Article Text

Effect of media on the mental health of elite athletes
  1. Marcia Faustin1,2,
  2. Monique Burton3,4,
  3. Shelley Callender5,6,
  4. Rhonda Watkins7,8,
  5. Cindy Chang7,9
  1. 1 Physical Medicine and Rehabilitation, UC Davis, Davis, California, USA
  2. 2 Family and Community Medicine, UC Davis, Davis, California, USA
  3. 3 Pediatrics, Seattle Children’s Hospital, Seattle, Washington, USA
  4. 4 Orthopedics and Sports Medicine, Seattle Children’s Hospital, Seattle, Washington, USA
  5. 5 Pediatrics, Mercer University, Macon, Georgia, USA
  6. 6 Family Medicine, Mercer University, Macon, Georgia, USA
  7. 7 Orthopaedics, UCSF, San Francisco, California, USA
  8. 8 Pediatrics, UCSF, San Francisco, California, USA
  9. 9 Family and Community Medicine, UCSF, San Francisco, California, USA
  1. Correspondence to Dr Cindy Chang, Orthopaedics; Family and Community Medicine, UCSF, San Francisco, California, USA; cjchangsportsmd{at}gmail.com

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After Naomi Osaka declined press conferences at the 2021 French Open due to concern that it would negatively impact her mental health, she was fined and threatened with expulsion. She withdrew, and questions arose about the impact of media relations and the mental health of elite athletes. The incident also raised questions regarding the contractual obligations of athletes regarding press conferences. Would she have been fined for missing a press conference due to a physical illness? Is mental health valued less than physical health?

Increasing attention to athlete mental health

Vulnerability about mental health has been considered inconsistent with competitive athletic culture and assumes elite athletes are role models of toughness both physically and mentally.1 Thankfully in recent years, sports medicine organisations have been focusing more attention on athlete mental health. In 2019, the International Olympic Committee (IOC) and the Canadian Center for Mental Health and Sport released publications regarding mental health evaluation, treatment and prevention.2 3 Soon after, the American Medical Society for Sports Medicine (AMSSM) published their position statement addressing psychological and environmental factors that commonly impact athlete mental health.4

Several recent efforts have aimed to better identify mental health challenges in athletes. The depression screening tool PHQ4 was added to the Preparticipation Physical Evaluation Monograph,5 and the IOC expanded provider resources with its mental health toolkit, which included the Sports Mental Health Assessment Tool.6 For the first time, the US Olympic and Paralympic Committee also required mental health screening for all Team USA athletes and brought mental health officers to the Tokyo Olympics and Paralympics.

The potential unhealthy impact of media

The AMSSM Position Statement on mental health in athletes acknowledges that mental health challenges can be affected by the athletic environment.4 This can include the direct and indirect interaction of athletes with the media, which is realised in various ways.

Often media will ‘hype up’ an upcoming event as a defining moment for an athlete, portraying athletic performance as the essence of an elite athlete’s identity and value on and off the field. This intense external pressure on athletes to which the media contributes can negatively affect both mental health and performance.7 As an example, Simone Biles was portrayed as the face of the Tokyo Olympics and favoured to win multiple medals before withdrawing for mental health reasons. She acknowledged the pressure was just too heavy to bear. She later returned to win a bronze medal on the balance beam.

The media also can exacerbate the belief that being under-represented in a sport carries the expectation to win for one’s entire race or culture. This was seen in the case of swimmer Anthony Ervin, who the media labelled ahead of the Sydney Olympics as the first African American swimmer to make the US Olympic team. This storyline sadly contributed to substance abuse and a suicide attempt.8 Sixteen years later in Rio, Ervin medaled, but this time the media changed the narrative by identifying him as the oldest swimmer in history to win Olympic gold.9

Timing matters

Beyond storylines, elite athletes are often required to immediately face the media after a competition. Losses can be devastating and require time to process. In August 2021, Simone Manuel pleaded that the practice of interviewing athletes right after competing should end due to the athlete’s mental and emotional exhaustion. In addition, encounters between journalists and athletes can be antagonistic and insensitive, perhaps to elicit responses desirable for publication. For example, a reporter first informed USA track athlete Sha’Carri Richardson that her biological mother had passed away. Naomi Osaka similarly broke down after an ‘aggressively toned’ reporter’s question.10 Elite athletes in a variety of sports have recently shared their challenges with mental health, pressure and the media (table 1).

Table 1

Athlete quotes on mental health, pressures and the media

Supplemental material

Sports and exercise medicine—time for action

International federations, professional sports organisations and national governing bodies have the responsibility to advocate for the mental well-being of their athletes, including the ground rules for interactions with the media. Sports medicine physicians, as trusted and respected members of the athlete support team, should be at the table in the development of mental health programmes and action plans for their athletes. Sports medicine physicians are accustomed to working as members of multidisciplinary teams to promote athlete well-being.5 Sports medicine physicians can encourage sports governing bodies to partner with independent advisory groups to provide formal guidance to athletes on how to proactively engage in more positive media interactions as well as offer professional assistance in contract negotiations that more favourably define athletes’ media and sponsorship obligations.

Closer collaboration with members of the media could result in collective solutions to best address concerns and respect athlete mental health and well-being. One potential direction includes sensitivity, empathy and implicit bias training for all who interact with athletes. Existing policies, procedures and expectations also can be reviewed and amended, such as defining parameters to delay post-competition press conferences to allow athletes time to process the outcome of the competition and compose their thoughts, or even make them optional. Similar to safeguards after physical injuries, we need to advocate for protecting athlete mental health in the timing and appropriateness of media interaction.

Athletes are under significant pressure from their sport in addition to everyday life challenges. Athletes have unique personalities, varying emotional resilience and different comfort levels for sharing themselves with the public. It is our responsibility to protect and strengthen their emotional and mental health, as well as to better prepare and advocate for them to have positive media interactions. We believe athletes and the media can find common ground in the goal of mutually beneficial interactions, moving together towards a more supportive, respectful and healthier relationship.

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References

Supplementary materials

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Footnotes

  • Contributors Every author listed has contributed to the writing of the paper. The senior author, Dr CC, is the guarantor and accepts full responsibility for the finished work.

  • 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 MF, MD—USA Gymnastics Athlete Health and Wellness Committee (unpaid). MB, MD—Chair, USA Track and Field Sports Medicine and Science Committee (unpaid); Chair, AMSSM Diversity Equity and Inclusion Subcommittee (unpaid); Leadership Team, King County Play Equity Coalition (unpaid). SC, MD—AMSSM Board of Directors (unpaid); ACSM Pronouncement Committee (unpaid). RW, MD, MPH—none declared. CC, MD—Korey Stringer Institute—review of AED policies in schools (consulting fee); independent lecturer for MCE conferences (Honorarium/travel); Pollara Law Group (Expert witness); Chair, CA Interscholastic Federation Sports Medicine Advisory Group (support for travel to two meetings a year to LA pre-COVID); NFL Research and Innovations Commttee (stipend); Agency for Student Health Research medical advisory board member (stock options); Baseline Global medical advisory board member (stocks); Neuroslam medical advisory board member (stock options); KSI Medical Advisory Board (unpaid); Ossur (Grant made to UCSF PCSM fellowship); TotalCare (Grant made to UCSF PCSM fellowship); AMSSM Practice and Policy Committee (unpaid).

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.