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The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers and mental health 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 mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct and transition from sport. Specific mental health 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. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.

A sports journalist relates the story of Ivy League freshman and track star Maddy Holleran, who seemingly had it all and succeeded at everything she tried, but who secretly grappled with mental illness before taking her own life during the spring semester.

Athletes often struggle to maintain attentional focus and performance consistency under pressure, particularly during high-stakes tasks like penalty kicks. This study examined the effects of brief mindfulness training on visual attention behaviors and penalty kick performance among university football players under non-pressure and pressure conditions. The study comprises two experiments: Experiment 1 was conducted in non-pressure conditions, whereas Experiment 2 involved pressure condition. Each experiment involved 40 participants, who were randomly assigned to either the intervention group or the control group. The intervention group underwent 15 minutes of brief mindfulness training, while the control group engaged in 15 minutes of quiet sitting. Eye-tracking technology was used to measure fixation count and fixation duration during the penalty kick tasks. In non-stress conditions, the mindfulness group showed a significant increase in fixation duration and fixation count, with no change in penalty kick performance. In pressure conditions, the mindfulness group again showed significant gains in fixation duration and fixation count, but penalty kick scores did not significantly improve. Comparisons across stress conditions revealed that fixation duration improvements were larger under pressure, suggesting mindfulness may enhance attentional stability when athletes are under stress. In conclusion, brief mindfulness training can enhance visual attention behaviors in university football players, especially under pressure, by promoting sustained focus on task-relevant visual targets.

Background In the cognitive-affective model of athlete burnout, anxiety is a key physiological response to stress that influences the development of burnout in athletes. Despite its importance, there has been little research on the relationship between competitive anxiety and athlete burnout, particularly regarding the mediating mechanisms. This study aimed to explore the relationship between competitive anxiety and athlete burnout, with a focus on the mediating role of general need satisfaction from self-determination theory. Methods The current study employed a cross-sectional design involving 618 college athletes (354 females, mean age 20.57 years), comprising 303 participants in individual sports and 315 in team sports. These participants completed the Sport Anxiety Scale-2 (SAS-2), the Athlete Burnout Questionnaire (ABQ), and the Basic Psychological Need Satisfaction Scale in General (BPNSS-G) online. Subsequently, correlation, regression, and mediation analyses were conducted using SPSS and JASP to examine the relationships between the variables. Results Regression results indicated that somatic anxiety (beta = 0.116, t  = 2.21, p  = 0.028) and concentration disruption (beta = 0.259, t  = 5.35, p  < 0.001) in competitive anxiety were positively correlated with athlete burnout. Worry in competitive anxiety was negatively correlated with competence (beta =-0.149, t =-2.70, p  = 0.007) and autonomy (beta =-0.179, t =-3.25, p  = 0.001) in needs satisfaction. Additionally, the regression results found that competence (beta =-0.178, t =-3.39, p  = 0.001) and Autonomy (beta =-0.208, t =-4.17, p  < 0.001) were negatively associated with athlete burnout. Mediation analyses revealed significant direct effects in the relationship between somatic anxiety (Effect = 0.116, p  = 0.026) along with concentration disruption (Effect = 0.259, p  < 0.001) and athlete burnout. In the indirect effect, worry (Effect = 0.071, p  = 0.002) as well as concentration disruption (Effect = 0.082, p  < 0.001) had significant effects in relation to athlete burnout, respectively. Conclusions Overall, the current study found that somatic anxiety and concentration disruption in competitive anxiety are related to athlete burnout. Moreover, competence and autonomy in need satisfaction mediated the relationship between competitive anxiety (worry and concentration disruption) and athlete burnout. The findings of this study not only shed further light on the relationship between competitive anxiety and athlete burnout but also provide theoretical insights into the mediating mechanisms of this relationship.

BackgroundThere are approximately 400 000 National Collegiate Athletic Association (NCAA) student athletes and 5–7 million high school student athletes competing each year. According to the US Department of Health and Human Services, the depression prevalence rate for young adults, which ranges from 10% to 85% across studies, is higher than that of other age groups. Given the relatively high prevalence of depression in individuals of collegiate age in the general population, the prevalence of depression among athletes in this age group warrants further study. This multiyear study examined the prevalence of depressive symptoms in college athletes, as well as demographic factors related to increased or decreased rates of depressive symptoms by gender and sport.ObjectiveTo describe the prevalence of depression symptoms among NCAA division I student athletes at a single institution over 3 consecutive years.MethodParticipants (n=465) completed a battery of measures during their yearly spring sports medicine physical across 3 consecutive years. The battery included the Center for Epidemiological Studies Depression Scale (CES-D) and a demographic questionnaire, administered during the course of routine sports medicine physical examinations. Differences in depressive symptoms prevalence and relative risk ratios were calculated by gender and sport.ResultsThe prevalence rate for a clinically relevant level of depressive symptoms, as measured on the CES-D (CES-D ≥16), was 23.7%. A moderate to severe level of depressive symptoms was reported by 6.3%. There was a significant gender difference in prevalence of depressive symptoms, χ2 (1)=7.459, p=0.006, with female athletes exhibiting 1.844 times the risk of male athletes for endorsing clinically relevant symptoms.ConclusionsThe CES-D identified clinically relevant levels of depressive symptoms in nearly one-quarter of college student athletes in this large cross-sectional sample. Female college athletes reported significantly more depressive symptoms than males. Findings suggest that depression prevalence among college athletes is comparable to that found in the general college population. In light of these findings, sports medicine personnel may wish to implement depression screening and assessment of depressive symptoms across sports to identify at-risk athletes. Risk factors related to depression in college athletes warrant additional study.

Female participation in NCAA athletics has grown significantly since the passage of Title IX—the 1972 U.S. federal law that prohibits sex-based discrimination in educational programs and activities receiving federal funding—yet much of the existing research continues to focus on male athletes, leaving important gaps in our understanding of women’s experiences in collegiate sports. One underexamined area with important public health implications is the role of coach–athlete relationships in shaping female athletes’ mental health, access to resources, and overall collegiate experience. This exploratory study draws on in-depth interviews with 19 former female NCAA athletes to examine how their relationships with coaches influenced their athletic careers, mental health, and perceptions of support. Participants represented a range of sports and competitive levels, allowing for variation in experiences across contexts. Findings reveal that coach–athlete relationships are not only central to performance and motivation but also serve as key sources of emotional, social, and material support—or, in some cases, stress and disengagement. The quality and impact of these relationships were shaped by competitive pressures, team dynamics, and institutional expectations. This study underscores the importance of relational context in understanding the broader landscape of female NCAA athletes’ experiences and suggests that coach–athlete dynamics merit greater attention in both research and athletic program development. These findings underscore the relevance of coach–athlete dynamics as a public health concern, particularly in relation to mental health and emotional well-being in competitive sports environments. Supporting healthier relational cultures in collegiate athletics is essential for promoting positive health outcomes among female student-athletes.

Aim is to determine if the training with heart rate variability biofeedback allows to improve performance in athletes of different disciplines. Methods such as database search on Web of Science, SpringerLink, EBSCO Academic Search Complete, SPORTDiscus, Pubmed/Medline, and PROQUEST Academic Research Library, as well as manual reference registration. The eligibility criteria were: (a) published scientific articles; (b) experimental studies, quasi-experimental, or case reports; (c) use of HRV BFB as main treatment; (d) sport performance as dependent variable; (e) studies published until October 2016; (f) studies published in English, Spanish, French or Portuguese. The guidelines of the PRISMA statement were followed. Out of the 451 records found, seven items were included. All studies had a small sample size (range from 1 to 30 participants). In 85.71% of the studies (n = 6) the athletes enhanced psychophysiological variables that allowed them to improve their sport performance thanks to training with heart rate variability biofeedback. Despite the limited amount of experimental studies in the field to date, the findings suggest that heart rate variability biofeedback is an effective, safe, and easy-to-learn and apply method for both athletes and coaches in order to improve sport performance.

PurposeExperiences of violence and abuse are becoming well recognized as a problem across sport settings, and nearly a third of student-athletes on college campuses experience sexual violence (SV). Filing a formal report can allow those who experience SV to receive institutional supports and services, however few choose to do so. The aim of this study was to identify structural and sport-related barriers to formally reporting SV among collegiate student-athletes.MethodsWe surveyed student-athletes at 10 National Collegiate Athletic Association (NCAA) Division I institutions across the United States to understand perceived barriers to formally reporting SV. We analyzed responses using descriptive statistics for closed-ended questions and inductive thematic analysis for open-ended questions.ResultsIn our sample of student-athletes (n = 1,004), 23% stated they would feel worried about formally reporting SV because of their membership in a particular identity group and 31% because of sport-related factors. In open-ended responses, student-athletes noted barriers to reporting at multiple levels: society, institution and athletic department, coach, and team. For example, student-athletes were concerned about negative perceptions and responses of teammates and coaches if they were to report, particularly because of stereotypes based on gender, race, sexual orientation, and religion. Other barriers included fear of negatively affecting their team standing or altering team dynamics.ConclusionsOur results highlight the need to address athlete-specific barriers to formally reporting SV. Efforts to change reporting-relevant policy or practice should center the experiences of minoritized athletes who may be facing heightened barriers to reporting.

Social support can positively influence both physical and psychological recovery from sport-related injury. However, few studies have examined the influence of the quantity, quality, and timing of social support on athletes’ psychological health following injury. This study examined the effects of changes in social support on post-injury depressive and anxiety symptoms among college-student athletes. We conducted a prospective cohort study among Division I college-student athletes. Participants completed surveys at baseline and at multiple time points post-injury until return to play (RTP). A total of 597 injuries sustained by 389 student athletes (n = 400 (67.0%) males; n = 238 (39.9%) football players; n = 281 (47.1%) freshman) were included. The overall amount of social support increased from baseline to 1-week post-injury (p < 0.05) and then remained unchanged until RTP. The overall satisfaction with the support received increased from baseline to 1-week post-injury (p < 0.05) but decreased (p < 0.05) from 1-week post-injury to RTP. Increases in satisfaction with the support received were associated with decreases in post-injury depressive (β = −0.404), p < 0.0001) and anxiety symptoms (β = −0.406), p < 0.0001). Interventions involving social support may help hasten college-student athletes’ psychological recovery from injury.