C., Kenttä, G., Eloranta, S. and Franck, J., 2020. The prevalence of mental health problems in elite athletes. Journal of Science and Medicine in Sport, [online] 23(4), pp.329-335. Available at: https://reader.elsevier.com/reader/sd/pii/S144024401930502X?token=BD510A625F302444D696490CF6C9672F7646B98025D8B7D16D2A0C40F7677B051DB043EA1223827AF6B8D6F0FFAA6A49&originRegion=us-east-1&originCreation=20220912010325>[Accessed 10 September 2022].
* 1 2 3 4 Gulliver, A., Griffiths, K., Mackinnon, A., Batterham, P. and Stanimirovic, R., 2015. The mental health of Australian elite athletes. Journal of Science and Medicine in Sport, [online] 18(3), pp.255-261. Available at: <https://www.jsams.org/action/showPdf?pii=S1440-2440%2814%2900075-9> [Accessed 10 September 2022].
* ↑ The Australian National University. 2022. Australian National University; Researchers. [online] Available at: <https://researchers.anu.edu.au/researchers/gulliver-ajg> [Accessed 12 September 2022].
* 1 2 Gulliver, A., Griffiths, K., Mackinnon, A., Batterham, P. and Stanimirovic, R., 2015. The mental health of Australian elite athletes. Journal of Science and Medicine in Sport, [online] 18(3), pp.255-261. Available at: <https://www.jsams.org/action/showPdf?pii=S1440-2440%2814%2900075-9> [Accessed 10 September 2022].
* ↑ Johnston, K. and Waicus, K., 2022. DEPRESSION AND ANXIETY IN SPORTS | Sports Medicine Today. [online] Sportsmedtoday.com. Available at: <https://www.sportsmedtoday.com/depression-and-anxiety-in-sports-va-245.htm> [Accessed 10 September 2022].
* 1 2 Purcell, R., Gwyther, K. and Rice, S., 2019. Mental Health In Elite Athletes: Increased Awareness Requires An Early Intervention Framework to Respond to Athlete Needs. Sports Medicine - Open, [online] 5(1). Available at: <https://sportsmedicine-open.springeropen.com/track/pdf/10.1186/s40798-019-0220-1.pdf> [Accessed 12 September 2022].