Mental health problems are significantly more common among elite and youth athletes than in the general population, according to a narrative review published in the Annals of Medicine and Surgery. The findings highlight a growing body of evidence suggesting that the pressures of high-performance sport take a serious psychological toll, and that current support structures are failing to keep pace.
The review, which drew on research published between 2000 and 2025, found that around 25% of elite athletes experience anxiety symptoms, 20% show signs of depression, and up to 35% report high levels of general psychological distress. Athletes competing in individual sports were found to be at greater risk than those in team settings, likely because of the heightened personal accountability and sense of isolation those disciplines can bring.
Youth athletes face a distinct set of pressures that compound the risk. Adolescents navigating elite sport must also contend with academic demands, peer comparisons, and the psychological instability that comes with early specialisation. Between 15% and 30% of young athletes show symptoms of anxiety or depression, with female athletes in appearance-focused sports particularly affected.
Injuries were identified as a major trigger for mental health deterioration. Concussions in particular were strongly linked to depression and anxiety, with between 17% and 46% of athletes reporting psychological symptoms following a head injury. The researchers noted that psychological distress could itself increase the risk of injury, creating a cycle that is difficult to break without combining physical and psychological rehabilitation.
Despite the scale of the problem, access to appropriate support remains inadequate. A 2022 study found that only 25.7% of NCAA Division athletic departments provided mental health or performance services. Many training academies still have no access to sports psychologists, with financial constraints and resistance from coaches and players cited as common barriers.
The review pointed to several promising approaches for improving athlete mental health. Cognitive behavioural therapy and mindfulness-based programmes have both shown positive results, with acceptance and commitment therapy reducing anxiety and improving emotional regulation among elite athletes. Digital mood-tracking tools such as Smartabase and WHOOP’s Stress Monitor are also gaining traction, allowing coaches and support staff to identify warning signs earlier.
High-profile athletes have played a meaningful role in shifting public attitudes. When Simone Biles withdrew from competition at the Tokyo 2021 Olympics citing mental health concerns, it challenged longstanding stigma and opened up wider conversations about psychological well-being in sport. Michael Phelps has spoken openly about his own struggles, using his platform to encourage others to seek help.
The researchers called on sporting federations and institutions to move beyond awareness and embed structured, evidence-based mental health support into everyday athletic programmes. They argued that a multidisciplinary model involving coaches, psychologists, and medical staff working in coordination is essential to catching problems early and ensuring athletes receive consistent care.
