COMMENTARY

Elite Athletes and COVID's Mental Health Tolls

Leanna M.W. Lui, HBSc

Disclosures

July 29, 2021

COVID-19 has certainly been a test of mental health and resilience for all the world's citizens. Among elite athletes, however, for whom training and competing are often full-time jobs, these stresses were compounded by losing ready access to that to which they had devoted most of their lives.

With the cancellation of sporting events, closure of training facilities, and competition restrictions, the pandemic seemed to close off yet another path to self-fulfillment and victory. This left many to wonder about the future of sport and those who participate in it at the highest levels.

With the Olympic games of summer "2020ne" (the unique spelling is in reference to the year that the postponed games were originally planned to occur) now underway in Japan, it's as good a time to ask as any: How did elite athletes fare during the pandemic?

The Syndemic of COVID-19 and Mental Health in Athletes

As a result of COVID-19 public health measures, many athletes were required to adapt their training plans, preparing in isolation or at home. Consequently, they were removed from their regular routines and had to adapt to the confines of new environments.

Data obtained throughout the pandemic indicate that as a result of these changes, elite athletes have experienced various physical and mental health challenges (eg, anxiety and depression, obsessive-compulsive disorder, increased consumption of alcohol and drugs, etc.). Suggested reasons for this increase in mental health symptoms and disorders include but are not limited to:

'It's OK Not to Be OK'

Although elite athletes have experienced an escalation in negative mental health outcomes during COVID-19, they were certainly not immune to such problems prior to the pandemic. A 2019 consensus statement from the International Olympic Committee reported that elite male athletes in team sports had a 5% prevalence of burnout and alcohol abuse, and a 45% prevalence of anxiety and depression. Among elite female athletes, the reported prevalence of depression and eating disorders ranged from 10% to 25%.

Such common mental health struggles among athletes may arise for a myriad of reasons (eg, physical injuries, financial stressors, maladaptive perfectionism, decreased sport performance). Athletes also often fall prey to a strict dichotomy: attempting to remain flawless on the field or in the arena while trying to maintain their vulnerability as human beings in the rest of their lives. Of course, striving for perfection and maintaining one's humanity shouldn't be mutually exclusive.

Numerous athletes have recently come forward to describe the inherent stresses in maintaining this internal division.

"I'm a human being. But I was so used to compartmentalizing everything," swimmer Michael Phelps, the most decorated Olympian in history, told Time magazine in a 2020 interview. "Being an athlete, you're supposed to be this strong person who doesn't have weaknesses, doesn't have any problems. No, that's wrong. I struggle through problems just like everybody else does."

Through his personal experiences with depression, anxiety, and suicidality, Phelps has become an avid supporter of bringing awareness to mental health.

"I wanted to open up and just talk about it. It is what makes me who I am," Phelps said.

The tennis superstar Naomi Osaka has also spoken openly about her mental health struggles. In late May, Osaka withdrew from the French Open as a result of anxiety associated with mandatory media activities. Her actions, and declaration that it's "OK to not be OK, and it's OK to talk about it," sparked international conversation about mental health among athletes.

Recently, Simone Biles, who is considered one of the greatest gymnasts of all time, withdrew from the Olympic team final and individual all-round competition to focus on her mental health. "Whenever you get in a high-stress situation, you kind of freak out," said Biles to reporters at the Games. "I have to focus on my mental health and not jeopardize my health and well-being … It just sucks when you're fighting with your own head." While her withdrawal occurred with the world watching, the conversation she sparked about protecting both physical and mental health dominated the event.

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