AMSSM position statement on mental health issues and psychological factors in athletes released

Reviewed by Kate Anderton, B.Sc. (Editor)Feb 12 2020

The American Medical Society for Sports Medicine (AMSSM) has released a position statement regarding "Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance, and Prevention."

This statement discusses how members of the sports medicine team, including team physicians, athletic trainers and mental health (MH) providers work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact MH, including sexuality and gender issues, hazing, bullying, sexual misconduct and transition from sport. Specific MH disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/ hyperactivity disorder are reviewed with a focus on detection, management, the effect on performance and prevention.

The position statement can be viewed by visiting the British Journal of Sports Medicine website. It is being concurrently published on the Clinical Journal of Sport Medicine website.

We believe this AMSSM position statement is novel in several respects. In addressing specific mental health disorders in athletes, our focus is not just on detection and management, but also any effect on performance and recommendations for prevention. It contains important topics such as psychological factors in athletes, including key personality issues, and the psychological response to injury and illness, including medication misuse. Lastly, it also discusses in depth the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct and transition from sport.

All these factors are contributory to the mental health of our athletes for whom we care, and it is vital that sports medicine providers understand the positive and negative impact of these variables on our athletes and how to monitor the athletic culture and environment that may precipitate or exacerbate their mental health issues."

Cindy Chang, MD, FAMSSM, co-lead author and AMSSM Past President

Athlete mental health is receiving increased attention in the sports medicine community. Although participation in athletics has many benefits, the very nature of competition can provoke, augment or expose psychological issues in athletes. Certain personality traits can aid in athletic success, yet these same traits can also be associated with mental health disorders. Importantly, the athletic culture may have an impact on performance and psychological health through its effect on existing personality traits and MH disorders. Consensus or position statements have been published by a number of organizations with each society bringing its own focus and perspective.

Sports medicine physicians are trained through their primary disciplines and sports medicine fellowships to provide comprehensive medical care to athletes, including the management of MH disorders. The team physician is often the coordinator of the athlete's overall health care and may oversee MH screening and treatment, the prescribing of psychiatric medication, and consultation with members of the MH care network. AMSSM convened a panel of experts to provide an evidence-based, best practice document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment and prevention of MH issues in competitive athletes.

This position statement focuses on the competitive athlete, from the youth and collegiate athlete to the Olympian and professional athlete, and how team physicians, athletic trainers, and MH care providers can assist with the detection and treatment of psychological issues in athletes. The unique signs and symptoms in athletes, prevalence of MH disorders in the athlete population and utilization of available screening tools are reviewed.

"Mental wellness concerns are common in athletes and can be associated with significant consequences including an increased risk for injury, delayed recovery, decreased quality of life and poor performance as well as more severe and disabling consequences," said co-lead author and AMSSM Past President Margot Putukian, MD, FAMSSM. "This AMSSM statement, put together by a multidisciplinary team, evaluates these issues through the lens of the competitive athlete, in the hope to normalize health-seeking behaviors and improve mental wellness."

The document finds that sports participation provides many benefits to individual health and wellbeing, but athletes are exposed to additional risk factors that may impact their MH. The sports medicine physician and other members of the athletic care network are uniquely positioned to detect MH issues early and intervene appropriately. Providers must have a full understanding of how issues commonly manifest in the athletic population and, importantly, an awareness of the relevant psychological, cultural, and environmental influences. The primary goal of this AMSSM position statement is to assist the team physician and other members of the athletic care network with the detection, treatment, and prevention of a select range of psychological issues and MH disorders in athletes.

An important component of management is an understanding of pharmacological treatment options including those that may be the most effective with the fewest side effects. Critical insight is needed into key personality issues (eg, "athlete identity"), demographic and cultural variables (eg, sexual orientation and gender identification), and environmental conditions (eg, hazing, bullying, and sexual abuse) that can impact athletes and how interactions among these variables may contribute to MH issues. It is important for the athletic care network to be attuned to risk factors for MH disorders and to monitor athletic environments that may trigger or exacerbate psychological issues in athletes under their care.