Are adolescent elite athletes less psychologically distressed than controls? A cross-sectional study of 966 Norwegian adolescents

Burnout trajectories among adolescent student-athletes: The role of gender, success expectations, and parental affection

In this longitudinal study, we examined the trajectories of sport and school burnout symptoms (exhaustion, cynicism, inadequacy) during the transition to lower secondary sport school among Norwegian student-athletes aged 13-14 years (n = 265; 58,5% males, 41,5% females). We also investigated how student-athletes' gender and individual success expectations, and their parents' reported levels of affection and success expectations, were associated with different burnout trajectories. Student-athletes completed associated questionnaires at the beginning and end of the first school year, while parents completed questionnaires at the end of the school year. Linear mixed models showed that sport and school burnout symptoms increased over the school year. Females reported higher baseline levels of sport burnout, and males lower baseline levels of school burnout. Low individual success expectations were associated with higher baseline levels of sport and school burnout, and increase in school burnout symptoms over time. High parental success expectations were associated with lower baseline levels of school-related exhaustion. Sport inadequacy increased for student-athletes whose parents reported either affection levels and success expectations that were either both high or both low. The results suggest that it is important that sport schools take the dual pressure student-athletes may experience into consideration, and provide them with adequate support during the transition to lower secondary education. In addition, interventions aimed at increasing parental knowledge of beneficial and harmful ways of involvement in student-athletes' lives are needed to facilitate student-athlete wellbeing.

Psychological and social factors associated with mental health of European dual career athletes: A systematic review

Dual careers (DCs) are challenging trajectories followed by athletes willing to develop their academic/professional career with their athletic careers. These trajectories usually entail additional stressors, which can decrease athletes' mental health or even increase their risk of mental ill-health. While existing research has recognized the importance of psychological and social factors in both of these areas separately, we lack systematic knowledge on which factors are associated with European DC athlete mental health outcomes, making evidence-based practice more challenging. In this regard, to advance the European DC tradition and to provide a strong base for researchers and practitioners working within this field, this systematic review aims to appraise this evidence identifying and categorizing the psychological and social factors associated with the European DC athletes' mental health. We conducted this review according to Preferred Reporting for Systematic Reviews and Meta-Analysis guidelines and performed the systematic search in six databases, finding 56 eligible articles. Our analysis identified 35 different psychological and social factors, most showing significant associations with athletes' mental health. Notably, affect, stress, motivational climate, mindfulness, resilience, perfectionism, goal orientation, motivation, and basic psychological need satisfaction showed the strongest evidence associated with mental health. Overall, this review provides a comprehensive synthesis of psychological and social factors, advancing the holistic ecological approach in dual careers and athlete mental health. Yet, our results highlight the need to strengthen the evidence regarding these factors and provide specific research avenues, such as focus on DC-specific factors and consideration of DC athlete definition and career trajectories.

The Comparison of Disordered Eating, Body Image, Sociocultural and Coach-Related Pressures in Athletes across Age Groups and Groups of Different Weight Sensitivity in Sports

The aim of the present study was to compare disordered eating (DE), body image, and sociocultural and coach-related pressures between athletes of different age groups (adolescents and adults) and between athletes participating in weight-sensitive (WS) and less WS groups. A total of 1003 athletes participated in this study. The age range of the sample was 15 to 44 years, and the mean age was 18.9 ± 5.8 years (51.3% were female). Athletes who voluntarily agreed to participate in the study were provided with the study measures on DE, body image and sociocultural attitudes towards appearance. Vomiting, laxative misuse and excessive exercise were more prevalent in adolescent female athletes than adults, while dietary restraint was more common in adult male athletes than adolescents. Adolescent female athletes experienced higher sociocultural (family, peers) and sport-related (coach) pressures and a less positive body image compared with adult female athletes. Adult male athletes experienced higher overweight preoccupation, more DE and unhealthy eating habits, and engaged in more frequent self-weighing behaviour compared with adolescent males. When the effect of weight sensitivity in sports was tested, a higher prevalence of DE and overweight preoccupation, more frequent self-weighing, and higher body-image-related pressure from coaches were observed in female athletes participating in aesthetic weight-sensitive (WS) sports as compared with those participating in less WS sports. No differences in positive body image were observed in female WS and less WS sports. Special DE prevention and positive body image promotion programs are necessary for female competitive athletes and parents of adolescent female athletes, especially those participating in aesthetic ones. For adult male athletes, special programs aiming to promote healthy eating should be implemented to prevent DE and body image concerns. Special education about DE prevention is compulsory for coaches who train female athletes.

Self-determination, restrictive eating, and psychological needs: Challenges for young athletes

OBJECTIVE

The purpose of this study was to examine the mediating role of self-determination for sport in the relationship between psychological needs in a sport context, and restrictive eating behaviors among adolescent athletes, while controlling for confounding variables.

METHOD

Self-report online surveys were completed by 983 adolescent athletes (41.3% identified as girls, M = 14.63 years, SD = 0.765). Structural equation modeling was conducted to investigate the hypothesized associations between basic psychological need satisfaction and frustration in sport, self-determination for sport, and restrictive eating behaviors, controlling for the level of competition and the type of sport practiced. Gender differences between the associations were assessed using moderation analysis.

RESULTS

Girls reported significantly more restrictive eating behaviors (M_girls = 0.85; SD = 1.39 vs. M_boys = 0.62; SD = 1.31). Both associations between basic psychological need frustration and satisfaction and restrictive eating behaviors were mediated by self-determination for sport (β = 0.054, 95% bootstrap IC = 0.027-0.089; β = -0.045, 95% bootstrap IC = -0.079 to -0.021). Further, gender moderated an association so that frustration of basic psychological in sport more strongly predicted restrictive eating behaviors in girls (β = 0.256; p = 0.008), compared with boys.

DISCUSSION

Our study reveals considerable gender differences in the mechanism underlying the adoption of restrictive eating in adolescent athletes. The research also fills a gap in the literature by supporting the assumptions of the Hierarchical Model of Intrinsic and Extrinsic Motivation in eating behaviors, specifically in the sport context.

Alexithymia, body image and disordered eating in fashion models and student athletes

PURPOSE

Fashion models and athletes are considered at risk for eating disorders, but research has produced mixed findings and little insight into psychological risk factors. Body-focused performance is common to both occupations, but emotional risk factors like alexithymia and body-image particularities have not been compared between them. This study aimed to: (1) examine the levels of alexithymia and affective states among female fashion models and athletes as body-performing occupations, and a control group, and (2) compare multidimensional body image and disordered eating among these groups.

METHODS

Data from 351 females aged 16-30 were compared among three samples: fashion models (n = 88), student athletes (n = 84) and control students (n = 179), who completed measures for alexithymia, affective states, multidimensional body image, and disordered eating.

RESULTS

Fashion models had significantly lower alexithymia compared with the other groups, and lower negative affect than controls. Positive affect was significantly lower among controls than the other groups. Body image comparisons revealed significantly higher fitness evaluation and orientation in fashion models and athletes compared to controls. Fashion models had significantly higher appearance orientation than the other groups. Student athletes had significantly higher appearance evaluation than controls and higher fitness evaluation than fashion models. Disordered eating did not differ among groups.

CONCLUSION

Lower alexithymia among fashion models is discussed in the context of emotional labor and artistic public performance. The findings suggest that body-focused performance may have emotional benefits and may drive higher body-image investment and satisfaction.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

I. Shalfawi S. Progression in training volume and perceived psychological and physiological training distress in Norwegian student athletes: A cross-sectional study

This cross-sectional study examined self-reported weekly training volume and perceived training distress in Norwegian student athletes according to gender, type of sport, school program, and school year. The Norwegian version of the Multicomponent Training Distress Scale (MTDS-N) was completed by 608 student athletes (M age = 17.29 ± .94). Univariate and multivariate techniques were used in data analyses. Results revealed significant differences in weekly training volume between sport types. No significant differences in weekly training volume were found for gender, school year, or school program. However, a multivariate effect was found for gender, with females perceiving higher levels of training distress than males. A multivariate interaction effect between school year and training volume was also observed. We recommend that practitioners use a conceptual framework to periodize training and monitor training distress in student athletes, particularly in females, to preserve physiological and psychological well-being and ensure a progressive training overload leading to positive performance development.

The Personal and Interpersonal Components of Perfectionism: The Italian Validation of "Multidimensional Inventory of Perfectionism in Sport"

The present research focused on the general theme of perfectionism in the sport domain, and it provided the first empirical validation of the original 72-item “Multidimensional Inventory of Perfectionism in Sport” (MIPS) among Italian athletes. The study, specifically, also focused on the relations linking personal and interpersonal components of perfectionism to athletes’ competitive anxiety. The research overall relied on data from 644 Italian sport science students and professional athletes and included both cross-sectional and longitudinal designs. Data analyses primarily focused on structural equation modeling, and the findings overall supported the psychometric and construct validity of the Italian version of the MIPS, also highlighting the key role of the personal components of perfectionism.

A repeated-measures examination of organizational stressors, perceived psychological and physical health, and perceived performance in semi-elite athletes

Organizational stressors can undermine the psychological well-being and performance of athletes. Less is known, however, about how these relationships unfold over time and whether organizational stressors can impact upon perceived physical health. The current study, therefore, used a repeated-measures design to examine relationships between organizational stressors with components of perceived psychological (anxiety and depression) and physical (illness symptoms and missed training days via illness) ill-health, and perceived performance at the within-person level. Twenty-three semi-elite female rowers completed monthly measures of study variables for six-months. Multilevel models indicated that selection-related stressors positively predicted symptoms of perceived psychological and physical ill-health, and negatively predicted perceived performance. Conversely, coaching stressors negatively predicted symptoms of perceived psychological ill-health. Logistics and operations stressors positively predicted perceived performance, whereas goals and development stressors negatively predicted perceived performance. These findings demonstrate for the first time that, with a repeated-measures design, organizational stressors can predict components of perceived physical and psychological ill-health, and perceived performance at the within-person level in athletes. From a practical perspective, practitioners should incorporate these findings when diagnosing the need for, developing, and optimally implementing primary and secondary stress management interventions.

Examining Body Appreciation and Disordered Eating in Adolescents of Different Sports Practice: Cross-Sectional Study

This cross-sectional study aimed to examine the associations between body appreciation, body functionality and disordered eating in a large adolescent sample of different levels and types of sports practice. Method: The sample consisted of 1412 adolescents (59.8% were girls). The ages ranged from 15 to 18 years old, with a mean age of 16.9 (SD = 0.5) for girls and 17.0 (SD = 0.4) for boys. Participants completed an anonymous questionnaire assessing the nature of sports participation, body appreciation, body functionality, self-esteem, body dissatisfaction, internalisation of sociocultural beauty ideals and disordered eating. A two-way ANOVA was employed to test the differences in body image concerns, body appreciation, perceived physical fitness and disordered eating behaviours in gender groups and groups of different sport types and levels. Multiple linear regression analyses were performed to predict disordered eating behaviours of different study variables. Results: Participants of leisure and competitive sports reported greater body appreciation, self-esteem and lower body dissatisfaction compared to non-participants. No differences in body appreciation and disordered eating were observed in adolescents involved in weight-sensitive and less weight-sensitive sports. Body appreciation and body functionality were associated with lower disordered eating in adolescent girls not participating in sports, leisure exercisers and participants of competitive sport as well as in boys participating in competitive sports, controlling for body mass index. Adolescent boys demonstrated greater body appreciation compared to girls. Conclusions: The results of this study support the knowledge of the protective role of positive body image preventing dysfunctional eating in adolescent girls of various sports practice and in competitive sports involved boys. Disordered eating prevention and clinical treatment programs for adolescents of different physical activity might benefit from including education about body appreciation and functionality.

Body Image and Disturbed Eating Attitudes and Behaviors in Sport-Involved Adolescents: The Role of Gender and Sport Characteristics

Disordered eating in adolescents who participate in sports is an issue of great concern. However, very few studies have examined the prevalence of sport-related determinants of disturbed eating attitudes and behaviours (DEABs) in sport-involved adolescents. The present study aims to assess body image and DEABs in the sample of adolescents involved in a sport of different characteristics (competitive sport, leisure sport; weight-sensitive and less-weight-sensitive sport) and to compare the results with those of the controls. A total sample of 732 adolescents (437 (59.4%) were female) participated in the study. The participants ranged in age from 16 to 19 years (mean = 17.2, SD = 0.6). Study participants completed a questionnaire assessing sports characteristics, body image, disordered eating, and health-compromising eating behaviours. Analysis of covariance was used to test the differences of major study variables between controls and weight-sensitive and less-weight-sensitive leisure and competitive sports groups. There was no significant difference observed in DEABs between the sports groups. Competitive athletes reported more satisfaction with body image than controls. The girls participating in weight-sensitive leisure sports reported higher overweight preoccupation and greater DEABs compared to those participating in less-weight-sensitive leisure sports. Boys participating in weight-sensitive leisure sports reported a greater drive for muscularity-related behaviour compared to those participating in less-weight-sensitive leisure sports. There was no observed interaction between gender and weight sensitivity in the competitive sports group. Adolescents involved in a competitive sport demonstrated greater body image satisfaction and did not seem to present a greater risk for DEABs than controls. Special prevention attempts for lowering body image concerns and DEABs should be addressed for adolescents participating in a weight-sensitive leisure sports.

Perfectly Active Teenagers. When Does Physical Exercise Help Psychological Well-Being in Adolescents?

In the context of physical activity and sport, perfectionism and the regular practice of physical activity are related to psychological well-being and the regulation of psychological resources necessary for adaptation to effort and satisfaction. At the same time, the most active students are also those who show greater appetites for physical education classes. The goal of this work was to identify the influence of perfectionist beliefs and the regularity of the practice of physical exercise on psychological well-being. The participants were adolescents (n = 436) aged between 14 and 19 years (M = 16.80, SD = 0.77). They were administered the Multidimensional Perfection Scale, the Psychological Wellbeing Scale, the Global Physical Activity Questionnaire (GPAQv2), and a sociodemographic questionnaire. The results showed, under a non-random and transversal design, that the participants gave important value to physical exercise because they feel both active and vigorous. Regarding perfectionism, the functional aspects of perfectionism (expectations of achievement and organization) correlated positively, while the dysfunctional aspects (fear of committing errors and external expectations) did so negatively with the importance given to physical exercise performed by adolescents; this in turn positively predicted psychological well-being. In this way, the hypothesized model contemplated the relevance of the included variables and reflected the mediation of the degree of importance given to the practice of physical exercise on perfectionist beliefs and psychological well-being. Currently, most physical activity practice proposals for adolescents focus on federated and structured environments for competition, and those that deal with recreational and health-oriented sports are far less common. Hence, “the perfect way of doing sports” for a teenager should be accompanied by cognitive schemes aimed at strengthening psychological resources that allow the regulation of beliefs, attitudes, and behaviors.

Mental Health Symptoms Related to Body Shape Idealization in Female Fitness Physique Athletes

Physical activity relates to optimal health, still the prevalence of mental health issues is high among athletes. Being young, female, and competing in aesthetic sports is a high-risk combination for mental health symptoms. Fitness physique athletes (FA) match this profile but are understudied. We aimed to study the intensity of mental health symptoms (i.e., body image, eating behaviour, relation to and routines for exercise, and perfectionism) in FA and in female references (FR), and to evaluate how preparing for fitness sport competitions affects these mental health symptoms. Before competition, FA had higher levels of drive for leanness (DFL) and eating restraint compared to FR. At the time of competition, eating restraint increased in FA only, concurrent with a reduction in symptoms of disordered eating. The levels of DFL, drive for muscularity, eating restraint, and exercising for figure toning were higher in FA compared to FR. At one-month post-competition, the differences between groups from competition time remained. Generally, perfectionism correlated with eating restrictions in FA and with disordered eating in FR. Overall, FA coped with the dieting, but self-control deteriorated post-competition with higher levels of disordered eating and an increased body shape concern. High DFL generally associated with more disordered eating behaviour, specifically in FR.

The Psychosocial Implications of Sport Specialization in Pediatric Athletes

Data on the psychosocial implications of sport specialization in pediatric athletes are lacking. Sport specialization often requires increased training hours and may predispose young athletes to social isolation, poor academic performance, increased anxiety, greater stress, inadequate sleep, decreased family time, and burnout. Sport specialization frequently introduces multiple stressors that could be expected to adversely affect mental health and function in young athletes and may increase the risk for burnout. This may be confounded by altered sleep duration and quality, increased drive for elite status, and perfectionistic personality types. The signs and symptoms of burnout in young athletes can be difficult to detect. It is important to be aware of the possible diagnosis of burnout in young athletes who display vague symptoms and a decrease in academic performance. The purpose of this review was to survey the available literature on sport specialization in young athletes and its association with mental health, sleep, the drive for success in sport, and burnout.

Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis

Objectives

To present an overview of the existing epidemiological evidence regarding the occurrence of mental health symptoms and disorders among current and former elite athletes.

Design

Systematic review and meta-analysis.

Data sources

Five electronic databases were searched from inception to November 2018: PubMed (MEDLINE), SportDiscus via EBSCO, PSycINFO via ProQuest, Scopus and Cochrane.

Eligibility criteria for selecting studies

We included original quantitative studies that were written in English, were conducted exclusively among current or former elite athletes, and presented incidence or prevalence rates of symptoms of mental disorders.

Results

Twenty-two relevant original studies about mental health symptoms and disorders among current elite athletes were included: they presented data especially on symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 2895 to 5555 current elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression. Fifteen relevant original studies about mental health symptoms and disorders among former elite athletes were included: they similarly presented data especially about symptoms of distress, sleep disturbance, anxiety/depression and alcohol misuse. Meta-analyses comprising 1579 to 1686 former elite athletes showed that the prevalence of mental health symptoms and disorders ranged from 16% for distress to 26% for anxiety/depression.

Conclusions

Our meta-analyses showed that the prevalence of mental health symptoms and disorders ranged from 19% for alcohol misuse to 34% for anxiety/depression for current elite athletes, and from 16% for distress to 26% for anxiety/depression for former elite athletes.

Mental health in elite athletes: International Olympic Committee consensus statement (2019)

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.

Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.