A Statement on the Mental Health Issues and Psychological Factors in Athletes

Research Paper Title

Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance and Prevention: American Medical Society for Sports Medicine Position Statement-Executive Summary.


The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment and prevention of mental health issues in competitive athletes.

This statement discusses how members of the sports medicine team, including team physicians, athletic trainers and mental health providers, work together in providing comprehensive psychological care to athletes.

It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness.

The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct and transition from sport.

Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance and prevention.

This document uses the Strength of Recommendation Taxonomy to grade level of evidence.


Chang, C., Putukian, M., Aerni, G., Diamond, A., Hong, G., Ingram, Y., Reardon, C.L. & Wolanin, A. (2020) Mental Health Issues and Psychological Factors in Athletes: Detection, Management, Effect on Performance and Prevention: American Medical Society for Sports Medicine Position Statement-Executive Summary. British Journal of Sports Medicine. 54(4), pp.216-220. doi: 10.1136/bjsports-2019-101583. Epub 2019 Dec 6.

Book: Preventing Bipolar Relapse

Book Title:

Preventing Bipolar Relapse: A Lifestyle Program to Help You Maintain a Balanced Mood & Live Well.

Author(s): Ruth C. White (PhD, MPH, MSW).

Year: 2014.

Edition: First (1st).

Publisher: New Harbinger Publications.

Type(s): Paperback and Kindle.


There is an old saying: “Prevention is better than cure.” If you have bipolar disorder, this is especially true. For you, it is incredibly important to read the warning signs of a possible episode. For instance, you may find you are not sleeping as well as usual, or you might be sleeping too much. You may stop doing things that you normally enjoy, or you may start acting out your impulses in ways that alienate those around you or get you into trouble.

While the path to wellness for those with bipolar may involve psychiatric visits and medication adjustments, preventing manic and depressive episodes is the true key to staying healthy and happy. So how do you do it? And most importantly, how can you keep yourself motivated?

In this powerful, breakthrough book, bipolar expert Ruth C. White shares her own personal approach to relapse prevention using the innovative programme SNAP (Sleep, Nutrition, Activity, and People).

White also offers practical tips and tracking tools you can use anytime, anywhere. By making necessary lifestyle adjustments, you can maintain balanced moods, recognise the warning signs of an oncoming episode, and make the necessary changes to reduce or prevent it.

This is the first and only book on bipolar disorder that focuses exclusively on prevention. To help you stay well, White includes links to helpful online tracking tools so that you can manage your symptoms, anytime, anywhere. If you are ready to stop living in fear of your next episode, this life-changing book can help you take charge of your diagnosis – and your life.

Linking Collaborative Care & Relapse Prevention for Depression

Research Paper Title

The role of relapse prevention for depression in collaborative care: A systematic review.


Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings.

Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care.

The researchers undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care.


The researchers searched for Randomised Controlled Trials (RCTs) of collaborative care for depression.

In addition to published material, they obtained provider and patient manuals from authors to provide more detail on intervention content.

They reported the extent to which collaborative care interventions addressed four relapse prevention components.


93 RCTs were identified.

31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention.

30 (32.3%) did not report relapse prevention approaches.

The researchers did not receive trial materials for approximately half of the trials, which limited their ability to identify relevant features of intervention content.


Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk.

Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.


Moriarty, A.S., Coventry, P.A., Hudson, J.L., Cook, N., Fenton, O.J., Bower, P., Lovell, K., Archer, J., Clarke, R., Richards, D.A., Dickens, C., Gask, L., Waheed, W., Huijbregts, K.M., van der Feltz-Cornelis, C., Ali, S., Gilbody, S. & McMillan, D. (2019) The role of relapse prevention for depression in collaborative care: A systematic review. Journal of Affective Disorders. pii: S0165-0327(19)30734-7. doi: 10.1016/j.jad.2019.11.105. [Epub ahead of print].