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Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment
  1. João Mauricio Castaldelli-Maia1,2,3,
  2. João Guilherme de Mello e Gallinaro3,
  3. Rodrigo Scialfa Falcão4,
  4. Vincent Gouttebarge5,
  5. Mary E Hitchcock6,
  6. Brian Hainline7,
  7. Claudia L Reardon8,
  8. Todd Stull9
  1. 1 Department of Neuroscience, Medical School, Fundação do ABC, Santo Andre, SP, Brazil
  2. 2 Department of Psychiatry, Medical School, University of São Paulo, Sao Paulo, SP, Brazil
  3. 3 ABC Center for Mental Health Studies, Santo André, SP, Brazil
  4. 4 Bradesco Sports Association, Osasco, SP, Brazil
  5. 5 Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
  6. 6 Ebling Library for the Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
  7. 7 National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
  8. 8 Department of Psychiatry, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  9. 9 Athletic Department, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
  1. Correspondence to Prof João Mauricio Castaldelli-Maia, Department of Neuroscience, Faculdade de Medicina do ABC, Santo Andre, SP 09060-650, Brazil; jmcmaia2{at}


Objective To summarise the literature on the barriers to athletes seeking mental health treatment and cultural influencers of mental health in elite athletes.

Design Systematic review

Data sources PubMed, Cochrane, Scopus, SportDiscus (Ebsco), and PsycINFO (ProQuest) up to November 2018.

Eligibility criteria for selecting studies Qualitative and quantitative original studies of elite athletes (those who competed at the professional, Olympic, or collegiate/university levels), published in any language.

Results Stigma, low mental health literacy, negative past experiences with mental health treatment-seeking, busy schedules, and hypermasculinity are barriers to elite athletes seeking mental health treatment. Cultural influencers of mental health in elite athletes include: (1) the lack of acceptance of women as athletes; (2) lower acceptability of mental health symptoms and disorders among non-white athletes; (3) non-disclosure of religious beliefs; and (4) higher dependence on economic benefits. Coaches have an important role in supporting elite athletes in obtaining treatment for mental illness. Brief anti-stigma interventions in elite athletes decrease stigma and improve literary about mental health.

Conclusion There is a need for various actors to provide more effective strategies to overcome the stigma that surrounds mental illness, increase mental health literacy in the athlete/coach community, and address athlete-specific barriers to seeking treatment for mental illness. In this systematic review, we identified strategies that, if implemented, can overcome the cultural factors that may otherwise limit athletes seeking treatment. Coaches are critical for promoting a culture within elite athletes’ environments that encourages athletes to seek treatment.

  • barriers
  • culture
  • athletes
  • mental health
  • stigma

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  • Contributors We confirm that all authors listed on this manuscript meet requirements for authorship credit. Specifically, all authors have participated in the following ways: Substantial contributions to the conception and design of the work, and the acquisition, analysis and interpretation of data. Drafting the work and revising it critically for important intellectual content. Final approval of the version published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement All the data collected in the present systematic review have been presented in the present manuscript.