A Needed Focus on Mental Health Research

Yogi Berra famously said, “Baseball is 90% mental; the other half is physical,” and for decades, the mental side of sport was attributed to mental toughness and athletic performance, with no room for discussions about mental weakness or struggle. The shift in conversations and the prioritization of mental health and well-being have occurred only in recent years due to high-profile athletes sharing their vulnerabilities on social media. Athletes who have opened up about their own struggles with mental health conditions include National Football League tight end Hayden Hurst, swimmers Michael Phelps and Allison Schmitt, gymnast Simone Biles, basketball player Kevin Love, and tennis player Naomi Osaka. These individual testimonials have increased awareness of the mental strain that can be associated with competing at a high level, involving public pressure to win, unsustainable expectations for perfection, and trying to outlast and be better than other athletes. Along with conversations about mental health promoted by these athlete mental health advocates, targeted efforts from professional associations, such as the International Olympic Committee¹  and National Collegiate Athletic Association,²  have led to numerous campaigns related to mental health education, advocacy, resource development, and research in athletic medicine.

Furthermore, clinical, educational, and research approaches to patient care have moved toward a biopsychosocial model that includes assessing and treating the physical, psychological, and social aspects of each patient.^3,4  This broadened view of health, often evaluated via disablement models, such as the International Classification of Functioning, Disability and Health,⁵  allows clinicians to holistically provide patient-centered care. Clinical efforts to adopt the International Classification of Functioning, Disability and Health model and educational programs in athletic training, for which patient-centered care is a core competency, are promoting the importance of evaluating and managing the mental and psychosocial aspects of injury and illness.

These 2 special issues of the Journal of Athletic Training highlight many of these research efforts. The first issue [58 (9)] includes expert commentary with expert commentary from Claudia Reardon, MD, on contemporary factors that influence mental health concerns among athletes; Margot Putukian, MD, and Keith Yeates, PhD, regarding anxiety and depression and the athletic trainer’s role in recognition and referral; Shelby Baez, PhD, ATC, and Kate Jochimsen, PhD, ATC, on the integration of psychologically informed practice; and Christianne Eason, PhD, ATC, questioning whether the mental health of athletic trainers affects patient care. The first issue also includes original research regarding general mental health considerations and the effect of concussion on mental health. The second issue [58 (10)] includes original research regarding disordered eating, musculoskeletal injuries (patellofemoral pain and anterior cruciate ligament injuries), and global topics related to athlete burnout, grit, coping, transition from sport, and the lingering effects of the COVID-19 pandemic. The authors in these issues also highlight critical topics for patients and athletic trainers regarding mental health resources, interprofessional collaboration for patients with mental health concerns, and mental health literacy. Lastly, the authors of several studies aim to improve our understanding of clinical measures to assess the constructs of mental health in our patients.

Athletic trainers will find this information valuable for gaining more insight into contemporary research regarding athlete mental health considerations. An integral role of the athletic trainer is to advocate for our patients, and with mental health concerns rising for individuals aged 18 to 25 years old,⁶  athletic trainers must be prepared with and well versed in the appropriate knowledge and resources to recognize, document, and refer patients when necessary. Along with existing National Athletic Trainers’ Association resources, such as the twin interassociation recommendations for the recognition and referral of student-athletes with psychological concerns,^7,8  the mental health emergency action plan,⁹  the National Collegiate Athletic Association mental health educational resources,¹⁰  and the International Olympic Committee mental health toolkit,¹¹  athletic trainers can access many valuable resources to better educate themselves and apply the information to policy development or revision.

Although Mental Health Awareness Month is celebrated in May and provides a great opportunity to remember the inherent value of taking care of oneself, mental health must be a daily priority for everyone. Victoria Garrick, of the University of Southern California, reminded us of the importance of this in her TED talk, “Athletes and Mental Health: The Hidden Opponent.” Athletic trainers must continue to learn the common signs associated with mental illness and have plans to manage conditions when they arise. Continued research is necessary not only to determine best practices for mental health in sport but also to change the negative stigma that currently surrounds mental health to a positive narrative.

Editor's note: Tamara C. Valovich McLeod, PhD, ATC, is a JAT Senior Associate Editor. Stephanie M. Singe, PhD, ATC, is a JAT Associate Editor.