Depression and Other Mental Health Disorders Among Athletes with Injuries: Challenges in Diagnosis, Treatment, and Rehabilitation
DOI:
https://doi.org/10.12775/JEHS.2025.81.59996Keywords
depression, mental health, mental health disorders, injuries, AthletesAbstract
Athletes are often praised for their physical resilience, but they are also vulnerable to mental health challenges, particularly following an injury. Musculoskeletal injuries, the most common type in sports, not only increase the risk of further harm but also impede recovery, contribute to depression or other mental health disorders, and adversely affect athletic performance. Emotional reactions such as sadness, isolation, anger, and a loss of motivation can exacerbate mental health issues. At the same time, psychological stress, fear of reinjury, and uncertainty about recovery timelines create a cycle of distress that hinders both physical and mental healing. Although emotional responses to injury are regular, prolonged or intense reactions can lead to more serious conditions, including depression, anxiety, eating disorders, or substance abuse. Given the critical link between mental health and recovery, it is essential to address the mental well-being of athletes during their rehabilitation process. Early intervention and psychological strategies are key in improving recovery outcomes and supporting overall mental health. However, many athletes face barriers to seeking help, such as stigma and lack of awareness. Practical strategies for supporting mental health during rehabilitation include mental health education, early screening, interpersonal therapy, cognitive-behavioral therapy, mindfulness practices, and visualization techniques. Integrating these approaches into rehabilitation plans enables athletes better to manage the mental and physical challenges of recovery. A collaborative approach involving coaches, healthcare providers, and mental health professionals is essential to ensuring comprehensive support for athletes' well-being throughout rehabilitation. By addressing the physical and psychological aspects of recovery, athletes can return to their sport with improved resilience and confidence.
References
1. Rogers DL, Tanaka MJ, Cosgarea AJ, Ginsburg RD, Dreher GM. How mental health affects injury risk and outcomes in athletes. Sports Health [Internet]. 2024 Mar 1 [cited 2025 Mar 27];16(2):222–9 https://doi.org/10.1177/19417381231179678
2. Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, Parker AG. The mental health of elite athletes: A narrative systematic review. Sports Med [Internet]. 2016 Sep 1 [cited 2025 Mar 27];46(9):1333–53. https://doi.org/10.1007/S40279-016-0492-2
3. Avedesian JM, Forbes W, Covassin T, Dufek JS. Influence of cognitive performance on musculoskeletal injury risk: a systematic review. Am J Sports Med [Internet]. 2022 Feb 1 [cited 2025 Mar 27];50(2):1–9. https://doi.org/10.1177/0363546521998081
4. Lyus R, Buamah C, Pollock A. Global Burden of Disease 2017 estimates for Major Depressive Disorder: a critical appraisal of the epidemiological evidence. J R Soc Med [Internet]. 2023 Sep [cited 2025 Mar 27];14(9). https://doi.org/10.1177/20542704231197594
5. Kemper HCG, Marconcin P, Silva AL, Flôres F, Nunes A, Lourenço JF, et al. Association between musculoskeletal injuries and depressive symptoms among athletes: a systematic review. Int J Environ Res Public Health [Internet]. 2023 [cited 2025 Mar 27];20. https://doi.org/10.3390/ijerph20126130
6. Hammond T, Gialloreto C, Kubas H, Davis HH. The prevalence of failure-based depression among elite athletes. Clin J Sport Med. 2013 Jul;23(4):273–7 DOI: 10.1097/JSM.0b013e318287b870
7. Wolanin A, Hong E, Marks D, Panchoo K, Gross M. Prevalence of clinically elevated depressive symptoms in college athletes and differences by gender and sport. Br J Sports Med [Internet]. [cited 2025 Mar 27]; https://doi.org/10.1136/bjsports-2015-095756
8. Nixdorf I, Frank R, Hautzinger M, Beckmann J. Prevalence of depressive symptoms and correlating variables among German elite athletes. J Clin Sport Psychol [Internet]. [cited 2025 Mar 27]; https://doi.org/10.1123/jcsp.7.4.313
9. Gouttebarge V, Castaldelli-Maia JM, Gorczynski P, Hainline B, Hitchcock ME, Kerkhoffs GM. Occurrence of mental health symptoms and disorders in current and former elite athletes: a systematic review and meta-analysis. Br J Sports Med [Internet]. 2019 [cited 2025 Mar 27];53:700–7. https://doi.org/10.1136/bjsports-2019-100671
10. Foskett R. The mental health of elite athletes in the United Kingdom. J Sci Med Sport [Internet]. [cited 2025 Mar 27]; https://doi.org/10.1016/j.jsams.2017.11.010
11. Kew ME, Dave U, Marmor W, Olsen R, Jivanelli B, Tsai SHL, et al. Sex Differences in Mental Health Symptoms in Elite Athletes: A Systematic Review and Meta-analysis. Sports Health. 2024 Aug 11; DOI: 10.1177/19417381241264491
12. Kuettel A, Pedersen AK, Larsen CH. To flourish or languish, that is the question: Exploring the mental health profiles of Danish elite athletes. Psychol Sport Exerc. 2021;55:101946. DOI: 10.1016/j.psychsport.2020.101946.
13. Altemus M, Sarvaiya N, Epperson CN. Sex differences in anxiety and depression: Role of gonadal hormones. Psychiatr Clin North Am. 2014;37(4):519–31. DOI: 10.1016/j.psc.2014.08.006.
14. Lane AM, Di Fronso S, Martín-Rodríguez A, Gostian-Ropotin LA, Beltrán-Velasco AI, Belando-Pedreño N, et al. Sporting mind: the interplay of physical activity and psychological health. Sports. 2024;12(1):37. doi: 10.3390/sports12010037.
15. Arnold R, Fletcher D. A research synthesis and taxonomic classification of the organizational stressors encountered by sport performers. J Sport Exerc Psychol. 2012;34(3):397-429. DOI: 10.1123/jsep.34.3.397
16. Sudano LE, Collins G, Miles CM. Reducing barriers to mental health care for student-athletes: An integrated care model. Fam Syst Health [Internet]. 2016 Nov 28;35(1):77–84. https://doi.org/10.1037/fsh0000242
17. Kristiansen E, Halvari H, Roberts GC. Organizational and media stress among professional football players: Testing an achievement goal theory model. Scand J Med Sci Sports. 2012 Aug;22(4):569-79. DOI: 10.1111/j.1600-0838.2011.01371.x.
18. Jones MV, Sheffield D. The impact of game outcome on the well-being of athletes. Int J Sport Exerc Psychol. 2007 Jan;5(1):54-65. DOI: 10.1080/1612197X.2007.9671835.
19. Uphill M, Sly D, Swain J. From mental health to mental wealth in athletes: Looking back and moving forward. Front Psychol. 2016 Jun 21;7:1309. DOI: 10.3389/fpsyg.2016.01309.
20. Moseid CH, Myklebust G, Fagerland MW, Clarsen B, Bahr R. The prevalence and severity of health problems in youth elite sports: A 6‐month prospective cohort study of 320 athletes. Scand J Med Sci Sports. 2018 Apr 1;28(4):1412–23. DOI: 10.1111/sms.13047.
21. Putukian M. The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med. 2016 Mar;50(3):145–52. doi: 10.1136/bjsports-2015-094777.
22. Smith AM, Scott SG, Wiese DM. The psychological effects of sports injuries coping. Sports Med. 1990;9(6):352–69. doi: 10.2165/00007256-199009060-00002.
23. Arnason A, Sigurdsson SB, Gudmundsson A, Holme I, Engebretsen L, Bahr R. Risk factors for injuries in football. Am J Sports Med. 2004 Jan;32(Suppl 1):5S-16S. doi: 10.1177/0363546503261843.
24. Zhao W. A longitudinal analysis of psychological, physiological, and rehabilitation outcomes in basketball players following acute sports injuries. Biomechanics TZM&C. 2024 [cited 2025 Mar 27]. DOI: https://doi.org/10.62617/mcb451
25. Haraldsdottir K, Watson AM. Psychosocial impacts of sports-related injuries in adolescent athletes. Current Sports Medicine Reports. 2021 [cited 2025 Mar 27]; DOI: 10.1249/JSR.0000000000000809
26. Herrero CP, Jejurikar N, Carter CW. The psychology of the female athlete: how mental health and wellness mediate sports performance, injury and recovery. Annals of Joint. 2021 [cited 2025 Mar 27]; DOI:10.21037/aoj-20-53
27. Wiese-Bjornstal DM. Psychology and socioculture affect injury risk, response, and recovery in high‐intensity athletes: a consensus statement. Scand J Med Sci Sports. 2010 Oct;20(Suppl 2):103–11. https://doi.org/10.1111/j.1600-0838.2010.01195.x
28. Gouttebarge V, Jonkers R, Moen M, Verhagen E, Wylleman P, Kerkhoffs G. The prevalence and risk indicators of symptoms of common mental disorders among current and former Dutch elite athletes. J Sports Sci. 2017 Nov 2;35(21):2148–56. https://doi.org/10.1080/02640414.2016.1246492
29. Husain W, Almashouk Y, Jahrami H. Integrating psychological care in sports injury rehabilitation: A comprehensive mini-review. Tunis J Sports Sci Med. 2024;2(1):14–20. DOI: https://doi.org/10.61838/kman.tjssm.2.1.2
30. Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM, Luque-Suarez A. Which psychological factors are involved in the onset and/or persistence of musculoskeletal pain? An umbrella review of systematic reviews and meta-analyses. Clin J Pain. 2020;36(8):662–73. Available from: https://doi.org/10.1097/AJP.0000000000000860
31. McGuine TA, Winterstein A, Carr K, Hetzel S, Scott J. Changes in self-reported knee function and health-related quality of life after knee injury in female athletes. Clin J Sport Med. 2012;22(6):543–8. https://doi.org/10.1097/JSM.0b013e318265c5b3
32. Biswas A, Biswas AK. Psychological interventions of injury in athletes: A review. Int J Res Pedagogy Technol Educ Movement Sci. 2023;12(01):80–7. DOI: https://doi.org/10.55968/ijems.v12i01.248
33. Brewer BW, College S, Petrie TA. A comparison between injured and uninjured football players on selected psychosocial variables. 1995.
34. Leddy MH, Lambert MJ, Ogles BM. Psychological consequences of athletic injury among high-level competitors. Res Q Exerc Sport. 1994;65(4):347–54.
35. Mannes ZL, Waxenberg LB, Cottler LB, Perlstein WM, Burrell II LE, Ferguson EG, et al. Prevalence and correlates of psychological distress among retired elite athletes: A systematic review. Int Rev Sport Exerc Psychol. 2019 Jan 1;12(1):265–94. DOI: 10.1080/1750984X.2018.1469162
36. Hammond T, Gialloreto C, Lee S, Roos R, Gibbons F. The prevalence of failure-based depression among elite athletes. Clin J Sport Med. 2013;23(4):348–53. DOI: 10.1097/JSM.0b013e318287b870
37. Huang J, Jacobs D, Derevensky J, Gupta R, Chou C. Gambling and health risk behaviors among US college student-athletes: Findings from a national study. J Am Coll Health. 2007;56(6):491–8. DOI: 10.1016/j.jadohealth.2006.11.146
38. Smith AM, Milliner EK. Injured athletes and the risk of suicide. J Athl Train. 1994;29(2):107–9. https://pmc.ncbi.nlm.nih.gov/articles/PMC1317809/.
39. Lavallée L, Flint F. The relationship of stress, competitive anxiety, mood state, and social support to athletic injury. J Athl Train. 1996;31(4):382–7. https://pmc.ncbi.nlm.nih.gov/articles/PMC1318911/.
40. Li H, Moreland JJ, Peek-Asa C, Yang J. Preseason anxiety and depressive symptoms and prospective injury risk in collegiate athletes. Am J Sports Med. 2017;45(9):2148–55. https://doi.org/10.1177/0363546517705735.
41. Yang J, Cheng G, Zhang Y, Covassin T, Heiden EO, Peek-Asa C. Influence of symptoms of depression and anxiety on injury hazard among collegiate American football players. Res Sports Med. 2014;22(2):147–60. https://doi.org/10.1080/15438627.2014.896774.
42. Timpka T, Jacobsson J, Bargoria V, Périard JD, Racinais S, Ronsen O, et al. Preparticipation predictors for championship injury and illness: cohort study at the Beijing 2015 International Association of Athletics Federations World. Br J Sports Med. 2017;51(4):271–8. https://doi.org/10.1136/bjsports-2016-096634.
43. Kleinert J. Mood states and perceived physical states as short term predictors of sport injuries: Two prospective studies. Int J Sport Exerc Psychol. 2007;5(4):340–51. https://doi.org/10.1080/1612197X.2007.9671839.
44. Appaneal RN, Levine BR, Perna FM, Roh JL. Measuring postinjury depression among male and female competitive athletes. J Sport Exerc Psychol. 2009;31(1):60–76. DOI: 10.1123/jsep.31.1.60
45. Belz J, Heidari J, Levenig C, Hasenbring M, Kellmann M, Kleinert J. Stress and risk for depression in competitive athletes suffering from back pain—Do age and gender matter? Eur J Sport Sci. 2018;18(7):1029–37. https://doi.org/10.1080/17461391.2018.1480243.
46. Alosco ML, Fedor AF, Gunstad J. Attention deficit hyperactivity disorder as a risk factor for concussions in NCAA division-I athletes. Brain Inj. 2014;28(4):472–4. https://doi.org/10.3109/02699052.2014.896474.
47. Labode-Richman VM, Groenewal P. The Importance of Sport Psychology in Basketball. In: Basketball Sports Medicine and Science. 2020. p. 969–81. https://doi.org/10.1007/978-3-030-31119-7_56.
48. Forsdyke D, Smith A, Jones M, Gledhill A. Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review. Br J Sports Med. 2016;50(9):537–44. https://doi.org/10.1136/bjsports-2015-094964.
49. Tracey J. The Emotional Response to the Injury and Rehabilitation Process. J Appl Sport Psychol. 2003;15(4):279–93. https://doi.org/10.1080/10413200390242162.
50. Podlog L, Wadey R, Stark A, Lochbaum M, Hannon J, Newton M. An adolescent perspective on injury recovery and the return to sport. Psychol Sport Exerc. 2013;14(4):626–34. https://doi.org/10.1016/j.psychsport.2013.03.001.
51. Ford IW, Eklund RC, Gordon S. An examination of psychosocial variables moderating the relationship between life stress and injury time-loss among athletes of a high standard. J Sports Sci. 2000;18(5):301–12. https://doi.org/10.1080/02640410050074248.
52. Ardern C, Taylor N, Feller J, Webster K. A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med. 2013;47(17):1120–6. https://doi.org/10.1136/bjsports-2013-092156.
53. Gulliver A, Griffiths K, Christensen H. Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study. BMC Psychiatry. 2012;12(1):157. https://doi.org/10.1186/1471-244X-12-157.
54. Gulliver A, Griffiths K, Christensen H, Mackinnon A, Calear A, Parsons A, Bennett K. Internet-based interventions to promote mental health help-seeking in elite athletes: an exploratory randomized controlled trial. J Med Internet Res. 2012;14(3):e69. https://doi.org/10.2196/jmir.1960.
55. Sudano L, Miles CM. Mental health services in NCAA Division I athletics: A survey of head ATCs. Sports Health. 2017;9(3):262–7. https://doi.org/10.1177/1941738116679127.
56. American College of Sports Medicine, American Academy of Family Physicians. Psychological issues related to injury in athletes and the team physician: a consensus statement. Med Sci Sports Exerc. 2006;38(5):9–13. DOI: 10.1249/mss.0b013e31802b37a6
57. Weiß M, Büttner M. The role of sport psychology in injury prevention and rehabilitation in junior athletes. Front Psychol. 2024;14:254. https://doi.org/10.3389/fpsyg.2023.1026581.
58. Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. JAMA Intern Med. 2006;166(10):1092–7. DOI: 10.1001/archinte.166.10.1092
59. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.
60. Putukian M, Echemendia R, Dettwiler-Danspeckgruber A, Duliba T, Bruce J, Furtado JL. Prospective clinical assessment using Sideline Concussion Assessment Tool-2 testing in the evaluation of sport-related concussion in college athletes. Clin J Sport Med. 2015;25(1):24–8. DOI: 10.1097/JSM.0000000000000102
61. Gerber M, Kalak N, Lemola S, Clough PJ, Perry JL, Pühse U, et al. Are adolescents with high mental toughness levels more resilient against stress? Stress Health. 2013;29(2):164–71. https://doi.org/10.1002/smi.2450.
62. Hjemdal O, Vogel PA, Solem S, Hagen K, Stiles TC. The relationship between resilience and levels of anxiety, depression, and obsessive-compulsive symptoms in adolescents. Clin Psychol Psychother. 2011;18(4):314–21. https://doi.org/10.1002/cpp.717.
63. Arvinen-Barrow M, Clement D, Hemmings B. “This Is the Final Jump,” I Respond. Why, Why Do I Utter Those Words? Sport Injury Psychology. 2020;207–16. DOI:10.4324/9780367854997-18
64. Simonsmeier BA, Andronie M, Buecker S, Frank C. The effects of imagery interventions in sports: a meta-analysis. Int Rev Sport Exerc Psychol. 2021;14(1):186–207. https://doi.org/10.1080/1750984X.2020.1732745.
65. Richlan F, Braid J. Virtual reality training in Olympic sports: Promises and pitfalls. 2024 Feb 8. DOI:10.31234/osf.io/dnrck
66. Brewer BW, Buman MP. Attentional focus and endurance performance: Review and theoretical integration. Kinesiologia Slovenica. 2006;12:82–97.
67. Depressive disorders in athletes. Sports Med. The Clinics. 2024. DOI: 10.1016/j.csm.2023.06.011
68. Trinh LN, Brown SM, Mulcahey MK. The influence of psychological factors on the incidence and severity of sports-related concussions: A systematic review. Am J Sports Med. 2020;48(6):1516–25. https://doi.org/10.1177/0363546519897197
69. Clement D, Arvinen-Barrow M, Fetty T. Psychosocial responses during different phases of sport-injury rehabilitation: A qualitative study. J Athl Train. 2015;50(1):95–104. DOI: 10.4085/1062-6050-49.3.52
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