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Mental health management of elite athletes during COVID-19: a narrative review and recommendations
  1. Claudia L Reardon1,2,
  2. Abhinav Bindra3,
  3. Cheri Blauwet4,
  4. Richard Budgett5,
  5. Niccolo Campriani6,
  6. Alan Currie7,8,
  7. Vincent Gouttebarge9,10,
  8. David McDuff11,12,
  9. Margo Mountjoy13,14,
  10. Rosemary Purcell15,16,
  11. Margot Putukian17,18,
  12. Simon Rice16,19,
  13. Brian Hainline20
  1. 1 Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  2. 2 University Health Services, University of Wisconsin, Madison, Wisconsin, USA
  3. 3 Zirakpur, Punjab, India
  4. 4 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
  6. 6 Sports Department, International Olympic Committee, Lausanne, Switzerland
  7. 7 Regional Affective Disorders Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
  8. 8 Department of Sport and Exercise Sciences, University of Sunderland, Sunderland, Tyne and Wear, UK
  9. 9 Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
  10. 10 AMC/VUmc IOC Research Center of Excellence, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam, The Netherlands
  11. 11 Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
  12. 12 MD Sports Performance, Ellicott City, Maryland, USA
  13. 13 Family Medicine, McMaster University Michael G DeGroote School of Medicine, Waterloo, Ontario, Canada
  14. 14 Bureau, FINA, Lausanne, Switzerland
  15. 15 Department of Research and Translation, Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
  16. 16 Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
  17. 17 Athletic Medicine, Princeton University, Princeton, New Jersey, USA
  18. 18 Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
  19. 19 Department of Research and Translation, Orygen The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
  20. 20 National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
  1. Correspondence to Dr Claudia L Reardon, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; clreardon{at}


Elite athletes suffer many mental health symptoms and disorders at rates equivalent to or exceeding those of the general population. COVID-19 has created new strains on elite athletes, thus potentially increasing their vulnerability to mental health symptoms. This manuscript serves as a narrative review of the impact of the pandemic on management of those symptoms in elite athletes and ensuing recommendations to guide that management. It specifically addresses psychotherapy, pharmacotherapy and higher levels of care. Within the realm of psychotherapy, crisis counselling might be indicated. Individual, couple/family and group psychotherapy modalities all may be helpful during the pandemic, with novel content and means of delivery. Regarding pharmacotherapy for mental health symptoms and disorders, some important aspects of management have changed during the pandemic, particularly for certain classes of medication including stimulants, medications for bipolar and psychotic disorders, antidepressants and medications for substance use disorders. Providers must consider when in-person management (eg, for physical examination, laboratory testing) or higher levels of care (eg, for crisis stabilisation) is necessary, despite potential risk of viral exposure during the pandemic. Management ultimately should continue to follow general principles of quality health care with some flexibility. Finally, the current pandemic provides an important opportunity for research on new methods of providing mental health care for athletes, and consideration for whether these new methods should extend beyond the pandemic.

  • athlete
  • mental
  • treatment
  • psychiatry
  • psychology

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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  • Contributors 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.

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