The mental health of Danish elite athletes is neither better nor worse than the population as a whole

A research project on the mental health and well-being of Danish elite athletes, which has just been published in the scientific journal “Psychology of Sport & Exercise” (No. 52 – 2021) shows that Danish elite athletes have the same mental health and well-being as the population as a whole. The research project also shows that there are marked differences in the mental health and well-being of female and male elite athletes in the 18 different sports that are included in the project. The research project, which has been prepared by Associate Professor Andreas Küttel, cand.scient. Andreas K. Petersen and Associate Professor Carsten Hvid Larsen from the Department of Sport Sciences and Biomechanics at the University of Southern Denmark and financially supported by Team Denmark, contain new knowledge that can – and should – contribute to a more nuanced debate on the subject.

Elite sports are not black or white – but with many colors

In recent years – both nationally and internationally – there has been an increasing focus on elite athletes’ mental health and well-being – or rather lack well-being. Personal stories in the media about eating disorders, performance anxiety, depression, dissatisfaction, unethical behavior and sexual abuse among coaches and managers have seriously shown the “shadow sides” of elite sports. And by the way, the positive gains of elite sports for the athletes in the form of increased self-confidence and stronger self-esteem, courage, will and mental toughness have been dragged into the background. Several international research projects have indicated that increasing demands and increased pressure from the environment on the individual athlete can have detrimental effects on the athletes’ mental health and well-being. This development has also led international organizations such as the International Society of Sport Psychology (ISSP), the European Federation of Sport Psychology (FEPSAC) and the International Olympic Committee (IOC) to launch a number of initiatives that can further focus on the topic.

First Danish research project on the mental health and well-being of elite athletes

The aim of the Danish research project is to investigate mental health and well-being among Danish elite athletes, including the prevalence of anxiety and depressive symptoms in male and female elite athletes. In addition, the aim is also to identify both mental risk factors (eg injuries, overtraining, stress, deselection and lack of sleep) and promoting factors (eg social support from family and friends, well-functioning training environments and certain personality traits of the individual athlete) in relation to his or her mental health and well-being, both in and outside of elite sports.

Athletes from individual sports and team sports with different mental health profiles

The research project’s respondents are 612 Danish elite athletes from 18 different sports who have answered an anonymous online version of the “Holistic Athlete Mental Health Survey”. The elite athletes represent both individual sports (including athletics, badminton, cycling, swimming, triathlon and tennis) and team sports (including basketball, football, handball, ice hockey and volleyball). The athletes were on average 19 years old and practice their elite sport at the national or international level. Based on the responses, the elite athletes were divided into three categories: “Strong mental health profile”, “Moderate mental health profile” and “Weak mental health profile”. Subsequently, differences and similarities between elite athletes in the three categories were analyzed based on a Kruskal-Wallis test.

Danish elite athletes have the same mental health profile as elite athletes in other countries

The results of the research project show that the vast majority of Danish elite athletes – 75% or 3 out of 4 – experience either average or high well-being in everyday life. This proportion is slightly higher than the Danish population in the same age group. Relatively few athletes – 14% – indicated that they had experienced moderate (10%) or severe symptoms (4%) of anxiety within the past two weeks, while 80% – or 4 out of 5 – stated that within the last two weeks two weeks had experienced moderate or no symptoms of depression. 11% of the athletes stated that they had experienced symptoms of both anxiety and depression within the past two weeks. The incidence of severe symptoms of anxiety and depression in Danish elite athletes is at the same level as among the same age group in the population. Likewise, the incidence of symptoms of anxiety and depression among Danish elite athletes is at the same level as among elite athletes in other countries, e.g. Sweden, Australia, Switzerland, Germany and the United Kingdom.

Significant gender differences

Among the research project’s most exciting results is that female elite athletes have a significantly higher incidence of symptoms of anxiety (20% vs. 10%) and depression (28% vs. 18%) than male elite athletes. In addition, female elite athletes also had a significantly lower overall score on mental well-being than male athletes. These marked gender differences are also found outside the world of elite sports, where the proportion of Danish teenage girls with symptoms of anxiety and depression, e.g. at high schools, has been markedly increasing in recent years. Unfortunately, the researchers do not state specific reasons for these gender differences. In turn, the researchers emphasize that there were no differences between athletes in individual sports and team sports. And that examples of dissatisfaction, anxiety and depression occur in all sports and in age groups.

The vast majority of elite athletes thrive really well in elite sports

The research project also shows that 64% – or almost 2/3 – can be categorized as elite athletes with a “strong mental health profile”, 30% of the elite athletes have a “moderate mental health profile” and only a modest minority – 6% – can be categorized as athletes with a “weak mental health profile”. Elite athletes with a “strong mental health profile” experience good social support, both in private life and in elite sports. Athletes with high well-being and absence of symptoms of mental disorders rate their sports environment to be more supportive in terms of self-determination, involvement, priorities, and choices in and outside of elite sports. Athletes with a “weak mental health” show a high degree of dissatisfaction, sleep less and experience far more stressful elements both in private life, in education and in elite sports. And many of these athletes will probably sooner or later opt out of a continued life as the elite athlete. Of course, it is important to focus on these athletes and not least the challenges and dilemmas that these athletes face in training and competitions. But there is also a great risk that coaches and sports managers in clubs and federations can spend (too) many resources on athletes, who basically do not “fit” into the selective and exclusive structure of elite sports. The researchers from SDU do not go so far with their conclusion, but instead point out that there is a need for individual and flexible solutions for the individual elite athlete.

All sports have independent characteristics and special challenges

Unfortunately, the article presenting the research project does not contain an analysis of the athletes’ mental health and well-being in the individual sports. In my opinion, there is no doubt that training culture, environment, scope and content, social relationships between athletes and between coaches and athletes, division of roles and responsibilities and much, much more are very different across individual sports and team sports. For that reason, coaches, sports managers and athletes – both in the researchers’s and in my opinion – should also be extremely careful about setting up “standard solutions” across sports. Among the researchers’ recommendations for clubs and federations, one thing in particular is clear and precise: Young talents must be dressed very well with knowledge and experience from current and former elite athletes and coaches in order to handle pressure, demands and expectations that undeniably come with a life as elite athlete.

The article: “To Flourish or Languish, that is the question: Exploring the mental health profiles of Danish elite athletes” (Psychology of Sport & Exercise, No. 52 – 2021) can be requested by contacting Associated Professor Andreas Küttel (mail: akuttel@health.sdu.dk).