You Are Not Alone – Depression, Stress and Anxiety in the Locker Room

Trends in student-athlete mental health in the National College Health Assessment, 2011-2019.

Edwards B, Froehle AW and Fagan SE. J Athl training. 2023,58(4):361-373. doi: 10.4085/1062-6050-0586.21.

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Take home message

College athletes and non-athletes are under a great deal of stress. Reported mental health symptoms and diagnoses are increasing, with 1 in 3 college students reporting a recent diagnosis. Fortunately, more college students are reporting receiving mental health information from institutions and treatment-seeking behaviors over time.

Background

Awareness of mental health issues is increasing among the general public, including college athletics. Educational efforts and access to mental health resources have increased, but it is unclear whether these efforts have improved student-athletes’ mental health and treatment seeking.

Study Objective

Edwards and colleagues analyzed 8 years of survey data to examine how the mental health of student-athletes, compared to their non-athlete peers, changed between 2011 and 2019.

Methods

Researchers obtained data from the National College Health Assessment. The data, which spanned 8 academic years, were reported anonymously by students at participating institutions. Respondents were classified as “athletes” or “non-athletes” based on their responses to specific survey questions. Researchers excluded students who participated only in club or intramural sports. The survey included “yes” or “no” questions grouped into 5 outcome groups: 1) “recent mental health symptoms,” 2) “recent mental health diagnosis,” 3) “mental health treatment seeking behavior,” 4) “mental health information received from institutions,” and 5) “recent impact of mental health on academic performance.”

Results

A total of 502,780 students from 607 unique institutions completed the surveys and met the inclusion criteria. This included over 54,400 athletes and 448,300 non-athletes. The main results are described in the table, which show that more students received mental health information from institutions and sought treatment or would consider treatment over time. Meanwhile, more students reported recent mental health symptoms/diagnoses and effects on academic performance over time. Student-athletes were less likely to report mental health symptoms/diagnoses and treatment-seeking behavior. However, more student-athletes reported mental health information from institutions.

	Changes over time	Differences between groups
Recent mental health symptoms	Increased over time	Athletes < Non-athletes
Recent mental health diagnosis	Increased over time	Athletes < Non-athletes
Behavior Seeking Treatment for Mental Health	Improved over time	Athletes < Non-athletes
Receiving mental health information from institutions	Improved over time	Athletes > Non-athletes
The Recent Impact of Mental Health on Academic Performance	Increased over time	Athletes < Non-athletes

Positions

More than 1 in 5 students reported symptoms of depression. A majority of students reported feeling very sad, very lonely, exhausted, or overwhelmed. Over the 8 years, we went from 1 in 5 students reporting a diagnosis of a mental health condition to 1 in 3 students. It is encouraging that treatment seeking behaviors and access to mental health information have increased over time. This study cannot address whether the increased symptoms/diagnoses of mental health are due to increased prevalence or increased ease of reporting. As access to educational materials increases, it would stand to reason that reporting of mental health issues would also increase. While the trends over time are encouraging, the overall numbers are still discouraging and we need to do more to encourage student-athletes to seek treatment.

Clinical implications

Clinicians need to know that athletes and non-athletes are under immense pressure due to the college experience. This requires clinicians to be fully aware of the signs and symptoms of mental health issues and have an appropriate and empathetic plan to help their athletes get the right treatment. We must also continue to reduce stigma and increase awareness among athletes that treatments are available.

Questions for discussion

What changes have you observed regarding mental health awareness, recognition, and treatment in student-athletes? What specific strategies do you think have had the most impact on mental health awareness, recognition, or treatment in student-athletes?

Written by Kyle Harris
Reviewed by Jeffrey Driban

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