Addressing psychiatric disorder among student-athletes: Challenges facing mental health...

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  • IntroductionUnique life circumstances of college student-athletes

    Many times moving away from home Leaving existing social networks and tackling new social integration

    Winning acceptance of peers, teammates, teachers, coaches friends Negotiating self-comparison, demotion, rejection

    Growing into adulthood and learning adult responsibilities Development of autonomy and relative self-sufficiency

    Balancing academic and athletic responsibilities Time management Is there really enough time??

    Rising to the expectations of the D-I athletic community An increase in the level of competitiveness/expectations/pressures

    (Carr, 2007;Etzel & Watson, 2007; Lu, Hsu, Chan, Cheen & Kao, 2012; Yang, Peek-Asa, Corlette, Cheng,)

  • IntroductionMost psychopathology research of athletes deals with sport-caused disorder rather than premorbid disorder.

    (Kamm, 2008; Reardon & Factor, 2010)


    The athletic, medical, and academic communities are giving more attention to premorbid mental disorder to this specific population, as well as the importance of early detection, diagnosis, and treatment.

    (Ackerman, 2010; Bennett, 2007; Carr, 2007; Chamberlain, 2007; Etzel & Watson, 2007; Flowers, 2007; Gardner, 2007; Gardner & Moore, 2004; Hack, 2007; Hosick, 2005; Morse, 2007-2010; Johnson, 2010; Reardon & Factor, 2010; Thompson & Sherman, 2007; Zillmer & Gigli, 2007)

  • Treatment and Research Issues

    When theyre sending our kids to the student counseling center, theyre not seeing somebody who knows what a 20-year-old collegiate athlete who plays in a revenue producing sport experiences, understands their stressors. Theyll think, Maybe we need to look at being a little smarter at taking care of our student-athletes psychological mental health issues.

    -Dr. Christopher Carr, in Hosick, 2005, p.1.

  • Treatment and Research Issues Determining whether psychopathological symptoms are a result

    of these life stressors or come from deeper underlying psychological mechanisms may be more complex a task than for non-athletes. Especially with college-age student-athletes.

    (Baum, 2012; Christie et al., 1988; Storch, Storch, Killiani & Roberti, 2005; Tod & Anderson, 2010).

    Age range is common to the onset of many pre-morbid psychopathological disorders

    (Christie et al., 1988; Kessler et al., 2005; Slopen et al., 2010).

    Anxiety: 17 years of age (median age) Drug dependence/Alcoholism : 20 years of age Major depressive episode: 24 years of age Other mood disorders: 25 years of age

  • Common Student-Athlete Psychiatric Disorder Anxiety, depression, and attentional disorders receive much attention in

    athlete psychopathology research (Angst, Gamma, Baldwin, Ajdacic-Gross & Rossler, 2009; Constant-Norville, 2012; Kamm, 2008; Reardon & Factor, 2010).

    Reports of the prevalence of psychopathologies in athletes compared to non-athletes vary (Kamm, 2008).

    Depressive symptoms and alcohol abuse may be higher among athletes (Kamm, 2008; Mummery, 2005; Yang et al, 2007).

    Comorbities, or co-occurrences, of different types of disorder, complicate diagnosis and treatment and is very common (Morse, 2008; Tzur-Bitan, Meiran, Steinburg & Shalar, 2012).

    Comorbid illness is often the rule rather than the exception, so any comorbid illness must also be treated (Morse, 2008, p. 202).

  • Stigmas, Assumptions, and Deterrents to Treatment

    The current conceptualization of an approach to mental illness is fraught with stigmatization, denial, and

    dichotomous paradigms of psychological and physical disease which are inaccurate, unhelpful, and deprive the

    athlete of effective care (Schwenk, 2000).

    Two types of illnesses need two different types of medical attention. Sport-based mental health services (mental health and mental

    performance) are not bifurcated but exist on a clinical continuum (Hack, 2007).

    Assumption of sport-related causes (Glick & Horsfall, 2001).

    Mental disorder = weakness, inferiority, incapability (Ackerman, 2012).

  • Referral to Psychology Professionals Members of the sports medicine or training staff are in

    direct and frequent contact with the athletes and get to know them on a more personal level than anyone else (Chamberlain, 2007).

    Athletic trainers may get to know the athletes personal information better than anyone (McDuff, 2012)!

    It is important they, as much as anyone, to understand the warning signs and symptoms of psychopathology and how to properly attend to them in order to properly refer them to the right people (Thompson & Sherman, 2007).

  • Sport Psychiatrist/Clinical Sport Psychologist

    Professions that are receiving more and more attention and consideration, sport psychiatry most recently (Ackerman, 2010; Baum, 2012; Donohoe et al., 2004; Glick & Horsfall, 2001; Glick, Kamm, & Morse, 2009; Keh, 2011; Reardon & Factor, 2010).

    Concentration on mental disorder and accompanying comorbidities, maladaptive coping responses, and other sport-related issues like medication (Baum, 2012; Constant-Norville, 2012; Glick et al., 2009; Keh, 2011; Morse, 2010).

    Personal accounts of practice in research by sport psychiatrist/clinical psychologist is becoming common as well

    (Bennett, 2007; Chamberlain, 2007; Flowers, 2007; Glick & Horsfall, 2001; Kamm, 2008; Morse, 2008; 2009; 2010; Zillmer & Gigli, 2007).

  • Sport PsychologistSport Psychology Consultant (SPC)Applied Sport Psychologist etc.

    Primarily concerned with competitive and training mental skills (Archaya, 2010; Morris et al., 2003; Sharp & Hodge, 2011; Weiss & Amorose, 2008).

    Certification really not necessary to practice performance but AASP certification requires counseling and psychopathology education (Acharya, 2010; Morris et al., 2003; Williams, 2010).

    Long developed and well established discipline gaining respect and more frequent utilization while still being questioned regarding legitimacy, effectiveness, and necessity

    (Acharya, 2010; Morse, 2010; Wrisberg et al., 2012).

  • Clinical Issues in Sport Psychology It is difficult for psychology professionals to determine whether

    mental distress is circumstantial (sport caused) or stable and inherited, regardless of sport participation. (Baum, 2012; Coles & Coleman, 2010; Morse, 2009; Reardon & Factor, 2010; Schwenk, 2000).

    Would a comprehensive sport-based psychological program best provide for mental health and performance issues? Mental health professionals may best understand what kind of mental skills

    training would work for individual clients (Carr, 2007; Flowers,2007).

    Sport-specific ethical considerations (Etzel & Watson; Morse, 2009). Medication prescriptions/doping regulations Maintaining appropriate doctor/patient relationship Coercion/Bribery by coaches, athletic directors, boosters etc.

  • Discussion and Conclusion There is no research conducted by someone from outside

    of the profession looking in. There is certainly no qualitative research that examines multiple

    mental health professionals experiences and perceptions regarding their clinical difficulties and common clinical pitfalls when working specifically with NCAA D-I student-athletes.

    I propose, through multiple interviews with these professionals at D-I schools across the country, the data may show certain clinical commonalities that, if strong enough, could be used to help develop amended diagnostic frameworks, unique classification systems, and custom intervention programs tailored specifically to college student-athletes.

  • (Near) Future Directions


  • References Ackerman, S.R. (2010). Attitudes toward help-seeking and mental health among college athletes: impact of the psycho-educational workshop. Dissertation Abstracts International: Section B: The Sciences and Engineering, 72(11-B):6658. Angst, J., Gamma, A., Baldwin, D.S., Ajdacic-Gross, V. & Rossler, W. (2009). Generalized anxiety spectrum: prevalence, onset, course, and outcome. European Archive Of Psychiatry and Clinical Neuroscience, 259: 37-45. Bartholomaeus, C. (2012). Im not allowed wrestling stuff: Hegemonic masculinity and primary school boys. Journal of Sociology, 48: 227-247. Baum, A.L. (2012). Sport psychiatry. Psychiatric Annals, 42(10):359-360. Bennett, G. (2007). The role of the clinical psychologist in a Division I athletics program. Journal of Clinical Sport Psychology, 1: 261-269. Chamberlain, R.B. (2007). Sport psychology in a collegiate athletic department setting. Journal of Clinical Sport Psychology, 1: 281-292. Christie, K.A., Burke, J.D., Regier, D.A. & Rae, D.S. (1988). Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults. The American Journal of Psychiatry, 145(8): 971-975.

  • References Constant-Norville, D. (2012). Treatment considerations for the ADHD-Affected Athlete. Psychiatric Annals, 42(10): 376-381. Cote, J., Salmeda, J.H., Baria, A. & Russell, S.J. (1993). Organizing and interpreting unstructured qualitative data. The Sport Psychologist, 7: 127-137. Dale, G.A. (2000). Distractions and coping strategies of elite decathl