Perspectives on mental health and well-being
Voices of Swiss Paralympic athletes
Abstract
Abstract:Introduction: The aim of this study is to provide an overview of Paralympic athletes’ views on mental health in a competitive sport context. Although research in the field of Paralympic sport has increased exponentially over the last two decades, mental health and its promotion have hardly been the subject of research so far. Previous research shows that the practice of competitive sports influences the mental health of Paralympic athletes both positively and negatively. Mental disorders are no exception, even in elite sports. Well-coordinated health care for the prevention and treatment of mental health challenges and mental disorders in elite sports is crucial for this purpose. Methods: The methodological approach of the present study is based on a qualitative research design. The data was collected through semi-structured interviews and their evaluation with the help of applied thematic analysis. For the interviews, 15 active, adult, Swiss elite Para athletes were recruited. Results: The results suggest that athletic success, the athletic activity itself and an improvement in physical health can lead to an increase in mental well-being. On the other hand, athletic failure, pressure to perform, and physical problems can cause psychological stress and facilitate mental disorders. Conclusion: In particular, the coordinated handling of mental health challenges and mental disorders among Paralympic athletes seems to need improvement, especially regarding the use of sports psychiatry and psychotherapy services.
Introduction
The highest attainable goal of a Para athlete is a successful participation in the Paralympic Games, which occur every four years. In this text, the terms Para athletes, professional Para athletes, elite Para athletes, and Paralympic athletes are used interchangeably. Within this manuscript, we mean under these terms individuals with disabilities who engage in competitive sports at an elite level as one of their primary occupations. These athletes participate in organized sports events and competitions, often under the umbrella of Para sports or adaptive sports, and their skill and dedication enable them to compete at a high level. Just like professional athletes without disabilities, professional Para athletes train rigorously, participate in competitions, and may receive financial support through sponsorships, endorsements, prize money, and other means related to their athletic careers. Participants of the Special Olympics are not included in this definition. Only the most exceptional athletes qualify for the opportunity to participate in Paralympic Games. In Tokyo 2021, for example, the Swiss Paralympic delegation comprised just 21 athletes [1].
Achieving this high goal necessitates years of dedicated training and involves immense physical and mental exertion. The associated competitive pressure poses a significant risk to Para athletes’ mental well-being [2]. However, despite the growing importance of Paralympic competitions in the last two decades [3, 4], there has been little research on the mental health of Paralympic athletes, including the impact of competitive pressure [5]. Even though the number of research publications related to Paralympic athletes increased from around 400 by the end of the 20th century to almost 6000 after the Paralympic Games in Rio de Janeiro (2016), there are still only very few publications related to mental health of Paralympic athletes [6, 7]. According to scientific data banks Pubmed (biomedical) and SportDiscus (multidisciplinary), on 21 July 2023, there were only 65 publications that referred to the words “Paralympic” and “mental health” in the abstract and just 10 publications with these keywords in the title.
Research indicates that participating in Para sports can positively impact mental health [8, 9]. Besides the classical physiological benefits of physical activity, it provides opportunities for socialization, enjoyment, a sense of freedom, and it challenges stereotypes of Paralympic athletes [10]. Additionally, it can effectively promote post-traumatic growth, particularly for individuals with severe initial reactions to their impairment [11]. However, several risk factors are also associated with mental health, particularly for elite Para athletes. Swartz et al. report that complaints challenging the or related to mental health are common among Paralympic athletes [6]. This includes chronic pain, overtraining, injury in complex medical situations, a lack of adequate adaptive sports facilities, logistical challenges in travel to competition sites, challenging sleep conditions and inferior sleep quality in Paralympic villages, rapid escalation of Paralympic sports competitiveness, and increased in training demands, malfunctioning sports equipment, costs associated with new technology, negative coaching behaviors, and being “misclassified” or assigned to the wrong category for competition [6]. Exclusion and stigmatization also pose significant risk factors for mental health in Para athletes [6]. Furthermore, there is research on the issue of non-accidental harm, especially bullying, in visually impaired athletes [12]. For Para athletes, who operate on a quadrennial cycle, there is also evidence of an increased risk of disappointment, identity foreclosure, and high life stress that can lead to poor mental health [2].
The aforementioned examples illustrate well that although there are similarities to the Olympic sports and the mental health and mental health challenges and needs of professional athletes without disabilities, the equality assumption between these two groups of athletes is severely limited. Brittain even is of the opinion that there is systematic discrimination of disabled athletes, stating that “This lack of perceived interest in Paralympic and disability sport is, for disabled people, simply a further affirmation of their exclusion from the rest of society based upon non-disabled perceptions of their abilities” [13, p. 1]. In light of the need to optimize mental health support systems in competitive sports [14, 15, 16] and overcome the research gap in this area [5, 13], it is crucial to thoroughly examine the mental health understanding, needs and complaints of Paralympic athletes [17, 18].
The present study sought to provide a preliminary overview of the perception and significance of mental health, mental health needs, and mental health challenges in the competitive sport context from the perspective of Paralympic athletes in Switzerland. Furthermore, we aimed to offer the Para sports associations initial insights into this topic from the point of view of the Para athletes to create fundamentals to enhance their mental health support system within the competitive sports system. Given the lack of research on this topic, we utilized a qualitative research design to investigate mental health in Paralympic and professional Para athletes from their point of view.
Aims
Our objectives were two-fold: to gain insight into the general perception of mental health among Swiss professional Para athletes, as well as to explore their views on the relationship between mental well-being and sports performance, mental health challenges and disorders, and mental resources and toughness in Paralympic athletes.
Methods
The study was conducted within the master thesis studies of the first authors in psychology at the University of Zurich.
Based on the fact that no comparable studies or publications exploring the point of view of Para athletes on the study topics, a cross-sectional, qualitative design was applied using in-depth semi-structured interviews.
The present study was the initial and independent study in the frame of a bigger project on mental health and (not doping-related) substance consumption among Swiss professional Para athletes. Another three studies: qualitative interviews with Para athletes regarding (not doping-related) substance consumption (with another sample), qualitative interviews with national trainers and related staff of the Para athletes (e.g., national doctors, physiotherapists, heads of federations) about their view on mental health and (not doping-related) substance consumption in professional Para sports, and, finally, an international survey among Para athletes are still ongoing or in the analysis phase.
Setting
In Switzerland, professional Para sports are organized by the Swiss Paralympic organization. It prepares and supports Para athletes for participation in major competitive championships. Swiss Paralympic is a joint venture between two umbrella organizations for disabled sports in Switzerland: PluSport and “Rollstuhlsport” (Wheelchair Sports). In addition, Procap Sports, which is only active in mass sports, completes the national sports system for persons with disabilities. Collectively, they offer over 700 regular sports groups (usually weekly) and nearly 160 sports camps (usually 1–2 weeks in duration) annually to approximately 20,000 members [19, 20] forming the basis for the selection to professional Para sports.
However, the number of Para athletes in Switzerland who could be classified as professional is relatively low, consisting of approximately 150 individuals. Once youth and developmental talent are excluded, this leaves a pool of roughly 60 elite Para athletes in the country.
Participants
Following previous qualitative research in the field and in accordance with expert literature, we interviewed n = 15 professional Para athletes using maximum variation sampling, in which data from as many different perspectives as possible on this topic are to be collected [4, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31]. Since the interviews were conducted in the summer, we aimed to recruit Para athletes active in summer sports (“on season”). Given the small population of active Swiss Para athletes who have ever participated in the Paralympic Games (29), at least 80% of our sample should include participants with experience in the major sports events (Paralympic Games or World Championships).
Interviewer
All interviews were conducted by a psychology master’s student from the University of Zürich. The interviewer had prior interviewing experience and was additionally trained in practicing open-ended interviewing. He has never met any of the participants before the interview.
Recruiting
Given that only two organizations work with professional Para athletes in Switzerland, it was possible to identify all prospective participants in the data banks of these organizations (inclusion criteria: Being part of the extended national squad and being of legal age). On May 4, 2022, they received a personalized email with a brief project description and an invitation to participate in the interview. At the same time, different national coaches were informed about the study and were asked to promote the interviews among athletes. If the athletes were interested, they could establish the first contact with the interviewer by email. After the first briefing about the study aims and procedure, an interview was arranged.
For anonymity reasons, the national coaches and associations involved in the recruitment process were not informed which Para athletes took part in an interview.
Process
All interviews were conducted in Swiss-Swiss-German ((?)) and recorded for transcription. Prior to the interviews, informed consent was obtained from all participants. Despite concurrent competitions, the interviews were conducted over a two-month period in June and July 2022, using online platforms such as Zoom (n = 14) or Microsoft Teams (n = 1). After the interviews, each participant received a small gift from the research team, which consisted of two cinema vouchers worth CHF 40 (approximately USD 40), as a token of appreciation for their participation. Participants were not informed about the gift prior to the interview and received no further compensation or other incentives.
Interview structure
Since no suitable interview guide existed for this target group for orientation, it had to be developed from scratch. The complete interview guide consists of 8 main questions related to 1) subjective understanding of mental health, 2) current mood, 3) possible links between athletic activity and mental well-being, 4) sport-related experiences with mental health challenges or 5) mental disorders, 6) subjective understanding of mental toughness in competitive sport, 7) understanding of mental health of other Para athletes, and 8) future challenges in Para sport. Further clarification questions were posed to deepen personal perspectives, experiences and the handling of mental health challenges.
Analysis
We employed applied thematic analysis, following the method outlined by Guest, MacQueen, and Namey [23]. Initially, the research team reviewed the dataset to identify key themes. An MSc in Psychology student created codes and grouped them together under the supervision of a senior researcher. The research team reviewed and agreed upon the coding framework, after which the final coding was applied to the entire dataset. Ambiguous or uncertain cases were discussed with a senior researcher. To eliminate potential bias, a research team member who was not involved in the initial coding coded 20% (n = 3) of the dataset using the final coding framework. Interrater reliability was excellent, with k = .90, as interpreted by Wirtz and Caspar [32].
The coding was performed using NVivo 12 software [33]. It is important to note that allocating one statement to several codes was possible since each statement could contain information relating to several themes.
Results
Demographics
Fifteen Swiss Para athletes (N=15), consisting of six females and nine males with physical or sensory impairments, were recruited for the interviews. Given the number of elite Para athletes active in the summer, the response rate might be around 30%. Their ages ranged from 19 to 50, with a mean age of 32.1 years (SD = 8.66). The sample only included athletes who participated in summer sports, including athletics (n = 5), Para-cycling (n = 4), wheelchair sports (n = 4), hand-bike (n = 1), and swimming (n = 1). Out of the 15 athletes, 14 had already participated in major international events, such as European Championships (n = 14), World Championships (n = 14), or Paralympic Games (n = 11). The remaining athlete belonged to the promotion squad and had not yet participated in any major international event. At the time of data collection, the Para athletes had been competing at the highest level for an average of 10.8 years (SD = 7.94; range 1–24). Additionally, all Para athletes worked part-time or full-time (n = 11) or were in education (n = 4), in addition to their competitive sports activities. Seven athletes acquired impairments from an accident or illness (e.g., paraplegia, tetraplegia, missing lower leg). In comparison, the remaining eight athletes were born with their impairments (e.g., spina bifida, arthrogryposis multiplex congenital).
Results related to guiding questions
In order to provide a comprehensive summary of the results, we have structured our findings into four key themes: perception and promotion of mental health, mental well-being in the context of competitive sport, mental health challenges and mental disorders, perception and promotion of mental toughness. Each subsection begins with a brief summary, followed by a detailed presentation of the results.
Perception and promotion of mental health
The Para athletes who were interviewed expressed that they associated mental health with positive affect, self-related cognitions, their performance in daily life and sports, their behavior, and daily activities, as well as the absence of mental health problems. The most frequently mentioned aspects on the affective level were well-being, balance, and vitality. Self-related cognitions were identified as self-awareness, self-confidence, and a positive attitude towards life. In daily life and sports, the Para athletes were primarily concerned with being able to perform well. Notably, more than a quarter of the Para athletes associated mental health with the absence of negative affect. An overview of the reported perception of mental health, the sub-codes, and their frequencies can be found in Table 1.
Furthermore, the interviewed Para athletes highlighted four key areas that they find particularly relevant for promoting mental health: 1) engaging in fulfilling activities such as sports and balancing activities; 2) having a healthy social environment including friends, family, and partners; 3) utilizing psychological services such as sports psychology; 4) utilizing self-regulatory techniques such as regeneration, mindfulness, and meditation. Table 1 provides an overview of the reported ways to promote mental health, along with the sub-codes and their frequencies.
Mental well-being in the context of competitive sport
At the time of the interview, most Para athletes (n = 14) reported high (n = 7) to very high (n = 7) levels of mental well-being, with only one athlete expressing indifference. When discussing mental well-being, the athletes preferred terms such as “positive/negative mood” or “positive/negative feelings.”
Regarding the competitive sport, most of the interviewed Para athletes (n = 12) see a relationship between their mental well-being and their athletic performance. This relationship is reported in both positive and negative directions: High mental well-being is associated with high athletic performance (n = 10) and low mental well-being is associated with low athletic performance (n = 9). One interviewee explained: “[…] the better my mood is, the less of a hurdle it is […] to do the training when it is more exhausting.” Another athlete described the connection as follows: “When my mood is not good, everything is much harder for me, and I am then also more spastic.” A few Para athletes see no connection between mental well-being and athletic performance (n = 3). One of them was of the opinion: “[…] even if the mood is perhaps not quite as good, I can still focus quite well on the races […], I have never noticed too much of a difference in terms of performance.”
All Para athletes reported that their athletic activity positively affected their mental well-being, with most attributing the increase to the athletic activity itself. One athlete stated, “[…] it is simply the sport itself that I like to do, and it fulfills me and makes me feel good.”
Other positive aspects of athletic activity included athletic success, better physical condition, and the social environment. However, failures or physical health problems could lead to a decrease in mental well-being, as one athlete said, “When I’ve failed in a race, I’m frustrated for quite a long time,” and another noted, “You ruminate: ‘Why isn’t it going well, what am I doing wrong?’“. Table 2 provides an overview of the reported competitive sports factors that positively or negatively affect mental well-being and their frequencies.
Mental health challenges and mental disorders
Many of the Para athletes interviewed appeared accustomed to experiencing mental health challenges associated with competitive sports. They frequently referenced physical health factors such as injuries and illnesses as potential causes of such complaints. For example, one interviewee noted that the use of prosthetics could lead to pain, wounds, and inflammation, which could be mentally taxing. Another participant shared his experience of breaking his shin and fibula before a major event, which was a significant mental hurdle to overcome.
Every third interviewee also identified performance pressure as a common mental health challenge. This pressure seems to be constantly present in the sport life of a Para athletes. One interviewee reported: “I think, certainly always before and during major events such as World Championships or Paralympics, the pressure is certainly always particularly high there, the pressure to perform.” Other mental health issues mentioned by the interviewees included mental exhaustion after major events, increasing competitive pressure, stressful interpersonal relationships, athletic failures, and issues related to equipment and technology. Table 3 shows the reported mental health challenges associated with competitive sports and their frequencies.
Five Para athletes disclosed having experienced at least one significant mental health issue. Four of these athletes faced mental health challenges directly associated with their participation in Paralympic sports, including sleep disorders (n = 2), depressive episodes (n = 2), and trauma-related consequences (n = 1). Factors such as traumatic athletic accidents or extreme performance pressure were mentioned as causes or contributing factors to their mental health problems. These affected athletes sought professional help from psychologists, psychotherapists, or psychiatrists. In addition, two of the athletes received medication, including antidepressants (n =2) and antipsychotics (n = 1). Treatment duration varied, lasting anywhere from several months to two years.
Among the Para athletes who have not experienced a mental health issue, the majority would initially consult their trusted sports psychologist in case of a mental health crisis. One respondent described their preference as follows: “Well, I worked with a sports psychologist. And that would certainly be one of the places where I would knock […]. And this person would then refer me if necessary. But I think it makes it […] easier if you can […] talk to someone who also knows the sport, who comes from that background, than if you just go to some psychologist who, yes, who maybe […] has never done sport […].”
Conversely, numerous interviewed Para athletes would initially turn to their social circles for support. Another athlete described their approach as follows: “Yes, I think I would always be in exchange with my family. Um, I just think they are always a good mirror because they know me well. And maybe they can already perceive things that I’m not so aware of.”
In addition to their social environment, Para athletes also mentioned sports physicians, coaches, organizations, and mental health institutions as potential resources for support. Understanding the mental health issue and addressing feelings of shame are deemed crucial for successful recovery. Table 4 provides a summary of the anticipated actions in the event of a mental health crisis, along with the associated sub-codes and their frequencies.
Perception and promotion of mental toughness
The Para athletes interviewed had varying interpretations of mental toughness in competitive sports. Most commonly, it was linked to self-confidence and the ability to step outside one’s comfort zone. One athlete commented on this by stating, “[…] that you [have] confidence in yourself and your material and […] have the feeling that ‘what I have suits me and I can ride the fastest race with it’, yes, exactly.” Another participant viewed mental toughness more as the willingness to leave one’s comfort zone, as demonstrated in the following quote:
I always have the feeling that it’s a bit of a buzzword. But I think it’s the right thing to do, to step out of this comfort zone a little bit. And for me, that’s actually what I have to do all the time if I want to get ahead. I know that whenever it’s uncomfortable, I’m actually in the right place. Because that’s what gets me ahead. And others are uncomfortable too, but they don’t expose themselves to it. Just having strategies to deal with it or to really expose yourself to it without it totally wearing you down, or just finding the right dosage.
Addressing personal disabilities was also frequently discussed. A participant expressed: “I think that every Para athlete has somehow already experienced something harder in his life and therefore already has quite a strong mental basis, […] most of them at least.” Another individual considered a positive outlook on their own disability as a demonstration of mental fortitude:
You come to a, to a limit every day, naturally. […] when you are in a wheelchair, you might do a competition, be the best on the whole course and come home in the evening […] and you don’t get to whatever is in the cupboard further up. […] I think these are things that you have much more in Para sports, that you are always confronted with your own limits in everyday life. And these are things […] where you might first have to find a way to deal with it, to accept it. And for me, sport has helped me a lot in this area.
Mental toughness was also associated with positive emotions, self-acceptance, resilience, and the capacity to perform at one’s best on a specific day. Similar to mental health, various methods for enhancing mental toughness were discussed, such as meditation, imagination, and visualization. Table 5 presents an overview of the perceptions of mental toughness and their frequencies.
A large number of the interviewed Para athletes have already consulted contact points to promote their mental toughness. Most of these athletes have already worked with a sports psychologist (n [known] = 10/n [consulted] = 8). The second most frequent source of support was a mental trainer (n [known] = 7/n [consulted] = 3). The Para athletes are also aware of the variety of contact points (e.g., athletic associations, their own social environment, or psychological psychotherapist, etc.). However, all of them were mentioned only by a few persons each. At the same time, some Para athletes had never sought help for improving mental resilience, either due to financial constraints or the belief that they could tackle athletic challenges independently.
Discussion
To the best of our knowledge, this is the first study to interview professional Para athletes about their comprehension of mental health and the associated challenges and issues within the context of professional Para sports. For this qualitative survey, we assembled a proper sample of 15 active adult Swiss Para athletes for this study. Among them, 11 have participated in at least one Paralympic Games, three have competed in at least one World Championship, and one has taken part in other international events.
The interviewed Para athletes associated mental health with factors such as positive emotions, constructive self-related thoughts, and the ability to perform in daily life and sports. Activities promoting mental health included fulfilling tasks, maintaining a healthy social environment, utilizing psychological services, and employing self-regulatory techniques. The athletes acknowledged a positive correlation between mental well-being and athletic performance.
In the context of their competitive sports, they experienced mental health challenges like physical issues or performance pressure. 33% of the sample had previously faced a mental health crisis, most of which were related to competitive sports. Here it’s reasonable to take a look on how the self-reported prevalence of mental disorders found in this study’s sample compares to existing research. The Swiss Health Observatory reported a lifetime prevalence of 50% for mental disorders in the general population [34]. Åkesdotter et al. documented a similar lifetime prevalence of mental health problems (MHP) at 51.7% in their sample of 333 Swedish elite athletes [35]. These prevalence rates are somewhat higher than those of Röthlin et al., in whose large representative sample of Swiss elite athletes 39% showed symptoms of a mental disorder in at least one category (e.g. depression or anxiety) [36]. Thereby it is remarkable that the prevalence rates of Röthlin et al’s study showed large intergroup differences, with female athletes (52%) being affected significantly more often than male athletes (30%) [36].
Moesch et al. suggest that comparing prevalence rates between elite athletes and the general population is reasonable, as they found comparable rates in both groups [15]. At the same time, the qualitative design of this study and the sample size do not permit generalization of the results to the entire population of Swiss Para athletes. Furthermore, the interviews exclusively focus on the period of the Para athletes’ elite sports careers, which averaged 10.8 years. Due to the qualitative approach and the atypical prevalence period examined in this study, a direct comparison with other research is not feasible.
Mental toughness was primarily understood as self-confidence, stepping out of one’s comfort zone, managing personal limitations, and having a sense of purpose. This finding is partly consistent with previous research that defines mental toughness as a multidimensional construct related to unwavering self-belief, the ability to bounce back after failure (resilience), perseverance or refusal to give up, dealing effectively with adversity and pressure, and maintaining focus in the face of many potential distractions [37, 38].
Sports psychologists and mental trainers were reported to be the primary resources for enhancing mental toughness and addressing mental health challenges or mental disorders.
At the same time, it might be concluded: There seems to be a great need of psychological services regarding general mental health, mental toughness, sports-specific mental health challenges and mental disorders. The knowledge about sport psychological support and mental training is very wide-spread among the interviewed Para athletes. Nevertheless, a few Para athletes are hardly familiar with this topic or haven’t used psychological support yet. A possible reason could be, that some Para athletes feel the need to cope with mental health challenges or even disorders on their own, without consulting psychological specialists.
According to the tandem concept of care and cooperation developed by Claussen et al., the primary contact points for mentally healthy top athletes should be sports psychologists and mental trainers, who are consulted, for example, to promote mental toughness and support athletes in their mental health challenges associated with sports [39]. Here, the present results are in line with the theoretical assumptions of Claussen et al. However, clear differences between the theoretical conception and the collected interview data in this thesis can be discerned in the case of mental health challenges and mental disorders. According to the tandem concept of care and cooperation, sports psychologists and mental trainers, respectively, sports psychiatrists and sports psychotherapists, should be equally competent points of contact for elite athletes in the case of mental health challenges [39]. The interviewed Para athletes, in contrast, turn exclusively to their trusted sports psychologist or mental trainer in case of mental health challenges. But, according to the tandem concept of care and cooperation, athletes with mental disorders should have the opportunity to diagnostic evaluation and treatment by sports psychiatrists or sports psychotherapists [39]. In contrast, more than half of the interviewed Para athletes (n = 8) state that they do not consult any sports psychiatrists/sports psychotherapists but also turn to their trusted sports psychologist/mental trainer in case of a mental health emergency.
The remaining athletes who have experienced a mental health emergency in the past (n = 7) state that they have consulted a psychiatric/psychotherapeutic professional, but not one who specializes in sport, as provided for in the tandem concept of care and cooperation [39]. This is not to be interpreted as a conscious decision against sport psychiatric/sport psychotherapeutic treatment but can be explained by the fact that this offer is simply not known among the interviewed Para athletes and respective structures are not yet established in Swiss Para sports. The collected interview data do not provide any information on how much knowledge of sports psychiatry/sports psychotherapy services would have influenced the decision-making behaviour of the interviewed Para athletes. Nevertheless, it can be assumed that many Para athletes would prefer a psychiatric/psychotherapeutic contact point that is specialized in sports. This assumption is based on the feedback of several Para athletes, who already emphasized in connection with the psychological services that it was important for them to be able to work with professionals who are specialized in sports and thereby have a better understanding of sports-specific mental health challenges. At the same time, it is important to bring up the fact that psychological support for athletes is not the sole responsibility of the athletes. Trainers are involved as well. For these reasons, sensitization of the trainers to this issue is probably needed. Furthermore, it is somehow unclear if the consulted psychiatric/psychotherapeutic professionals are aware of specific sports psychiatric/sports psychotherapeutic treatments and offer and if they were ready to refer the athletes to the more specialized unit in accordance with the stepped care model of the health care.
Limitations
Although the sample represented around 25% of Swiss Paralympic athletes, it still does not allow a generalization of the results to the entire population. Additionally, data was only gathered through interviews with Para athletes, excluding coaches, associations, and psychological institutions. This point limits the explanatory power of the study as well. The homogeneity might be questionable, given that the sample included not only Paralympic athletes but also Paralympic hopefuls who have participated in World Championships or other international competitions as well an athlete from promotion square. It only features individual summer sports athletes, and it’s likely that a more diverse sample, such as winter athletes and teams, would yield different findings. A further limitation is formed by the psychiatric diagnoses, which were reported by the Para athletes and could not be verified professionally. Para athletes’ responses are as in every other population surveyed generally subject to some degree of recall bias.
Conclusion
Despite the limitations, the results indicate that mental health, mental toughness, mental health challenges, and mental disorders are critical topics for Swiss Paralympic athletes. There appears to be a significant need for psychological services in preventing and treating mental health issues, with differences from the tandem concept of care and cooperation [39] identified in managing mental health challenges and disorders. Moreover, the responsibility for Paralympic athletes’ mental health extends beyond the athletes themselves to include coaches and athletic associations, who should promote professional psychological services by establishing a collaborative network with sports psychologists, mental trainers, sports psychiatrists, and sports psychotherapists. Paralympic athletes should also receive comprehensive information on psychological services through informative guidebooks, address lists, or thematic presentations. This emphasis on awareness and access to support aligns with Moesch et al., who recommend “education packages (e.g., Mental Health First Aid, workshops on promoting good mental health, multidisciplinary case formulation) for members of the support team and the use of multimedia sources (including old-fashioned posters and flyers)” ([15], pp. 69–70).
Furthermore, the study presents intriguing findings; however, as a qualitative study, it is subject to the aforementioned limitations. Further research should aim to corroborate these results and address additional subsequent questions by engaging a larger sample of Para athletes. This could potentially include participants from other countries as well, and one approach might involve conducting a large survey among Para athletes to evaluate the topic of mental health within paralympic sports. Moreover, the opinions and views of other professionals working with the present target population might be included to create a better understanding of the issue. Finally, comparative research among different subgroups within the Para sports (based on specific sports, disability, gender, age, congenital or acquired disability, etc.) and between Para sports and “regular” sports could also shed more light on a better understanding of the topic as well as specific need within each subgroup.
Special thanks to the Para athletes who made time for interviews despite their busy schedules. Your valuable contributions were instrumental in this research. We are truly grateful for your support and dedication.
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