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Setting the bar: athletes and vulnerability to mental illness

  • Lynette Hughes (a1) and Gerard Leavey (a2)
Summary

Whereas physical sport activity is generally considered a health benefit, extreme exercise may be harmful. Of particular concern in this regard is the considerable variation between doctors in the primary care setting and those working within the sports setting around the diagnosis and treatment of athletes presenting with similar symptoms. Known risk factors for athletes are herein presented to raise awareness of the negative side of sport and to bring attention to the psychological outcomes and needs of athletes. The need for research into the incidence and aetiology of mental illness within elite level sport is also raised.

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Copyright
Corresponding author
Lynette Hughes, Compass Research and Policy, Northern Ireland Association of Mental Health, 80 University Street, Belfast BT7 1HE, Northern Ireland. Email: l.hughes@compasswellbeing.org
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Declaration of interest

None.

Footnotes
References
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1 Schwenk, TL. The stigmatisation and denial of mental illness in athletes. Br J Sports Med 2000; 34: 45.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Setting the bar: athletes and vulnerability to mental illness

  • Lynette Hughes (a1) and Gerard Leavey (a2)
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eLetters

Athletes and doctors share psychological vulnerabilities

Mike Skelton, Core Trainee (CT3) Psychiatry, Nottinghamshire Healthcare NHS Trust
16 February 2012

Sir, Hughes' and Leavey's editorial1 on athletes' vulnerability to mental illness is welcome. Increasingly, we are becoming aware of how elite athletes often struggle with mental illness whilst endeavouring to excel in their sport. Furthermore, crises may arise not only during the sporting lifetime, but in retirement, seen in cases such as Frank Bruno (hospitalised post retirement and later diagnosed with bipolar disorder) or that of the former Tour de France winner, Marco Pantani, who had received treatment for depression, later died from accidental cocaine poisoning. Professional cricket has been asserted to have the highest suicide risk of any sport, though the evidence may not be conclusive2, andsystematic research into the link between different types of sport and mental illness and suicide is required to provide a counterweight to the wealth of anecdote and media speculation about individual cases.

What struck us about athletes' lives - striving for perfection, living under pressure and in the public eye, is how much they have in common with the medical profession. For example, the BMA outlines the following personality attributes of doctors - perfectionism, over conscientiousness, approval seeking, need to be in control, chronic self-doubt, dislike of praise and a tendency to delay gratification3.

It may be helpful to consider the similarities between doctors and athletes when tackling their respective psychological vulnerabilities. Doctors find it difficult to seek help for mental health problems, for a variety of reasons, including fear of professional censure, peer pressure and professional loyalty3. Doctors are known to be at a relatively high risk of suicide4. Psychiatry is not immune to this problem, and unfortunately has a higher risk than some other subspecialties5. Ironically, the well-publicised plight of emotionally distressed sportspeople might help combat the stigma associated with mental illness as evidenced by the sympathetic coverage of the death of footballer, Gary Speed and cricketer, Marcus Trescothick's vivid description of his recurrent depressions. Hopefully both these high profile groups in the public eye may be helped by a less marginalised approach to mental health problems, as well as specific measures such as rapid access to confidential professional help.4

References1 Hughes, L and Leavey, G. Setting the bar: athletes and vulnerability tomental illness. BJP February 2012 200:95-96; doi:10.1192/bjp.bp.111.0959762 Harris, N. Cricket's darkest statistics, and why assumptions about suicide might be wrong. www.sportingintelligience.com. Nov 15, 2011.3 Peters, M. Mental Health and Ill Health in Doctors. BMA Doctors for Doctors Unit4 Hawton,K and Taylor,T. Treatment of suicide attempters and prevention of suicide and attempted. Suicide. New Oxford Textbook of Psychiatry. Ed. Gelder,M et al. Vol 1, 2nd edition, 2009.5 Hawton, K., Clements, A., Sakarovitch, C., Simkin, S., Deeks, J.J. (2001) Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979-1995. Journal of Epidemiology and Community Health, 55, 296-300

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Conflict of interest: None declared

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