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).

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.