When talking to a player whom you think might have a mental health problem, or when performing a pre-competition medical assessment, it is important to assure the player that all information will be treated with the highest confidentiality. It is important to present a warm and open environment. Many athletes may regard a mental health problem as a sign of weakness. Therefore, it should be made clear that mental health problems are a part of everyday life – just like physical problems. There is no reason to hide it. Effective treatments for such problems are available. The use of antidepressants in elite football players is relatively low – when compared with the general population. It is, however, important to enquire about this.
It is also important to consider some comorbidity, such as gambling, alcohol and drug use. Since people with mental health problems are at a higher risk of suicide, it is always important to ask about the suicide intention, and take immediate and adequate action in such cases. This is an essential component of the history-taking.
Some issues might predispose a player to developing symptoms of depression, anxiety or other conditions. Some of these are discussed further below.
- Player age
- In general terms, younger players are more likely to experience a mental health condition than those who are older. This reflects a similar trend in the general population. Older players who are planning to retire are, however, an at-risk group.
- Player gender
- Female players are more likely to experience depression, anxiety or eating disorders when compared with their male peers.
- Level of play
- It appears that players who are more elite are less likely to experience depression or anxiety symptoms. Youth players and amateur players are more likely to suffer from these symptoms.
- Players who sustain a significant injury are more likely to become depressed (when compared with those who are not injured). This means that in addition to treating the physical injury, it is important to also manage the player’s mental well-being.
- Conflicts with coaches, managers and other players can be a risk factor for developing depression and anxiety symptoms.
- Harassment and abuse
- Harassment and abuse are potential causes of mental health issues. The risk of experiencing psychological, physical and sexual violence rises as the athlete progresses up the talent ladder and performance pathway. Players who represent minority groups (elite, disabled, child and LBGT players) are most at risk.
The majority of abuse occurs from abuses of power. For example, a coach can have a significant influence over players for whom they are responsible. When dealing with a player who has a mental health condition, it is always important to consider the possibility of abuse (both past and current).
- Players who are planning to retire, or who have recently retired, are more likely to experience depression or anxiety. It is important to have structures in place to plan for players’ retirement and to offer support during this period. Players who have actively made plans for their retirement, and life after football, are less likely to experience depression than those who have not.
- Medication use
- It is important to enquire about past and current treatment. The use of antidepressants in elite football players is relatively low – when compared with the general population. It is, however, important to enquire about this.
- Other social issues
- A range of lifestyle factors can have a marked influence on a player’s mental health and general well-being. Significant adverse life events (for example, a relationship break-up or moving house), career dissatisfaction or a lack of social support can all have a major influence.