Mental Health in Youth Sports

“People who wade into discomfort and vulnerability and tell the truth about their stories are the real badasses.” -Brené Brown

Mental health in athletics is an issue often overlooked and viewed as a weakness. Seeking help should not be looked down upon or discourage. Speaking out and telling your truth shows strength and courage and should be advocated for, and services should be available as an outlet for athletes to seek help when needed. What I want to show you is that by acknowledging your mental health struggles as an athlete is showing vulnerability, and that vulnerability is the ultimate display of courage, not weakness.

In my last article I talked about how we can slow our lives down, particularly for athletes and those of us in the health and fitness industry. I talked about lifestyle changes we can implement to take care of our mental health, but I didn't talk about why mental health is even an issue in an athletic population. 

We sometimes forget that athletes are very much susceptible to mental health issues just like the general public. Despite often being an overt picture of health and fitness, they are also humans like the rest of us. Mental health issues in athletes can approach a prevalence of near 50% in some studies (PMID: 24882147), but for the most part are comparable in prevalence to the general population in terms of anxiety and depression disorders (PMID: 26896951). As outwardly fit individuals, athletes often feel pressured to uphold this image, and may suppress mental health issues they may be struggling with. These conditions vary but can include depression and anxiety disorders, dysfunctional sleep, eating disorders, substance abuse, and gambling to name a few (NCAA: Mind, Body, and Sport; PMID: 26896951). These all exist in a cycle that feeds off the culture of sport; this, I believe, is where change can happen. 

Below are some of the factors that negatively impact the mental health of athletes. This list isn't exhaustive, but it is a place to start understanding why we need a mindset and culture shift when it comes to how we view the mental health of athletes. In the athletic community, we need to view mental health with the same importance as we view mental toughness.   

Early specialization is when athletes, either by pressure or choice, fully immerse themselves in a single sport while removing themselves from all other sports they were previously involved in. The idea behind early specialization is that by putting all of the athlete's focus and effort into one sport, they are developing the skills and stamina required by that specific sport. At some point in an athlete's development, high level athletes pursuing their sport with professional level aspirations will have to specialize. Although this may appear to be true throughout youth sports relative to their local peers, evidence tells us that the majority of top world-class athletes participated in multiple sports and specialized later in their development (PMID: 24444233, 31532693). One study found that athletes who participated in 3+ sports at the ages of 11, 13 and 15 were more likely to compete at the national level between the ages of 16 and 18 (PMID:22974248). An Idea behind this is that multi-sport participation develops greater overall physical fitness that may improve the performance of sport specific skills and fitness (PMID: 26502420). Aside from the idea that early specialization doesn't prove to yield world class athletes, there are detrimental effects of early specialization that all have the potential to effect the mental health of these young, vulnerable athletes. I detail some of these factors throuhgout the rest of the article. 

Sport participation and exercise usually has a positive impact on mental health, and is often a method used to treat conditions like depression (PMID: 27253219). However, early specialization in sport can have a significant effect on mental health. Specializing in a single sport introduces a number of stressors that all can have an impact on the mental health of the young athlete. Some of the effects of negative stressors during early specialization are increased occurrence of injuries, increased psychological stress, and early sport dropout rates (PMID: 24427397). 

Positive self-image is an aspect of one's life that can be affected in the sporting world, especially so in early specialization and high level athletes. The biggest predictor of positive self-image in athletes is sport enjoyment, rather than sport type or volume. When looking at the mental health benefits of exercise, a fallacy exists between effort, success, self-esteem, and enjoyment. It is often thought that children want to win; and to win, they must practice many hours per week; and that by practicing excessively and becoming the best player on their team, this will increase their self-esteem, and thus achieve happiness. This success-model may be the case in some athletes, but for most, it has been shown that self-esteem isn't the product of success, but that the biggest predictor of self-esteem in sport, is sport enjoyment (PMID: 23933963). What that looks like for each individual is different, but communication between parent and child is key to determining an individual's threshold for happiness and enjoyment in sport. 

Training Volume is the next big factor that is closely related to mental well-being. Training volume is very closely related to sport enjoyment, and therefore mental well-being. There appears to be a dose-dependant nature of physical exercise and mental health. An online survey of 16-20 year old athletes found that mental well-being peaked at 14 hours of physical activity per week on average (PMID: 24257080). At just 17.5 or more hours per week, chances of mental well-being decreased 230%, equivalent to the metal wellbeing of athletes having been physically active for 3.5 hours or less. This doesn't necessarily mean physical exercise in one sport, these numbers are cumulative for all physical exercise throughout the week. Training volume for peak wellness will be different for everyone, so the above numbers are just a reference to keep in mind. Training volume also has a fairly direct relationship to risk of injuries (PMID: 30403911), and we know that injuries play a significant role in the mental health of athletes. 

Injury Risk not only takes a physical toll, but also affects the mental well-being of an athlete. Two major kinds of injuries exist: overuse injuries and impact injuries. Of the impact injuries, the most common (and significant) are concussions (PMID: 25275889), and both overuse and impact injuries are implicated as a result of early specialization. Concussions are a whole topic to dive into on its own, but what I will say here is that young high level athletes who have sustained at least one concussion have poorer mental health outcomes compared to their non-concussed peers including self-harm, depression and suicide attempts (PMID: 30808466). There is a surge of research being conducted currently investigating the effects of concussions on athlete's well-being that will be important for policies in youth sports going forward. Overuse injuries are due to specific, repetitive physical stresses and are most often associated with high level single sport athletes (PMID: 24379720). So not surprisingly, a number of correlations to early specialization and high volume of organized sports have been made. According to a study from 2018, NBA players who played multiple sports in high school were much less likely to sustain an injury (25%) than those who were single sport athletes in high school (43%) (PMID: 29135275). This highlights another benefit of promoting multi-sport athletes early in life and delaying sport specialization. There are multiple aspects of how non-concussion injuries affect mental health. Social isolation and sports withdrawal due to injury can temporarily or permanently cause an athlete to lose their identity, an aspect of their life that they have potentially dedicated a large part, or most, of their youth building towards. This is an area that gets neglected and mental health support should be available to players who incur injuries. 

Sport figure influencers play a big role in developing athletes, particularly high level athletes where sport is a big part of their lives. A study by the US Anti-Doping Agency in 2012 surveyed athletes aged 8-18 and found that athletes rated their coaches as the top positive influential people in their lives, with athletes competing at the national level rating their coaches a 90/100 as "mostly good" influences and local athletes rating their coaches 78/100 on the same scale. This shows that coaches have the opportunity to strongly impact their athlete's lives in a positive way. However, I would argue that it also gives them an obligation or responsibility to take their role seriously as it puts them in a powerful position with regards to their athlete's mental well-being and quality of life in a time where these young athletes are very vulnerable to change and development.   

Sleep is immensely important for the maintenance of mental health and disordered sleep has been implicated in most, if not all, mental health disorders (PMID: 27416139) and has even been reported to cause mental health conditions (PMID: 28888927). This is no exception in an athlete population, and it has been found that young athletes sleep 1-1.5 hours less than the recommended 8-10 hours of sleep for their age group on average (PMID: 24993935). There are many different kinds of disordered sleep patterns that are very distinct in how they affect ones sleep, so it is a tricky condition to definitively diagnose and treat appropriately. However, one aspect common to all sleep disorders or deficits is that they all have the potential to affect mental health of those suffering from insufficient sleep, and potentially more detrimental effects in the long term. Adolescents in particular have increased requirements for sleep, as their bodies are changing. Add in adolescent athletes whose bodies also need to heal from the increased training and its effect on the body, then they likely need to aim for the upper range of sleep recommendations (10 hours of sleep), but are only getting on average 6.5-7 hours of sleep each night. A recent article published in the official journal for the Depression and Anxiety Association of America found that insufficient sleep and daytime sleepiness had a significant effect on individuals moods (PMID: 29790238). This is particularly important given daytime sleepiness can contribute to decreased performance, but it can also be monitored by parents, teachers and coaches of adolescents making this an important observation to seek sleep support. High level adolescent athletes are particularly at risk for sleep issues, as athletes who have high athletic aspirations and goals and those who practiced more than 10 hours per week were shown to have poorer sleep compared to athletes who pursued sport for enjoyment rather than success and those who practiced for 3 hours or less (Stracciolini et al, 2019; Milewski et al, 2019). In addition, elite adolescent athletes were found to perform worse in school, showing a decreased effect on academic performance (PMID: 24947107). 

So how can I integrate all this information? If peak mental well-being is found at an average of 14 hours of physical activity per week, but athletes who practiced greater than 10 hours per week have decreased sleep, what is the magic number? It comes down to what is right for your child as an individual, not an average. Proper communication and observation of body language of each individual child surrounding sport type and volume of activity will help determine how much is enough. 

Athlete Burnout has gained a few definitions over the years, and early on was believed to include the eventual withdrawal from sport ( Smith, 1986). However, we later understood that burnout can exist without the eventual withdrawal from sport, as Raedeke (1997) defined it as "chronic psychological syndrome consisting of emotional and physical exhaustion, reduced sense of accomplishments, and sport devaluation." What is clear about this definition is that burnout has significant implications in one's mental well-being. Symptoms that may exist in young athletes experiencing burnout can vary, but may include: fatigue, depression, loss of motivation, insomnia, irritability, anxiety, decreased self-confidence, loss of appetite, decreased mental concentration, and recurrent illnesses among many others (PMID: 31532693). All of these symptoms overlap with the presentations of various mental health conditions. Burnout isn't the most common reason young athletes withdrawal from sports, however it is something that can take months to recover from and have long lasting effects. In high-level young athletes, there are inevitably parts of training and competition that aren't enjoyable, and although it is a hard task to make sport participation for all high level athletes purely enjoyment-motivated, there are ways to lower risk of burnout. It has been found that focusing on long term development instead of short-term success, and emphasizing one's best effort instead of success as the determinant of value, have lower rates of young athlete burnout (PMID: 27724495, 26408202). There is still much to be learned, but by focusing on athlete resilience, and monitoring athlete's perceived stress and emotional affect we can help prevent youth athlete burnout and the negative implications that result (PMID: 31336729). 

Sport culture is the final aspect I want to highlight that has implications for the mental well-being and overall personal experience in sport of young athletes. The stigma of mental health alone is enough for athletes to want to hide or suppress feelings that make them appear weak in the eyes of their colleagues, fellow athletes, coaches, and fans. Factors that affect the mental health of athletes include: social history of the athletes, profit- and success-motivated sports organisations, expectations placed on the athlete by parents and the organisations they compete for, personal or organisational financial gain or loss, and the effect that the media plays on the individual athlete (PMID: 26626270). Along with the regular stresses of society, athletes are often exposed to the above additional stressors, which can sometimes prove to be too much for the athlete to handle. There has long been the emphasis on skill development and fitness in sports, but there has been a great a lack of emphasis on developing the psychological skills and capacity to cope with the mental stressors imposed on athletes within sports culture. Mental toughness and mental health are viewed as contradictory in sport, As Dr. James Bauman points out, psychologist and researcher of sports and human performance. This is an area that needs a culture shift, to change the mentality that seeking help for mental health issues shows weakness and vulnerability, when we should be promoting that vulnerability is strength. 

Overall, mental health issues are comparable, but slightly lower in prevalence in youth athletes compared to the age-matched general population. However, high-level success-driven athletes are exposed to the stresses of life as a developing child with the added burdens of being an athlete in today's society. This may put the young high level athlete at higher risk for negative mental health outcomes. Given the mental health concerns that some athletes struggle with, there are many far reaching benefits of physical activity and sports participation during childhood, and should be encouraged in a supportive environment, with enjoyment being the main driving force behind their choice of activity. 

I want to end with a quote by Dr. Craig A Williams, PhD, Director of the Children’s Health and Exercise Research Centre (CHERC), and Professor of Pediatric Physiology and Health/Director of Research at the University of Exeter: 

"The challenge for researchers in elite youth sports is to ensure that practices we pursue with our young charges promote their health and well-being and that sports is for the benefit of the athlete and not the other way around" (PMID: 29417870). 

Photo by Ben White on Unsplash