Injury and mental health: are you in a doom loop?

As the study of sports science has evolved, one thing that has become increasingly apparent is the role of the brain in regulating physical performance. In recent years, research has identified that physical performance can be strongly influenced by a wide range of factors governed by the way we think or feel, or by exposure to external factors that can impact on brain function and frame of mind. Some examples include:

·        The positive impact of music on exercise performance^(1,2).

·        The negative impact of mental demands, either before^(3,4) or during exercise⁽⁵⁾.

·        The positive or negative effects of mental expectations on exercise performance⁽⁶⁾

·        The placebo effect (where beliefs enhance performance) and the nocebo effect (where beliefs harm performance).

Mental health and performance

Given that the brain can play such a role in determining physical performance, it’s hardly surprising that athletes who are struggling with mental health can experience a decline in physical performance. This decline can result from a number of resulting factors, including lack of motivation to train, and disordered eating patterns, social avoidance of group training sessions. You might think that because of their ‘tough personalities’, athletes are less likely to succumb to mental illness, or that athletes who might be prone to mental illness are protected to a degree by their high levels of physical activity [NB: sports or physical activity participation can be a protective factor for mental health, given its associations with improved social outcomes (eg a sense of belonging) and reduced levels of depression, anxiety, and stress]^(7,8). Unfortunately however, the reality is far less clear.

One French study examined the psychological health of more than 2,000 elite athletes⁽⁹⁾. In particular, it aimed to identify the principal psychological problems encountered within French elite athletes, and the variations in prevalence according to gender and the sport practiced (see figure 1). The sample used in this study was very comprehensive as it represented 13% of the country’s elite athletes at the time. The main findings were as follows:

·        Seventeen percent of the athletes had a current or recent psychopathology (eg anxiety, eating disorders, depression, sleep problems etc) at the time of their evaluation, with generalised anxiety disorder being the most prevalent at 6%.

·        Women were a third more likely than men to have a current or recent psychopathology (20.2% of women vs. 15.1% of men).

·        Female athletes were 56% more likely than males to have suffered from anxiety disorders over their lifetime.

·        Significantly higher rates of anxiety disorders (around four times higher in women and three times higher in men) were found in aesthetic sports such as gymnastics, synchronised swimming and figure skating.

Figure 1: Lifetime prevalence (%) of minor or major depression by type of sport practiced