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Br J Sports Med. 2019 Jun;53(11):707-721. doi: 10.1136/bjsports-2019-100710. Epub 2019 May 15.

Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment.

Author information

1
Department of Neuroscience, Medical School, Fundação do ABC, Santo Andre, SP, Brazil jmcmaia2@gmail.com.
2
Department of Psychiatry, Medical School, University of São Paulo, Sao Paulo, SP, Brazil.
3
ABC Center for Mental Health Studies, Santo André, SP, Brazil.
4
Bradesco Sports Association, Osasco, SP, Brazil.
5
Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.
6
Ebling Library for the Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.
7
National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA.
8
Department of Psychiatry, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA.
9
Athletic Department, University of Nebraska-Lincoln, Lincoln, Nebraska, USA.

Abstract

OBJECTIVE:

To summarise the literature on the barriers to athletes seeking mental health treatment and cultural influencers of mental health in elite athletes.

DESIGN:

Systematic review DATA SOURCES: PubMed, Cochrane, Scopus, SportDiscus (Ebsco), and PsycINFO (ProQuest) up to November 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES:

Qualitative and quantitative original studies of elite athletes (those who competed at the professional, Olympic, or collegiate/university levels), published in any language.

RESULTS:

Stigma, low mental health literacy, negative past experiences with mental health treatment-seeking, busy schedules, and hypermasculinity are barriers to elite athletes seeking mental health treatment. Cultural influencers of mental health in elite athletes include: (1) the lack of acceptance of women as athletes; (2) lower acceptability of mental health symptoms and disorders among non-white athletes; (3) non-disclosure of religious beliefs; and (4) higher dependence on economic benefits. Coaches have an important role in supporting elite athletes in obtaining treatment for mental illness. Brief anti-stigma interventions in elite athletes decrease stigma and improve literary about mental health.

CONCLUSION:

There is a need for various actors to provide more effective strategies to overcome the stigma that surrounds mental illness, increase mental health literacy in the athlete/coach community, and address athlete-specific barriers to seeking treatment for mental illness. In this systematic review, we identified strategies that, if implemented, can overcome the cultural factors that may otherwise limit athletes seeking treatment. Coaches are critical for promoting a culture within elite athletes' environments that encourages athletes to seek treatment.

KEYWORDS:

athletes; barriers; culture; mental health; stigma

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