We have to do better. Recognizing and treating anxiety among student-athletes

Factors influencing anxiety-related symptoms, diagnosis, and treatment among college student-athletes in the National College Health Assessment.

Edwards B and Froehle AW. J Athl training. 2023, [epub ahead of print]. doi: 10.4085/1062-6050-0334.22.
Full text freely available

Take home message

Eight in 10 student-athletes report feeling overwhelmed, and nearly half report overwhelming anxiety. Yet fewer than 1 in 4 of these students report having received a diagnosis or treatment.

Background

College athletes are under significant stress due to the demands placed on athletes and students. About half of student-athletes report feeling overwhelming anxiety within a year, but only 12% of athletes report receiving an anxiety diagnosis. This could indicate that many athletes experience anxiety but may not seek treatment. If we knew what factors are associated with anxiety symptoms and treatment avoidance, we could better identify and help high-risk student-athletes.

Study aim

Edwards and Froehle analyzed eight years of data to examine the factors associated with anxiety symptoms and treatment avoidance.

Methods

Researchers obtained data from the National College Health Assessment. The data, which spans eight academic years, was reported anonymously by students at participating institutions and includes extensive demographic information such as school year, self-identified gender, sexual orientation, race/ethnicity, international student status, and history of mental health treatment. . The researchers only included respondents who were classified as “varsity athletes” based on their responses to specific survey questions. The researchers excluded students who participated only in club or intramural sports. The survey included “yes” or “no” questions, allowing researchers to categorize respondents into three groups: 1) “not diagnosed/treated,” 2) “diagnosed but not treated,” and 3) “treated.” The researchers examined eight factors that may be associated with anxiety-related diagnosis and treatment: 1) year in school, 2) gender, 3) sexual orientation, 4) race/ethnicity, 5) school type, 6) international student, 7) history of treatment in mental health, and 8) history of anxiety interfering with academic performance.

Results

A total of 51,882 student-athletes completed the surveys and met inclusion criteria. At least 8 in 10 respondents (83%) reported feeling “overwhelmed by everything you had to do,” and 48% reported “overwhelming anxiety.” Within these responses, female and non-binary athletes consistently reported more symptoms than men. Additionally, white or biracial/multiracial students, students with a history of mental health treatment, and American students were more likely to report symptoms than black students, students with no history of mental health treatment, and international students, respectively.

Among athletes who reported overwhelming anxiety, only 23% of respondents reported receiving either a diagnosis or treatment (~72% received both; ~28% had an untreated diagnosis). An untreated diagnosis was more common in people with no history of mental health treatment than in those with a history.

Viewpoints

A large portion of student-athletes report anxiety, but many do not seek treatment or diagnosis. The data presented in this study also identified factors associated with feeling “overwhelmed by everything you had to do” or “overwhelming anxiety.” These include gender, sexual orientation, race/ethnicity, and history of mental health treatment. These analyzes are limited because they only provide a snapshot of each athlete. We don’t know how our student-athletes change over time and how issues relate to the onset or worsening of anxiety symptoms. Despite these limitations, these results paint an alarming picture: 8 in 10 student-athletes report feeling overwhelmed and nearly half report “overwhelming anxiety.” Additionally, fewer than 1 in 4 student-athletes report receiving a treatment diagnosis with overwhelming anxiety. Collectively, these results suggest that we are failing to meet the mental health needs of our student-athletes, and that we do not have a complete picture of younger athletes.

Clinical implications

Clinicians should be aware that the athlete in front of them is most likely feeling overwhelmed. Doctors must consider the signs and symptoms of mental health problems and have an appropriate and empathetic plan to help their athletes obtain appropriate treatment when warranted. Additionally, many student-athletes never seek mental health care, highlighting the need to reduce stigma and increase awareness among athletes about mental health treatments.

Questions for discussion

What changes have you observed regarding student-athlete mental health awareness, recognition, and treatment seeking? What strategies do you use to screen student-athletes to identify those at high risk of feeling overwhelmed?

Written by Kyle Harris
Reviewed by Jeffrey Driban

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