Sports Medicine Group Issues Guidance on Athletes' Mental Health

By Scott Baltic

January 15, 2020

NEW YORK (Reuters Health) - Although participating in sports provides multiple benefits, it also exposes athletes to factors that can endanger their mental health. A new evidence-based, best practices document from the American Medical Society for Sports Medicine is intended to help team physicians and other health care personnel prevent, detect, and treat psychological issues and mental health disorders in athletes.

The AMSSM Position Statement on Mental Health Issues and Psychological Factors in Athletes focuses on competitive athletes from youth up through collegiate, Olympic and professional athletes.

In comparison to position or consensus statements on athletes and mental health released since 2017 by other professional organizations, the AMSSM document claims to break new ground in at least three ways.

First, it addresses topics that were not fully explored in earlier publications, including key personality issues, such as "athletic identity," the degree to which athletes see themselves within the athletic role and look to others for acknowledgement of that role; demographic and cultural variables, including sexual orientation; and environmental conditions, such as hazing, bullying, or sexual abuse.

Second, the statement discusses how these variables interact to both help and harm competitive athletes, as well as how team physicians and others can monitor the athletic environment for factors that might precipitate or aggravate mental health issues.

Third, it defines the levels of evidence and the knowledge gaps in this field.

Findings include

- Long-term psychological consequences from career-ending injuries are common among athletes.

- College student-athletes have a higher incidence of suicide than their non-athlete peers, with the highest risk seen in college football players.

- Benzodiazepine sedative hypnotics are not recommended for athletes because of their substantial "hangover" effect, which lengthens reaction time. Short-term melatonin use, however, is safe and does not harm athletic performance.

Dr. Cindy J. Chang of the Departments of Orthopaedics and Family & Community Medicine at the University of California, San Francisco, who co-chaired the panel that wrote the position statement, told Reuters Health by email that the authors are "a multidisciplinary group of sports medicine experts who routinely interact with competitive athletes, as a practical resource to assist other sports medicine providers with their athletes' mental health issues."

Dr. Simon Rice, of the Centre for Youth Mental Health at the University of Melbourne, Australia, told Reuters Health in an email that the AMSSM statement "builds on the work of recent consensus statements by drilling further into athlete-specific risk and protective factors for mental health problems."

The position statement, he continued, "provides specific identification, management and prevention guidance across a range of domains. It is thoroughly referenced and gives sports medicine practitioners an important reference for intervention and prevention."

Dr. Rice who wasn't involved in the AMSSM statement but who coauthored a 2016 systematic review on elite athletes' mental health, said he appreciates that the statement rates the quality of evidence underpinning the document's recommendations, while also acknowledging that evidence-based data specifically addressing athletes is limited.

More attention to athletes and mental health has the "potential for broader population mental health benefits as high-profile athletes share their experiences and normalise help-seeking efforts," Dr. Rice said. "This may help to shift stigma at the community level and support the growing focus on ... early intervention."

SOURCE: British Journal of Sports Medicine, online December 6, 2019.