Abstract
Abstract.Introduction: The mental health of elite athletes is a growing area of research however there remains a paucity of data to support evidence-based screening and prevention programmes as well as holistic yet targeted care. Olympic Weightlifting has long been associated in the media with the use of banned substances at an elite level however little is known about the mental health impact that this might represent and what the wider mental health needs of this group might be. Methods: A systematic search of PsychINFO, MEDLINE, EMCARE, EMBASE and CINAHL databases was conducted from inception up until January 2022. Peer reviewed studies of any methodology looking at mental illness or symptoms amongst current elite level Olympic weightlifters were eligible for inclusion. Results: Four articles met all inclusion criteria. Two cross-sectional studies looked at depression and anxiety and two case studies reported psychosis following long-term use of Mephentermine. Results seemed to broadly align with research looking at elite athletes in other sports however it was not possible to compare results between the two cross-sectional studies due to methodological differences. Conclusion: There is very little published research in this area and it is of varying methodological quality. A narrow subset of mental health symptoms were investigated and most of the data were based on self-reported symptoms rather than diagnostic data. Further research is needed to explore the mental health burden in this group and to inform appropriate support programmes.
References
1 . The mental health of elite athletes: A narrative systematic review. Sports Med. 2016;46:1333–53. https://doi.org/10.1007/s40279-016-0492-2
2 Occurrence of mental health symptoms and disorders in current and former athletes: a systematic review and meta-analysis. Br J Sports Med. 2019;53:700–6. https://doi.org/10.1136/bjsports-2019-100671
3 . Mental health in elite athletes: Increased awareness requires an early intervention framework to respond to athlete needs. Sports Med – Open. 2019;5. https://doi.org/10.1186/s40798-019-0220-1
4 Determinants of anxiety in elite athletes: a systematic review and meta-analysis. Br J Sports Med. 2019;53(11):722–30. https://doi.org/10.1136/bjsports-2019-100620
5 . The prevalence of failure-based depression among elite athletes. Clin J Sports Med. 2013;23(4):273–7. https://doi.org/10.1097/JSM.0b013e318287b870
6 . Depression among elite athletes: prevalence and psychological factors. Deut Z Sportmed. 2013;64:320–6. https://doi.org/10.5960/dzsm.2013.088
7 . The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med. 2016;50:145–8. https://doi.org/10.1136/bjsports-2015-095586
8 Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med. 2019;53:667–99. https://doi.org/10.1136/bjsports-2019-100715
9 Doping practices in international weightlifting: analysis of sanctioned athletes/support personnel from 2008 to 2019 and retesting of samples from the 2008 and 2012 Olympic Games. Sports Med – Open. 2021;7(4). https://doi.org/10.1186/s40798-020-00293-4
10 . The neurobiology and addiction potential of anabolic androgenic steroids and the effects of growth hormone. Brain Res Bull. 2016;126(1):127–37. https://doi.org/10.1016/j.brainresbull.2016.05.003
11 . Interdisciplinary and psychiatric treatment of anabolic androgenic steroids users. Prax Bern 1994. 2022;111(6):e339–44. https://doi.org/10.1024/1661-8157/a003868
12 . Drug abuse in athletes. Subst Abuse Rehabil. 2014;5:95–105. https://doi.org/10.2147/SAR.S53784
13 . Cognitive deficits in long-term anabolic-androgenic steroid users. Drug Alcohol Depend. 2013;130:208–14. https://doi.org/10.1016/j.drugalcdep.2012.11.008
14 . Anabolic androgenic steroids, antisocial personality traits, aggression and violence. Drug Alcohol Depend. 2021;221. https://doi.org/10.1016/j.drugalcdep.2021.108604
15 . Muscle dysmorphia in male weightlifters: A case-control study. Am J Psychiatry. 2000;157(8):1291–6. https://doi.org/10.1176/appi.ajp.157.8.1291
16 . Presence of muscle dysmorphia symptomology among male weightlifters. Compr Psychiatry. 2006;47(2):127–35. https://doi.org/10.1016/j.comppsych.2005.06.001
17 . Recognition and treatment of muscle dysmorphia and related body image disorders. J Athl Train. 2005;40(4):352–9.
18 . Muscle dysmorphia and its associated psychological features in three groups of recreational athletes. Sci Rep. 2018;8:8877. https://doi.org/10.1038/s41598-018-27176-9
19 . Symptoms of muscle dysmorphia, body dysmorphic disorder and eating disorders in a nonclinical population of adult male weightlifters in Australia. J Strength Cond Res. 2015;29(5):1406–14. https://doi.org/10.1519/JSC.0000000000000763
20 Medical care provision at the venue of the weightlifting event of the Tokyo 2020 Olympic Games. Sport Sci Health. 2021;19:1–6. https://doi.org/10.1007/s11332-021-00865-1
21 A multifactorial evaluation of illness risk factors in athletes preparing for the Summer Olympic Games. J Sci Med Sport. 2017;20(8):745–50. https://doi.org/10.1016/j.jsams.2017.02.010
22
PRISMA . PRISMA 2020 Checklist. Available from: http://www.prisma-statement.org/. [Accessed January 2022].23 Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC methods programme. Lancaster University; 2006. Available from: https://www.lancaster.ac.uk/media/lancaster-university/content-assets/documents/fhm/dhr/chir/NSsynthesisguidanceVersion1-April2006.pdf. [Accessed March 2022].
24
Joanna Briggs Institute, The University of Adelaide . Critical Appraisal Tools. Available from: https://jbi.global/critical-appraisal-tools. [Accessed January 2022].25 . Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Mil Med Res. 2020;7. https://doi.org/10.1186/s40779-020-00238-8
26 . The Masters athlete in Olympic weightlifting: Training, lifestyle, health challenges, and gender differences. PLoS One. 2020;15(12):
e0243652 . https://doi.org/10.1371/journal.pone.024365227 . Psychological predictors of elite and non-elite performance in Olympic weightlifting. Int J Sport Psychol. 1989;20(1):1–12.
28 . Mephentermine dependence with induced psychosis. Ger J Psychiatry. 2012;15(2):69–71.
29 . Mephentermine dependence with psychosis. Gen Hosp Psychiatry. 2013;35(6):681.e9–10. https://doi.org/10.1016/j.genhosppsych.2013.04.019
30
Drugbank Online . Mephentermine. Available from: https://go.drugbank.com/drugs/DB01365. [Accessed January 2022].31 . Pharmacology of stimulants prohibited by World Anti-Doping Agency (WADA). Br J Pharmacol. 2008;154(3):606–22. https://doi.org/10.1038/bjp.2008.124
32 . The ninth mental measurements yearbook. Lincoln, NB: Buros Institute of Mental Measurements, University of Nebraska; 1985.
33 . Profile of mood states. San Diego, CA: Educational and Industrial Testing Service; 1971.
34 . Conceiving the self. New York: Basic Books; 1979.
35 . The Psychological Skills Inventory for Sports (R-5). 5th ed. Goleta, CA: Health Science Systems; 1988.
36
The Wall Street Journal . Weightlifting on the Rise. 2017. Available from: https://www.wsj.com/articles/u-s-weightlifters-elevate-their-sport-1511368315. [Accessed September 2021].37 . Some psychological traits of Slovenian Olympians (Beijing 2008) – a gender comparison. Kinesiol Slov. 2012;18(2):5–18.
38 . Sex differences in depression and anxiety disorders: potential biological determinants. Horm Behav. 2006;50(4):534–8. https://doi.org/10.1016/j.yhbeh.2006.06.031
39 . Females are more anxious than males a metacognitive perspective. Iran J Psychiatry Behav Sci. 2011;5(2):83–90.
40 . The psychology of the female athlete: How mental health and wellness mediate sports performance, injury and recovery. Ann Jt. 2021;6(38). https://doi.org/10.21037/aoj-20-53
41 . Depression in athletes: Prevalence and risk factors. Curr Sports Med Rep. 2015;14(1):56–60. https://doi.org/10.1249/JSR.0000000000000123
42 . Team sport athletes may be less likely to suffer anxiety or depression than individual sport athletes. J Sports Sci Med. 2019;18(3):490–6.
43 Psychological balance in high level athletes: Gender-based differences and sport-specific patterns. PLoS One. 2011;6(5):
e19007 . https://doi.org/10.1371/journal.pone.001900744 . The mental health of Australian elite athletes. J Sci Med Sport. 2015;18(3):255–61. https://doi.org/10.1016/j.jsams.2014.04.006
45 . Mental and psychosocial health among current and former professional footballers. Occup Med. 2015;65(3):190–6. https://doi.org/10.1093/occmed/kqu202
46 . Mood states of professional female tennis players. Percept Mot Skills. 1991;73(1):187–90. https://doi.org/10.2466/pms.1991.73.1.187
47 . Psychological resilience in young female athletes. Int J Environ Res Public Health. 2021;18. https://doi.org/10.3390/ijerph18168668
48 fMRI BOLD signal changes in elite swimmers while viewing videos of personal failure. Brain Imaging Behav. 2008;2(2):84–93. https://doi.org/10.1007/s11682-007-9016-x
49 . Working with elite athletes. In: Exploring sport and exercise psychology. 3rd ed. Washington, DC: American Psychological Association; 2014. p. 401–25.
50 . Self-reported psychopathology in athletes: A comparison of intercollegiate student-athletes and non-athletes. J Sport Behav. 2005;28:86–98.
51 . Personality characteristics of successful and unsuccessful oarsmen. Int J Sport Psychol. 1978;9(2):119–33.
52 .
Iceberg profile . In: Eklund RCTenenbaum G, editors. Encyclopedia of sport and exercise psychology. SAGE Publications Inc; 2014. p. 362–6.53 . Hazardous drinking in New Zealand sportspeople: Level of sporting participation and drinking motives. Alcohol Alcohol. 2007;42(4):376–82. https://doi.org/10.1093/alcalc/agm035
54 . Hazardous drinking in elite New Zealand sportspeople. Alcohol Alcohol. 2005;40(3):239–41. https://doi.org/10.1093/alcalc/agh145
55 . Drinking by professional Australian Football League (AFL) players: Prevalence and correlates of risk. Med J Aust. 2008;189(9):479–83. https://doi.org/10.5694/j.1326-5377.2008.tb02138.x
56 . Risk factors for anabolic-androgenic steroid use among weightlifters: a case-control study. Drug Alcohol Depend. 2003;71:77–86. https://doi.org/10.1016/S0376-8716(03)00069-3
57 . Alcohol and marijuana use among american high school seniors: empirical associations with competitive sports participation. Sociol Sport J. 2011;28(3):362–79. https://doi.org/10.1123/ssj.28.3.362
58 . Body image, disordered eating and anabolic steroid use in female bodybuilders. Eat Disord. 2009;17(3):200–10. https://doi.org/10.1080/10640260902848485
59 . Human growth hormone abuse in male weightlifters. Am J Addict. 2011;20(1):9–13. https://doi.org/10.1111/j.1521-0391.2010.00093.x
60
ProCon.org . Doping cases at the Olympics. 2021. Available from: https://sportsanddrugs.procon.org/doping-cases-at-the-olympics/#sport. [Accessed February 2022].61 . A systematic review of research into coach perspectives and behaviours regarding doping and anti-doping. Psychol Sport Exerc. 2020;59. https://doi.org/10.1016/j.psychsport.2020.101780
62 An intervention to optimise coach-created motivational climates and reduce athlete willingness to dope (CoachMADE): A three-country cluster randomised controlled trial. Br J Sports Med. 2021;55(4):213–9. https://doi.org/10.1136/bjsports-2019-101963
63 Athlete mental health: Future directions. Br J Sports Med. 2021;55(22):1243–4. https://doi.org/10.1136/bjsports-2021-104443
64 . Disordered eating behaviours in female physique athletes. Eur J Sport Sci. 2020;20(9):1206–14. https://doi.org/10.1080/17461391.2019.1698659
65 . Exercise dependence and muscle dysmorphia in novice and experienced female bodybuilders. J Behav Addict. 2013;2(4):244–8. https://doi.org/10.1556/JBA.2.2013.4.8
66 . Cultural influences on body size ideals. Eur Psychol. 2015;20(1):44–51. https://doi.org/10.1027/1016-9040/a000150
67 .
Risk factors in the development of body image, eating problems, and obesity . In: Smolak LThompson JK, editors. Body image, eating disorders, and obesity in youth: Assessment, prevention, and treatment. American Psychological Association; 2009. p. 135–55.68 .
Transitional challenges and elite athletes’ mental health . In: Baker JSafai PFraser-Thomas J, editors. Health and elite sport. 1st ed. Routledge; 2014.69 When the final whistle blows: Social identity pathways support mental health and life satisfaction after retirement from competitive sport. Psychol Sport Exerc. 2021;57. https://doi.org/10.1016/j.psychsport.2021.102049