REF-633 · Reardon et al. (IOC consensus), 2019 · British Journal of Sports Medicine, · Paper · PubMed
Mental health in elite athletes (IOC consensus 2019): symptoms and disorders are common, impair performance, raise injury risk and delay recovery
And sit outside the coach's scope: recognise, support, refer
Key Findings
Mental health symptoms and disorders are common among elite athletes, may have sport-related manifestations, and impair performance.
Mental health cannot be separated from physical health: symptoms and disorders increase the risk of physical injury and delay subsequent recovery.
There were no evidence- or consensus-based guidelines for diagnosis and management in elite athletes; diagnosis must distinguish character traits particular to elite athletes from psychosocial maladaptation.
Management should address all contributors (biopsychosocial factors relevant to athletes), and must involve both treatment of the individual athlete and optimising the environments in which all elite athletes train and compete.
Sport-specific risk windows named in the statement body (full text; not checked against the abstract): injury, overtraining/overreaching, performance failure, career transition/retirement, harassment/abuse.
Not from this paper (related work; each checked against its own abstract): Gouttebarge 2019 meta-analysis (DOI 10.1136/bjsports-2019-100671) — in 22 studies of current elite athletes (meta-analyses of 2,895–5,555 athletes) prevalence ranged from 19% (alcohol misuse) to 34% (anxiety/depression symptoms); in former elite athletes from 16% (distress) to 26% (anxiety/depression).Rice 2016 systematic review (DOI 10.1007/s40279-016-0492-2) — 60 studies; elite athletes carry a broadly comparable risk of anxiety and depression to the general population, few studies (25%) were methodologically rigorous.
Practical Application
The IOC consensus states that mental health symptoms and disorders are common in elite athletes, impair performance and raise injury risk and slow recovery; roughly one in three current elite athletes reports anxiety/depression symptoms (34%, Gouttebarge 2019).Know the red flags (persistent low mood or anxiety, withdrawal, sleep/appetite change, disordered eating, unexplained performance collapse) and watch the high-risk windows (post-injury, deep overreaching, post-event/off-season). (Red-flag list: the base's own practice.)
Scope of practice: don't diagnose or treat; design within clinical limits; refer out (physician, clinical or sport psychologist). Have referral pathways ready *before* they are needed.
The statement's management principle applies to coaches too: optimise the training environment (climate, load, communication), not just the individual — and reduce stigma; distinguish performance anxiety (psychological skills, REF-632) from clinical anxiety/depression (refer).
Limitations
Consensus statement, not a trial; prevalence figures are heterogeneous (self-report, varied cut-offs, elite samples) — quote them as approximate; the robust claim is "common and under-treated".
How this entry was checked and changed
Why this level
regraded 2026-09-27 from B: major consensus statement (rubric A), the IOC Consensus Work Group's critical evaluation of the evidence with recommendations
Content correction 2026-09-27
Level B -> A per the 2026-09-26 rubric (major consensus / position statement).
Added what the abstract actually states: symptoms impair performance, increase injury risk and delay recovery; diagnosis must separate elite-athlete traits from maladaptation; management = individual treatment + environment.
"At least comparable to the general population" re-sourced to Rice 2016 (broadly comparable); the "~1 in 3" figure sourced to Gouttebarge 2019 (34% current, 26% former); sport-specific risk factors labelled as statement body.