Athlete mental health support from coaches “under explored” in research amidst deselection concerns
Review of 104 studies shows little research focused on athletes’ access to mental health support or semi-formal sources such as coaches
University of Birmingham
A paper published in BMJ Open today (Friday 8 August) led by researchers from the University of Birmingham highlights how few studies conducted into athlete help-seeking for mental health have looked into support provided by semi-formal sources such as coaches, with the majority of research conducted on formal sources.
The team reviewed 104 relevant studies conducted around the world and found that while many athletes experience mental health issues, they face unique sport-specific barriers when seeking help and guidance. The review mapped the research on athletes’ views on access to support, their attitudes toward seeking it, and their past experiences from formal and semi-formal sources of support.
Kirsty Brown, PhD student, from the University of Birmingham and lead researcher said:
“We know that athletes’ face specific barriers to seek help for mental health. By mapping the research on athletes’ views on access, attitudes and experiences of support, this research uncovers more about the process of help-seeking in athletes, and where further research is required.”
“Our new research highlights that while there is a growing academic understanding of how sports people experience mental health support, there are still unexplored areas in the research that leaves many questions unanswered about how athletes’ utilize formal and semi-formal sources of support. It is essential that these support networks understand the unique needs of athletes and are equipped to provide mental health support and signposting.”
Formal or semi-formal support?
Athletes may rely on coaches for semi-formal support with mental health despite stigma and deselection concerns, but a new study highlights little research has been conducted in this “crucial” area.
Most of the research focused on formal sources of support (55%) such as psychologists or counsellors, with only 2% of papers looking at athlete interactions with semi-formal support such as coaches or academic advisors. 26% both formal and semi-formal were looked at.
Attitudes to seeking help
Athletes’ attitudes to seeking support for their mental health was the most researched area among the studies that the team looked at, with 79% of papers investigated incorporating this question.
Notably, access was the least studied area with less than a third (32%) of papers investigating this issue, despite being a foundational factor in help-seeking behaviour.
Where next?
In addition, the study highlights gaps in studies looking at athlete help-seeking in lower-income and non-Western contexts, where cultural and structural barriers may differ. The team suggest that future research should also explore semi-formal sources of support more thoroughly, especially given their accessibility and potential influence on athletes’ willingness to seek help. Additionally, a more consistent use of validated help-seeking measures and established psychological help-seeking theories and frameworks would strengthen study comparability and impact.
Professor Jennifer Cumming from the University of Birmingham and senior lead author of the study said:
"This is important research to understand where more focus is needed. For us to have the best possible models of support for athletes, it’s important that we have a strong evidence base to work from.”
Journal
BMJ Open
Method of Research
Commentary/editorial
Subject of Research
People
Article Title
Where athletes seek mental health support - and where the literature falls short
Article Publication Date
8-Aug-2025
Yale study: Mobile phone app reduced suicidal behavior among high-risk patients
Yale University
August 08, 2025
A mobile phone app designed to deliver suicide-specific therapy reduced suicidal behavior among high-risk psychiatric inpatients, according to a new study by scientists at Yale School of Medicine and The Ohio State University Wexner Medical Center and College of Medicine.
The study, published Aug. 8, 2025 in JAMA Network Open, found that the app, OTX-202, reduced the recurrence of post-discharge suicide attempts by 58.3% among patients who had previously attempted suicide. This reduction is a critical achievement for a group that is particularly vulnerable to repeated suicidal behaviors, the researchers said.
Users of the app also experienced sustained reductions in suicidal thoughts for up to 24 weeks after psychiatric hospitalization, according to the study. In contrast, patients who used an active control app in addition to treatment as usual showed early improvement, but suicidal thoughts rebounded by week 24.
These findings suggest that OTX-202 may help preserve long-term gains in mental health during the high-risk period following hospital discharge, according to the study.
“Although suicide-specific therapy is highly effective for reducing suicidal thoughts and urges, finding therapists who know how to do this life-saving therapy after leaving the hospital can be challenging. OTX-202 provides a possible solution to that problem,” said study co-first author Craig Bryan, PsyD, professor in Ohio State’s Department of Psychiatry and Behavioral Health and director of its Suicide Prevention Program.
Suicide remains among the top 10 causes of death in the U.S.; it is the second leading cause of death among individuals aged 10–14 and 25–34, the third leading cause among those aged 15–24, and the fourth leading cause among those aged 35–44. Since 1999, suicide rates have risen by more than 33%.
Each year, more than 1 million adults engage in nonfatal suicidal behavior, and nearly 500,000 are hospitalized for suicide attempts. Suicide and suicide attempts also cost the U.S. healthcare system and broader economy an estimated $500 billion annually underscoring the urgent need for scalable, effective, and economically viable interventions. Suicide is the only top killer without any prescription products for the vast majority of patients at risk.
“It can take weeks to months to see an outpatient provider after discharge; however, the weeks and months after discharge from psychiatric hospitalization are among the highest risk periods for suicide mortality, underscoring the critical need for effective interventions like OTX-202,” said co-first author, Patricia Simon, assistant professor adjunct of psychiatry at Yale School of Medicine.
OTX-202, developed by Oui Therapeutics, offers a scalable and cost-effective approach during this critical gap.
Testing of OTX-202 by the Yale and Ohio State researchers involved a multi-site, double-blind randomized controlled trial with 339 psychiatric inpatients from six diverse hospitals across the United States.
The participants were randomly assigned to either the OTX-202 app or an active control app, both in addition to their usual treatment. The OTX-202 app delivered a suicide-specific therapy module while the control app included safety planning and psychoeducation.
Compared to the active control, patients using OTX-202 were significantly more likely to show clinical improvement, as measured by the Clinical Global Impression for Severity of Suicide-Change (CGI-SSC) scale. The CGI is widely used because it provides a standardized, clinician-rated measure of symptom severity and improvement over time, allowing for consistent assessment across diverse patient populations and treatment settings.
“Patients and those who care for them do not have access to reliable and effective tools and resources to reduce future suicide risk. This population faces arguably the biggest gap in access to effective interventions of any leading killer. The potential clinical and population health impact of this new option is extraordinary,” said senior author Seth Feuerstein, MD, JD, assistant clinical professor of psychiatry at Yale.
Yale authors include Patricia Simon, PhD; Samuel T. Wilkinson, MD; Lauren Astorino, MSN, APRN; Alecia D. Dager, PhD; and Seth Feuerstein, MD, JD.
Ohio State authors include Craig Bryan, PsyD; Kristen M. Carpenter, PhD; Luke Misquitta, MD; Katherine Brownlowe, MD; Lauren R. Khazem, PhD; Jarred Hay and Austin G. Starkey.
Funding support: This research was supported in part by Oui Therapeutics Inc and by a grant from the National Institute of Mental Health (R42MH123357).
The study was funded by a grant from the National Institute of Mental Health. The content is solely the responsibility of the authors, and it does not necessarily represent the official views of the National Institutes of Health.
Journal
JAMA Network Open
Article Title
A Digital Therapeutic Intervention for Inpatients With Elevated Suicide Risk
Article Publication Date
8-Aug-2025
Research highlights depression risk in high-performance athletes, despite benefits of physical activity
Taylor & Francis Group
Research by sports scientists reveals that high-performance athletes face unique mental health challenges despite the well-established benefits of physical activity for depression prevention and treatment.
While moderate exercise is widely recognized for its positive impact on mental health, elite athletes experience specific pressures that can contribute to depression, including performance nerves, injury concerns and identity crises.
These findings are detailed in the comprehensive new book, Physical Activity, Physical Fitness and Depression, edited by researchers Adilson Marques and Élvio Rúbio Gouveia. The book brings together critical reviews examining the relationship between physical activity, fitness and depression, with contributions from more than two dozen academics across multiple disciplines.
Depression among elite athletes
Depression represents a significant global health burden, affecting over 264 million people worldwide, and elite athletes are just as susceptible.
In a chapter by authors Hugo Sarmento, Diogo Martinho and Pedro Teques, which specifically addresses mental health challenges in elite sports, the researchers explain: “Depression in high-performance sports is a complex phenomenon influenced by multiple factors.”
Their studies suggest that ‘young athletes and high-performance athletes can be vulnerable to depression’ despite their high levels of physical activity, and the standard self-reporting criteria used for the general population may not be sufficient in identifying depressive symptoms in athletes.
The scholars find several risk factors unique to elite athletes, including performance pressure, identity challenges and difficult career transitions. The researchers recommend that athletes get specific support upon retirement, as this period is a particularly vulnerable time when many athletes struggle with identity loss and purpose.
While physical activity generally serves as a protective factor against depression, the intense training regimens and competitive pressures of elite sports create a different dynamic. Although meta-analyses show the relative number of athletes experiencing depressive symptoms generally mirrors the wider population, it may be harder to identify using standard clinical methods as they might not fit the physical profile and could be more likely to underreport due to favoring traits like perseverance.
The authors explain: “The high prevalence of depression indicates that it constitutes a public health problem with potentially severe consequences.”
The researchers call for comprehensive mental health programs integrated into athletic training environments, and for sports organisations, coaches and health professionals to work collaboratively to develop effective screening tools and support systems specifically designed for high-performance athletes.
Physical activity and depression
For the general population, the book provides extensive evidence supporting moderate physical activity as an effective intervention for both preventing and treating depression. While antidepressant medications remain a cornerstone of treatment, their efficacy varies considerably among patients.
“Regular physical activity is associated with lower depressive symptoms and risk of depression in adults and older adults,” the authors suggest. Research cited in the book indicates that people engaging in higher levels of physical activity exhibit a 17% decreased risk of depression onset.
Physical activity offers substantial benefits for individuals with depressive symptoms by improving cognitive function and emotional regulation. The authors argue that physical activity should be considered as a complementary or alternative approach to traditional treatments, particularly when medication is not working.
Despite promising findings, the researchers emphasize that physical activity, exercise and depression research has a ‘long way to go’, and they call for more investigation, including looking at how to translate trials into clinical practice to enable clinicians to give specific advice on how much exercise, what type and for how long.
The authors conclude that tailored approaches are key, whether a high-performance athlete or member of the general public, but add: “Given its numerous benefits, physical activity should be integrated into clinical settings as a standard component of depression treatment.”
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