The Paris Olympic and Paralympic Games have us admiring top athletes and their amazing achievements. But what about their mental health? Is their psychological state as good as we might think?
- Physical injuries, overtraining, non-selection (for example for the Paris 2024 Games), poor performance, peer pressure and social media often have a negative impact on mental health.
- The existence of certain signs in high-level athletes, such as abnormal fatigue, repeated injuries, a certain amount of worry, ruminations, or even sleep or eating disorders, should raise alarm bells.
- Psychological disorders in a high-level athlete can manifest themselves through depressive signs that can lead to suicide attempts, anxiety, attention difficulties, and sometimes the consumption of illegal substances.
Despite their prowess, let’s not forget that top athletes are human beings with their weaknesses and disappointments.
Athletes are speaking out and, as we can see in the media and on all sorts of social networks, they do not hesitate to share their difficulties and periods of distress.
Dr. Sébastien Le Garrec, sports physician and head of the medical center of INSEP in Paris, during the session “Olympic and Paralympic Medicine” at the Academy of Medicine in June 2024, confirms that the high-level athlete regularly encounters “difficulties related to his athletic project, on the sporting but also personal and professional side”. And according to him, “prevention has its place here”.
Key periods in favor of psychological concerns
Certain periods represent risks of mental health impairment for high-level athletes. Dr. Le Garrec explains that there are in fact key periods:
- First of all, entering a high-level structure which involves more demanding and more significant training sessions in terms of number and intensity. The competition within the groups is not insignificant, bringing additional pressure. Added to this is the distance from the family home for athletes who are often very young.
- Then comes the end of the career and the sports project with a change in the pace of life. You have to mourn the sports career. It is a period when you have to carry out new personal and sports projects.
This can lead to “a feeling of loss of identity.”
Favoring factors not to be overlooked
We must be vigilant about the risk factors for the deterioration of the mental health of high-level athletes.
As Dr. Le Garrec specified during the symposium of the Academy of Medicine, certain elements must be monitored, such as:
- Physical injuries that are part of an athlete’s life and cause a stoppage in training and competitions. They then lead to a separation from the training group with changes in the pace of life and often economic consequences, which can be difficult to experience. Particular vigilance must also be exercised with regard to concussion, which is considered an “invisible” injury, but which can be responsible for psychological disorders (risk of depression in 20% of cases).
- Overtraining is also possible. Daily fatigue is normal and recovery is essential. It is therefore necessary to be vigilant about overtraining, which should be suspected if there are more than 5 to 7 training sessions per week with persistent fatigue for more than 4 weeks and a reduction in performance greater than 10% (without illness associated with this drop in performance). The diagnosis is often delayed, with the possible consequence of a temporary or even permanent cessation of sports practice.
- Non-selection (such as for the Paris 2024 Games) and poor performance are often experienced as a failure with psychological repercussions.
- The pressure from the entourage is not left out. Indeed, the family, the coaches, the sports agents or the managers have expectations towards the athlete. The psychological pressure and the emotional burden are important.
- Social networks, omnipresent, are part of the daily life of young athletes. There is a strong media coverage of athletes. Negative comments, anonymous or not, are potentially hurtful. It is necessary to know how to manage the use of social networks and to be able to stop looking at them.
Warning signs to watch for
Manifestations of impaired mental health may include:
- An alteration in the quantity and quality of sleep
- Depressive signs that can lead to suicide attempts
- Anxiety disorders
- Attention difficulties
- Eating disorders
- Sometimes the use of illegal substances.
Dr. Le Garrec recommends being attentive to warning signs, such as:
- Abnormal fatigue
- Repeated injuries
- Some worry and ruminations
- Sleep disorders
- Eating disorders
- A weight variation
- A loss of motivation
- Difficulty concentrating
- A loss of self-esteem
- An isolation
Prevention, a key element
A prevention strategy has been in place for several years with “essential communication between different health professionals and with the sports and family environment”. In addition, “regulatory medical surveillance (SMR) has also included annual psychological monitoring since 2006”. Several mental health assessment tools have been developed, such as the SMHAT-1 (Sport Mental Health assessment Tool, for health professionals) and the SMHRT-1 (Sport Mental Health Recognition Tool, for athletes and their entourage).
Individual and comprehensive support
According to Dr. Le Garrec, care must be personalized and comprehensive with monitoring by a doctor and/or a psychologist.
If necessary, drug treatment may be implemented after analyzing the positive and negative effects on the athlete’s safety and performance while respecting the obligations of the anti-doping regulations.
It is essential to include coaches in this care, while maintaining support from the family environment.
The recognition and management of the mental health of high-level athletes has improved thanks to better listening to athletes. But it remains necessary to always inform athletes, technical staff and family circle in order to detect warning signs in time.
