“Weight of Gold,” a new documentary narrated by Olympic swimmer Michael Phelps, addresses mental health concerns of Olympic athletes. The documentary, which aired on HBO Max in early August, discusses some of the thoughts going through the minds of athletes from a young age, thoughts about what it takes to reach the top of their sport, the pressure and exhilaration of reaching the Olympics, and what happens afterward.  ^1,2

Many of these athletes have been working toward the Olympics their entire life. In “Weight of Gold” athletes from many sports describe the depression and anxiety they face as they adjust to returning to ‘normal’ life, along with their loss of athletic identity. While this documentary supplies an inside view into the emotions and mental health of these athletes, showing their humanity, the brevity of the 1-hour documentary leaves questions unanswered. Namely, what needs to change to improve mental health in athletes and reduce suicide rates?³

Nearly eight million high school students participate in sports and about 480,000 play collegiate sports. Less than 1% of those collegiate players become a professional or Olympic athlete. As highlighted in the documentary, mental health is a significant concern for elite athletes (collegiate, professional and Olympic/Paralympic athletes). Suicide is the second leading cause of death among all college students.⁴

In many ways, participation in sports can be protective; however, in a large study of elite collegiate student athletes in the US, 7.3% of all deaths were attributed to suicide.⁶ Male athletes were at greatest risk.⁵ Some of the unique factors affecting elite athlete mental health include harassment and abuse, athletic injury and performance, and external pressure to succeed. About half of elite athletes transitioning out of sports will experience symptoms of anxiety and depression.⁵ Some risk factors for increased symptoms include involuntary retirement due to injury or deselection; loss of athletic identity and the unknown of what comes next; chronic pain; and a lack of retirement planning leading to financial struggles.

It can be challenging to identify athletes (or anyone) with depression because they may withdraw socially and isolate themselves. They may feel guilty and consider themselves a burden to those around them, so they do not ask for help, and instead hide their symptoms. People suffering from depression and anxiety may engage in harmful behaviors—such as substance misuse and disordered eating—to cope with their feelings. It can be easy to focus on these problem behaviors, rather than the underlying primary mental health condition.⁴

One way to address mental health and reduce suicide in athletes is to educate athletes, coaches, and the staff around them about the symptoms of mental illness. Here are some of the common warning signs and signs of imminent danger:

• Recognize warning signs⁶
  • Talking, writing, or thinking about death
  • Impulsive, aggressive, or reckless behavior
  • Increased alcohol and drug use
  • Social withdrawal from friends, family, and the community
  • Dramatic mood swings
• Signs of Imminent Danger⁶
  • Putting affairs in order and giving away possessions
  • Saying goodbye to friends and family
  • Mood shifts from despair to calm
  • Unexplained interest in obtaining firearms or controlled substances
  • Talking about death
  • Self-harming behaviors

Empathic and prompt action on the part of family, friends or sports staff who notice any of the above warning signs is critical. Some helpful tips include:

• Do not assume the person is engaging in suicidal thoughts or actions for "attention.”
• Respond quickly.  This lets a person know that you take their health, difficulties, and life seriously. A lack of response may be interpreted as confirmation that they are not worth the time or trouble.³
• Make an immediate referral to a mental health professional or counseling center, or for emergencies situations go to the nearest hospital emergency room.

Resources for Athletes, Coaches, Family and Others

• Risk and Protective Factors – Suicide Prevention Resource Center
• American Psychiatric Association on Suicide Prevention – Information for patients and families about suicide prevention and resources
• NCAA, Managing Student-Athletes’ Mental Health Issues – This handbook’s provides information to help effectively and quickly identify student-athletes who are at risk or are experiencing emotional symptoms.
• NCAA SSI Mental Health Education Resources – From the NCAA Sport Science Institute, these resources for college athletes, coaches, athletics administrators, and campus partners are intended to help support the health and well-being of student-athletes.
• Athlete 365 – #MentallyFit – Official website for Olympic athletes with resources on mental health.

By Adithy Nagarajan, M.D. Candidate,
University of Wisconsin,
School of Medicine and Public Health

Reviewed by Claudia Reardon, M.D., Associate Professor,
University of Wisconsin School of Medicine and Public Health Department of Psychiatry