Background Athletes have started a public conversation about the psychological struggles they are facing. To create a safer psychological environment, the sporting community has the duty to support this movement by increasing awareness, providing educational resources, addressing stigma and encouraging mental health research.

Objective Illustrate an overview of the current literature regarding the mental health of elite athletes.

Design Narrative review

Setting Elite division

Results Physical exercise can reduce the risk of mental illness, nevertheless, at elite levels, the constant physical and psychological stress has a negative impact on athletes’ mental health. Consequently, symptoms such as: anhedonia, depressed mood, anxiety, irritability, decreased self-esteem and suicidal ideation can arise and lead to serious psychiatric disorders. A meta-analysis focused on the prevalence of mental health disorders concluded that 34% of elite athletes suffer from anxiety/depression and 19% have reported alcohol misuse. A cohort study of Olympic Athletes revealed that 49% had suboptimal sleep quality. Emerging data suggests a higher rate of suicidal ideation amongst transgender compared to cisgender athletes. Regarding the mental health of para athletes, there is currently limited available data. The International Olympic Committee Sport Mental Health Assessment Tool 1 is a great screening tool that has been psychometrically validated in athletes. It is also important to plan strategic psychopharmacological and psychotherapeutic interventions. The most effective approaches for preventing and managing mental health issues are mindfulness and cognitive-behavioural therapy.

Conclusions Athletes are humans first. Integrating a bio-psycho-social model into the existing healthcare strategy should be a priority. The future of sport should include a mental health action plan for each country. In order for the sport culture to evolve, all those involved should start considering the price of winning a medal.